Cancer survivorship: Is there a role for cancer survivor clinics?

e272 Background: The population of survivors of cancer is increasing worldwide. In Italy, 2,243,953 patients (4% of the Italian population) survived after a cancer diagnosis in 2006. The drafting of survivorship care plans (SCPs), consisting of a written treatment summary and a follow-up care plan, is regarded by both the Institute of Medicine and the American Society of Clinical Oncology as an essential step in the care of survivors of cancer. However, Salz et al. in 2013 reported in Cancer that although oncology providers have positive feelings regarding SCPs, only 52% of them ever provided any component of an SCP to their patients. Ultimately, the lack of integration of SCPs into clinical practice is due to the absence of definite guidance regarding what constitutes standards of care for survivors of cancer. Methods: We propose the establishment of cancer survivor clinics (CSCs), which consist of health professionals (i.e., medical oncologists; radiation therapists; psychologists; nurses; and other physicians such as cardiologists, gynecologists, and urologists) dedicated to the care of survivors of cancer who we have previously defined as disease and treatment free for at least 5 years and that is established within our Institution since 2013. Results: The number of these CSCs should be planned in relation to the estimated number of survivors of cancer in each country and designed within the medical oncology departments. Conclusions: CSCs should assess: 1) the occurrence of any known side effects from cancer or its treatment (i.e., neurocognitive problems, premature menopause, infertility, cardiorespiratory system dysfunctions, and chronic fatigue); 2) the concomitant presence of comorbidities and their influence on the patient’s general health status; 3) psychological disturbances (i.e., fear of cancer recurrence, anxiety, depression, and body image perception disorders); and 4) problems regarding social and employment reintegration. Moreover, CSCs should provide screening guidelines for cancer recurrence and second primary tumors, design proper clinical follow-up pathways, promote behavioral changes (i.e., smoking cessation and alcohol intake reduction), and improve screening and prevention programs for the relatives of cancer survivors.

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An evaluation of survivorship care plan program.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.62 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 62-62

Author(s):

Debra Spoljaric ◽

Brittany Depp ◽

Allison A. King

Keyword(s):

Side Effects ◽

Phase I ◽

Phase Ii ◽

Cancer Survivor ◽

Late Effects ◽

Survivorship Care Plan ◽

Survivorship Care ◽

Care Plans ◽

The Impact

62 Background: The Commission on Cancer mandated the development and implementation of survivorship care plans (SCP) in 2015. Minimal evidence exists to suggest SCP are meaningful to survivors and primary care physicians (PCP). We sought to evaluate the usefulness of the SCP as perceived by both survivors and PCP. Methods: Phase I was 8-month pilot using a 7-page SCP detailing medical information and follow up sections addressed to the survivor and to the PCP. To evaluate patient and PCP views on the SCP, a telephone survey was created for patients and a two-page Likert scale survey for PCP was faxed. Phase I evaluations revealed 90% of survivors did not look past page 2 of the document and 16% of PCP felt it was too long and busy to read. The SCP was edited for a 3-page version and implemented in Phase II over 11-months. Results: In Phase I, 78 SCP were delivered to survivors, 58% were surveyed. Of PCP, 24% responded. In Phase II, 895 SCP were delivered, and 274 (31%) survivors surveyed. In Phase I and II, when asked to identify themselves as a cancer survivor, 282 (88%) confirmed and 21 (7%) were unsure. After reviewing the SCP, 93.1% understood their plan of care; 79.6% understood potential late effects; 33% were aware of support or resources available; 96% would recommend to another cancer survivor to get one. In Phase II, 16% (43) of PCP responded. Overall replies were positive: 61% found resource list helpful; 66% wanted more specific information about patient potential late effects; 87% agreed knowing symptoms of late effects is helpful. 70% wanted clarity on follow up tests needed and who should order. PCP overwhelmingly agreed (88%) the SCP is helpful. 90% agreed that knowing ongoing side effects of treatment was important. Conclusions: Survivors liked having their cancer treatment in one concise document and PCP physicians feel that the SCP is meeting their basic needs. PCP are interested in more specific long term side effects to monitor in their patients and direction on what follow-up tests are needed and who is ordering them. Further research is needed to study the impact of SCP on survivors’ health.

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“The danger still hangs over my head” Fear of Recurrence among Israeli Breast Cancer Survivors

Journal of Health Sciences ◽

10.17532/jhsci.2019.687 ◽

2019 ◽

Author(s):

Inbar Levkovich

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Cancer Recurrence ◽

Phenomenological Approach ◽

Physical Symptoms ◽

Fear Of Recurrence ◽

Fear Of Cancer Recurrence ◽

The Impact

Introduction: Many breast cancer survivors report a fear of recurrence of the disease, which finds expression in anxieties that the original cancer will return or that another form of cancer will begin to develop. The present study evaluated perceptions of and feelings about the fear of recurrence from the point of view of breast cancer survivors, the impact of this fear on their lives, and their means of coping. Method: Qualitative research was conducted using the phenomenological approach. The sample included 13 breast cancer survivors aged 34-67 who were within 1 year after completion of chemotherapy. Participants included survivors who had been diagnosed with localized breast cancer, Stages I-III, without metastases, and without previous cancer diagnoses. Participants provided their personal details, while details of the disease and treatments were collected from the patients’ files. Results: Two main themes emerged: (1) Along with the desire to gradually return to normal life, the study participants described an ongoing sense of existential threat, a lack of security and a sense of being out of control when any follow-up tests or pain linked to potential cancer caused fear and anxiety and (2) their fears also concerned their family members as they were afraid their loved ones might get sick and go through the suffering they had experienced. Conclusions: The fear of cancer recurrence is a multidimensional phenomenon. This emotional response can arise as a result of physical symptoms causing suspicions that the disease has returned or as a result of external factors, such as follow-up tests or other people’s illnesses.

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Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis

Journal of Clinical Oncology ◽

10.1200/jco.19.00572 ◽

2019 ◽

Vol 37 (31) ◽

pp. 2899-2915 ◽

Cited By ~ 24

Author(s):

Nina M. Tauber ◽

Mia S. O’Toole ◽

Andreas Dinkel ◽

Jacqueline Galica ◽

Gerry Humphris ◽

...

Keyword(s):

Systematic Review ◽

Psychological Intervention ◽

Meta Analysis ◽

Cancer Recurrence ◽

Fear Of Cancer Recurrence ◽

Psychological Interventions ◽

Controlled Trials ◽

Number Of Patients ◽

Fear Of Cancer

PURPOSE Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis. METHODS We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514). RESULTS A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges’s g) were found both at postintervention ( g = 0.33; 95% CI, 0.20 to 0.46; P < .001) and at follow-up ( g = 0.28; 95% CI, 0.17 to 0.40; P < .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; g = 0.42) were larger than those of traditional CBTs ( g = 0.24; β = .22; 95% CI, .04 to .41; P = .018). At follow-up, larger effects were associated with shorter time to follow-up (β = −.01; 95% CI, −.01 to −.00; P = .027) and group-based formats (β = .18; 95% CI, .01 to .36; P = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR. CONCLUSION Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition—for example, worry, rumination, and attentional bias—rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients’ FCR presentation.

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Fear of cancer recurrence trajectory during radiation treatment and follow-up into survivorship of patients with breast cancer

BMC Cancer ◽

10.1186/s12885-018-4908-2 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Y. Yang ◽

J. Cameron ◽

C. Bedi ◽

G. Humphris

Keyword(s):

Breast Cancer ◽

Radiation Treatment ◽

Cancer Recurrence ◽

Fear Of Cancer Recurrence ◽

Fear Of Cancer

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A method to integrate an institutional database with multiple practice EHRs.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.248 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 248-248

Author(s):

Louis H. Barr ◽

Meiling Wu ◽

Heather Burner

Keyword(s):

Cancer Registry ◽

Cancer Recurrence ◽

Patient Specific ◽

Tumor Site ◽

Care Providers ◽

Site Specific ◽

Care Plans ◽

Cancer Registry Data ◽

Treatment Summary

248 Background: Survivorship care plans (SCP) are endorsed or required for accreditation by many organizations including ASCO, NCCN and ACoS. SCP elements include a treatment summary and follow up plan. Information for these elements is usually found in a practice’s electronic health record (EHR), but is not always readily identifiable. Practitioners get information from multiple EHRs across practices and hospitals. Barriers include EHRs not readily accessible to all staff or don’t communicate with each other. No simple means exists for the required data points to auto-populate from practice-based databases. Methods: We approached this by combining Cancer Registry data with an online template to populate a SCP, utilizing the Electronic Registry System, Inc. (ERS), a Cancer Registry software company, and a survivorship template provided by a free online open source company Journey Forward (JF). The Registry is told when a patient is scheduled for a survivorship appointment. A file is created of the patient’s demographics, specific cancer characteristics, and treatment summary. This is sent to the practitioner through a shared drive or secure email. The tumor site-specific JF template is then selected by practice staff who import the Registry file created from ERS. Information required for the SCP is auto-populated in the template during this process. Results: The remainder of the template contains recommendations for follow up and is completed by a physician or designated practitioner working with their EHR. Supplemental tumor site-specific education materials are available in the JF Library. Patient-specific concerns such as cancer recurrence or treatment side-effects can be addressed as well. Any of these prepared documents may be incorporated into the SCP follow up recommendation section with a mouse-click. The printed SCP is given to the patient and forwarded to care providers. A notice of SCP given to the patient is then sent to the Registry which closes the loop. Conclusions: This process utilizes the Cancer Registry, allows specific input from patient care providers, and eliminates the necessity to access multiple EHRs to complete SCPs.

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