Improving service delivery to cancer survivors in primary care settings project.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 52-52
Author(s):  
Lewis E. Foxhall
Keyword(s):  
Primary Care ◽  
Colon Cancer ◽  
Cancer Survivors ◽  
Care Management ◽  
Survivorship Care ◽  
Behavioral Counseling ◽  
Colon Cancers ◽  
Screening And Prevention

52 Background: An estimated 14 million cancer survivors live in the U.S., with up to 18 million expected by 2020. Methods: We established a partnership with three Texas family medicine training programs to provide interactive educational sessions focused on survivors’ needs for primary prevention and lifestyle counseling, surveillance and screening, and prevention of psychosocial and long-term effects. Surveys assessing resident and PCP knowledge, self-efficacy, and practices regarding survivorship care management were administered through REDCap in July 2016 and 2017. Results: Baseline response rates were 64% (60/94) and 59% (55/93) at follow-up. Compared to baseline, providers at follow-up were significantly more likely to report being “very confident” in their knowledge about: appropriate surveillance to detect recurrent breast cancer (5% vs 24%; p = 0.01); long-term physical effects of colon cancer and its treatment (8% vs 18%; p = 0.04); potential adverse psychosocial outcomes of colon cancer treatment (24% vs 44%; p = 0.01); appropriate screening for new primary breast (29% vs 61%; p < 0.001) and colon cancers (27% vs 51%; p = 0.01); and preventive lifestyle/behavioral counseling for breast (39% vs 59%; p = 0.03) and colon cancers (37% vs 59%; p = 0.01). Participants were also more likely to “strongly agree” that they have the skills necessary to: provide follow-up care related to the colon cancer and its treatment (10% vs 28%; p = 0.02); initiate appropriate screening for other new primary cancers for breast (28% vs 56%; p < 0.01) and colon cancer survivors (28% vs 58%; p < 0.01); and conduct lifestyle/behavioral counseling to prevent cancer for breast (33% vs 53%; p = 0.03) and colon cancer survivors (34% vs 55%; p = 0.02). Conclusions: Preliminary results suggest our project has improved provider knowledge, self-efficacy, and practices regarding survivorship care management, with the highest levels in areas pertaining to screening and prevention. We aim to continue this trajectory of improvement in subsequent project years and disseminate the project to other primary care training sites in Texas and beyond.

scholarly journals Optimizing childhood oncology care transition from pediatric to adult settings: A survey of primary care physicians’ and residents’ perspectives

2020 ◽  
Vol 43 (2) ◽  
pp. E14-23
Author(s):  
Sophie Marcoux, MD, PhD Marcoux ◽  
Caroline Laverdière
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Primary Care Physicians ◽  
Adult Survivors ◽  
Likert Scale ◽  
Care Transition ◽  
Term Care

Purpose: The majority of childhood cancer survivors suffer from late adverse effects after the completion of treatment. The prospect of most survivors reaching middle-age is a relatively new phenomenon, and the ways by which current and future primary care physicians (PCPs) will address this novel public health challenge are uncertain. Methods: A survey assessing knowledge level and information delivery preferences regarding long-term follow-up guidelines for adult patients having survived a childhood cancer was distributed by e-mail through the Quebec (Canada) national associations of PCPs and residents (n=238). Results: Participants reported an estimated average of 2.9 ± 1.9 cancer survivors in their yearly caseload, and only 35.3% recalled having provided services to at least one survivor in the last year. Most participants indicated ignoring validated follow-up guidelines for these patients (average score 1.66 on a Likert scale from “1—totally disagreeing” to “5—totally agreeing”). Scarce access to personalized follow-up guidelines and lack of clinical exposure to cancer survivors were identified as main obstacles in providing optimal care to these patients (respective averages of 1.66 and 1.84 on a Likert scale from “1— is a major obstacle” to “5—is not an obstacle at all”). Conclusion: The PCPs and residents rarely provide care for childhood cancer adult survivors. On an individual basis, there is a clear need for increased awareness, education and collaboration regarding long-term care of childhood cancer adult survivors during medical training. On a more global basis, structural, organizational and cultural changes are also needed to ensure adequate care transition.

Long-term follow-up of childhood cancer survivors in the Murcia Region: Preferences and attitudes of Primary Care professionals

2015 ◽  
Vol 83 (4) ◽  
pp. 264-271 ◽  
Author(s):  
A. Cárceles-Álvarez ◽  
J.A. Ortega-García ◽  
J.L. Fuster-Soler ◽  
G.A. Rivera-Pagán ◽  
M. Bermúdez-Cortés ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Long Term Follow Up ◽  
Primary Care Professionals

Shared Care For Hematologic Malignancy Survivors: Challenges Between Primary Care Physicians and Hematologist/Oncologists

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2958-2958
Author(s):  
Haleh Kadkhoda ◽  
Clare Karten ◽  
Emily Van Laar ◽  
Elisa Weiss ◽  
Kevin C. Oeffinger ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Primary Care Physicians ◽  
Clinical Information ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Effective Management ◽  
Treatment Summaries ◽  
Care Plans

Abstract Background Many cancer patients are cured, or have a series of remissions interspersed with periods of re-treatment. In 2006, the Institute of Medicine's From Cancer Patient to Cancer Survivor: Lost in Transition recommended comprehensive treatment summaries and follow-up care plans for all cancer survivors. [Parry 2013] There were about 14 million cancer survivors in the US as of January 2012; this population is expected to be 18 million by 2022. [Siegel 2012] Among survivors, 64% have survived 5 years or more; 40% have survived 10 years or more; and 15% have survived 20 years or more after diagnosis. [de Moor 2013] Many survivors in this growing population experience physical, psychological, and/or financial long-term/ late effects. The complexities of managing cancer survivors suggest their care should not be conceived as a transition from the hematologist/oncologist to the primary care provider, but rather as an ongoing, flexible collaboration determined by individual survivor needs. Methods Polling surveys were conducted within the 2012 online education activity Sharing Care for Survivors of Hematologic Malignancies, developed by The Leukemia & Lymphoma Society and Medscape Oncology. Case-based education was delivered by an expert panel of hematologist/oncologists (Hem/Oncs) and primary care physicians (PCPs) to illustrate effective communication methods and critical communication points between (Hem/Oncs) and (PCPs). Results As of June 30, 116 Hem/Oncs and 171 PCPs overall responded to the polling surveys, which address current practices and barriers in shared care of cancer survivors. Responses were analyzed to identify gaps in continuity of care among specialties. A summary of responses shows the most significant barrier in effective management is the lack of survivorship care plans and treatment summaries (41% Hem/Oncs vs 51% PCPs). Only 8% and 5% of Hem/Oncs and PCPs, respectively, use survivorship care plans, although both Hem/Oncs and PCPs agreed that such plans and summaries are the most useful communication vehicle among professionals (73% Hem/Oncs vs 67% PCPs). PCPs used patient self-reported data more frequently to document cancer treatment, compared with Hem/Oncs (21% vs 7%, respectively); Hem/Oncs used caregiver reports more often than did PCPs (12% vs 3%, respectively). Similar numbers of Hem/Oncs and PCPs estimated that PCPs spend more than 4 hours of non-reimbursed time weekly researching issues related to patient care (47% Hem/Oncs vs 41% PCPs). Despite progress in electronic health records and widespread Internet access, these physicians most typically use the phone to communicate about the management of cancer survivors (64% Hem/Oncs vs 74% PCPs), followed by faxed/mailed letters, with email ranking as least used. Lack of prompt communication between Hem/Oncs and PCPs was the second highest barrier listed by respondents to effective management (22% and 27%, respectively). Conclusion Analysis of the Hem/Onc and PCP learner responses to the polling surveys point to clinical complexities and persistent challenges in the co-management of survivors of hematologic cancers. The challenges relate to communication, technological, healthcare system and healthcare coverage issues.Timely, ongoing communication of the right clinical information between Hem/Oncs and PCPs is essential for optimal management of the growing number of cancer survivors. Hem/Oncs and PCPs devote significant time each week to addressing the cancer survivors' needs; the lack of reimbursed time for PCPs may be an impediment to optimal care. Hem/Oncs and PCPs place a high value on the utility of survivorship care plans; however, they are not widely used. Phone calls are the current preferred communication mode. Until other technological solutions are more widely used to share clinical information, it is important to employ practical solutions, such as providing PCPs with information to help prioritize cancer survivors' follow-up care needs and providing patients/caregivers with brief cancer treatment summaries. Communication strategies to address potentially preventable causes of death, such as cardiac disease and second cancers, as well as acknowledgment and treatment for anxiety and depression related issues [Harrington 2010], which often accompany the uncertainty many cancer survivors live with, are critical. Disclosures: No relevant conflicts of interest to declare.

Primary care providers as partners in long-term follow-up of pediatric cancer survivors

2012 ◽  
Vol 6 (3) ◽  
pp. 270-277 ◽  
Author(s):  
Lillian R. Meacham ◽  
Paula J. Edwards ◽  
Brooke O. Cherven ◽  
Michael Palgon ◽  
Sofia Espinoza ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Pediatric Cancer ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pediatric Cancer Survivors ◽  
Long Term Follow Up

scholarly journals Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care

BMJ ◽  
2013 ◽  
Vol 346 (jun05 2) ◽  
pp. f2570-f2570 ◽  
Author(s):  
J. J. Gallo ◽  
K. H. Morales ◽  
H. R. Bogner ◽  
P. J. Raue ◽  
J. Zee ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Care Management ◽  
Term Effect ◽  
Depression Care ◽  
Long Term Effect ◽  
Depression Care Management ◽  
Cluster Randomized

Caring for adult survivors of childhood cancer: A primary care based adult transition clinic.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 40-40
Author(s):  
Becky N. Lowry ◽  
Kyla Alsman ◽  
Wendy McClellan ◽  
Jennifer R. Klemp ◽  
Hope Krebill ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Rating Scale ◽  
Medical Center ◽  
Future Research ◽  
Survivorship Care ◽  
Term Survival ◽  
Transition Clinic

40 Background: Long-term survival is an expected outcome for childhood cancer patients. Caring for adults who are childhood cancer survivors requires dedicated late effects monitoring. Recognizing transition challenges from pediatric to adult and oncologic to primary care settings, we developed a dedicated monthly survivorship transition clinic (STC) in an internal medicine office at the University of Kansas Medical Center. We describe the first year practice experience (2014-2015). Methods: Retrospective chart review was completed on 41 STC patients - age 20 to 52 years. Each survivor self-selected to establish in STC, with either consultative survivorship care (correspondence sent to existing primary care physician (PCP)) or combined primary and survivorship care (if no established PCP). Selections were recorded. Two oncology providers performed blinded independent reviews of treatment summaries and scored these using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Scores were provided to the STC and unblinded. ITR-3 scores were matched with data on subspecialty referral patterns for each survivor to determine if ITR-3 scores correlated with referral needs. Results: Of 41 patients, 26 (63%) requested PCP and survivorship care. Only 15 (37%) had an established PCP. Survivors were grouped by ITR-3 into low (1 or 2) or high (3 or 4) intensity scores. Subspecialty referrals in each group were analyzed as follows: total number of referrals / average referrals per survivor / median referral number. Referral data: low intensity group 14 / 1.27 / 1, high intensity group 96 / 3.56 / 3. Conclusions: Despite complex medical histories and long term follow-up needs, a high percentage of Midwest cancer survivors were in need of survivorship, PCP and subspecialty care emphasizing the importance of intentional transition efforts. ITR-3 scores correlated with subspecialty referral needs. Future research will include an increased number of survivors to determine further predicative value of this scale in estimating survivor needs complexity.

Surveillance and beliefs about follow-up care among long-term breast cancer survivors: a comparison of primary care and oncology providers

2015 ◽  
Vol 10 (1) ◽  
pp. 96-102 ◽  
Author(s):  
Betsy C. Risendal ◽  
Rebecca L. Sedjo ◽  
Anna R. Giuliano ◽  
Susan Vadaparampil ◽  
Paul B. Jacobsen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Follow Up Care ◽  
Oncology Providers

Gaps in survivorship care plan delivery and potential benefits to survivorship care.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9594-9594 ◽  
Author(s):  
Laura Pence Forsythe ◽  
Carla Parry ◽  
Catherine M. Alfano ◽  
Erin E. Kent ◽  
Corinne Leach ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Care Coordination ◽  
Primary Care Physicians ◽  
Physician Attitudes ◽  
Physician Communication ◽  
Survivorship Care ◽  
Treatment Summaries ◽  
Treatment Summary

9594 Background: Survivorship care plans (SCPs), consisting of a treatment summary and follow-up plan, are intended to promote coordination of post-treatment cancer care. Yet, little is known about the provision of these documents by oncologists to primary care physicians (PCPs). This study compared self-reported oncologist provision and PCP receipt of treatment summaries and follow-up plans, characterized oncologists who reported consistent provision of these documents to PCPs, and examined associations between PCP receipt of these documents and survivorship care. Methods: A nationally representative sample of medical oncologists (N=1130) and primary care physicians (PCPs; N=1020) were surveyed regarding follow-up care for breast and colon cancer survivors using the cross-sectional Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) in 2009. Results: Nearly half of oncologists reported always/almost always providing treatment summaries, while 20.2% reported always/almost always providing SCPs (treatment summary + follow-up plan). Approximately one-third of PCPs indicated always/almost always receiving treatment summaries, while 13.4% reported always/almost always receiving SCPs. Oncologists who reported training in late and long-term effects of cancer and use of electronic medical records were more likely to report SCP provision (p<0.05). PCP receipt of SCPs was associated with better PCP-reported care coordination, physician-physician communication, and confidence in survivorship care knowledge compared to receipt of neither treatment summaries nor SCPs (p<0.05). Conclusions: Providing SCPs to PCPs may enhance survivorship care coordination, physician-physician communication, and PCP confidence in caring for survivors. However, a minority of oncologists report routinely delivering SCPs to PCPs. Considerable progress will be necessary to achieve sharing of SCPs among oncologists and PCPs.

A model for delivering survivorship care: Integrating the oncology and the primary care setting—An Italian experience.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. e275-e275
Author(s):  
Elena Lorenzi ◽  
Lucia Morello ◽  
Rita Mazza ◽  
Isabella Garassino ◽  
Raffaele Cavina ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Early Stage ◽  
Care Delivery ◽  
Care Plan ◽  
Disease Stage ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Early Stage Disease

e275 Background: The population of cancer-survivors faces different lifetime health risk. Thus, models for high-quality and personalized care delivery are strongly needed. ASCO provides different models for survivorship care delivery but there is not an agreement on what is the best in meeting patients’ needs and in terms of cost-effectiveness. In our institution we started a program that tries to integrate survivors’ health care provided by the oncologist and by the Primary Care Physician (PCP). Methods: We included patients (pts) aged more than 18 yrs-old at the time of diagnosis, affected by hematologic or solid tumors. Pts had no evidence of disease from at least 5 yrs from the diagnosis. They are referred to the PCP with the following documents: Survivorship Care-Plan, Survivorship Care-Program, letter to the PCP. Recurrence rate, death rate, treatment related serious clinical events will be calculated after 12 months from the start of the project. Results: We includedin our program 269 cancer-survivors (60% of pts referred to our survivorship-clinic from April to July 2015). The median age was 67 yrs, they were mainly females. The different cancer types were: breast (157), colorectal (36), hematologic (30), gynecologic (11), gastric (9), melanoma (6) lung (5), genitourinary (5), head/neck (3), sarcoma (3) and others (4). 189 of pts had an early stage disease (stage I-II) at diagnosis. 234 of pts underwent surgical treatment and 161 received chemotherapy with different schedules based on tumor types. 59% of pts received anthracycline-based-chemotherapy, 78% at a cumulative dose > 240 mg/m2 . 154 of pts underwent radiation therapy (90% in thoracic field) with a median dose of 60 Gy. We observed 11 cases of secondary cancer after a median of 2.7 yrs from the first diagnosis. The median observation time from the diagnosis to the inclusion in our program was 10 yrs (range 2-31). Conclusions: The observation period from the beginning of the program is too short to provide follow-up data. A high percentage of pts present a high risk of cardiologic late toxicities, therefore they need a more intensive cardiologic follow-up. We will present the first follow-up analysis of this cohort of pts in April 2016.

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