National Cancer Control Programme in India: Proposal for Organization of Chemotherapy and Systemic Therapy Services

Cancer is a major health problem in India, with an estimated incidence of 1 million cases in 2012 that is likely to double in 2035 to approximately 1.7 million. The majority of cases are diagnosed in advanced stages, and approximately two thirds of patients die as a result of their disease. The mortality-to-incidence ratio is 0.68 in India, which is far higher than that in developed countries (approximately 0.38). One of the important reasons for this discrepancy is inequitable distribution and inaccessibility of health care resources in India. One component of scarce health care resources is the low ratio of oncologists to patients with cancer (1:2,000), which leads to delivery of systemic anticancer therapy in many hospitals by health care professionals who do not have required training. Given these facts, there is a need to focus on organization of medical oncology services in terms of manpower and infrastructure to standardize the delivery of systemic anticancer therapy. Redistribution of resources can streamline the delivery of cancer care, preferably close to the patient’s home. This article describes the blueprint for organization of medical oncology services and delivery of chemotherapy and other systemic therapies to Indian patients. The model uses existing health care services in the country and is a four-tiered system of increasing sophistication: District Hospitals, Medical College Hospitals, Regional Cancer Centres, and Apex Cancer Centres. Delivery of quality care to patients with cancer through standardized protocols is crucial in improving cancer outcomes in India.

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Perception of Iranian Patients with Cancer, Their Relatives, and Health Care Professionals Towards Length of Life and Quality of Life: A Local Survey

Shiraz E-Medical Journal ◽

10.5812/semj.103598 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Negin Nourbakhsh ◽

Bahareh Tahani ◽

Azadeh Moghaddas

Keyword(s):

Quality Of Life ◽

Health Care ◽

Survival Time ◽

Health Care Professionals ◽

Treatment Modalities ◽

Cancer Center ◽

Treatment Choices ◽

Patients With Cancer ◽

Length Of Life

Background: Recently, therapeutic decision-making in oncology is changed to a big challenge for both patients and involved oncologists due to an increase in available treatment modalities with a variety of benefits or adverse effects. Objectives: The current study aimed at comparing the perception of treatment priorities regarding lengthening of survival time or maintenance of the quality of life (QoL) among patients with cancer by health care professionals (HCPs). Methods: The current cross-sectional study was conducted on patients with cancer, their relatives, and healthcare professionals in the referral cancer center of Omid affiliated to Isfahan University of Medical Sciences. To identify treatment choices, priority, and related variables influencing their opinions, all participants were interviewed using a standard and valid questionnaire in Persian. The collected data were analyzed using the SPSS software version 20, and the P-value less than 0.05 was considered statistically significant. Results: A total of 299 participants, including 100 patients, 109 relatives, and 90 HCPs (74.2% nurses, 20.2% physicians, 5.6% others) participated in the study. The priority of treatment between survival time (66.1% for relatives vs. 47.9% for patients and 21.3% for HCP) and QoL (33.9% vs.52.1% and 78.7%) was significantly different between the three groups (P < 0.001). Most of the HCPs, patients, and their relatives believed that the physician is the only person who should accept the responsibility of treatment choices and process (98.9% vs. 100% and 98%, respectively; P = 0.002). Conclusions: Among the Iranian population, both the length of life and QoL were valuable; however, it was observed that patients with cancer and HCPs preferred mostly to expand the QoL, while the length of life was more valuable for relatives. Also, all patients, their relatives, and HCPs preferred to choose the physicians as the decision-makers. The results of the study can be helpful in choosing treatment regimens and designing clinical trials.

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Burn-out of the Medical Oncology Health Care Professionals and Associated Factors in Tunisia

Psycho-Oncologie ◽

10.3166/pson-2020-0134 ◽

2020 ◽

Vol 14 (4) ◽

pp. 207-216

Author(s):

W. Khechine ◽

F. Ezzaairi ◽

J. Sahli ◽

I. Belaid ◽

A. Daldoul ◽

...

Keyword(s):

Health Care ◽

Emotional Exhaustion ◽

Health Care Professionals ◽

Medical Oncology ◽

Maslach Burnout Inventory ◽

Public Hospitals ◽

Personal Accomplishment ◽

Unexplained Pain ◽

Burn Out ◽

Functional Complaints

Introduction: Burn-out is defined as a syndrome of emotional exhaustion, depersonalization and diminished self-achievement that affects individuals exposed to chronic occupational stress. Physicians and caregivers faced with the death of their patients, such as oncology, are particularly vulnerable to this syndrome. Objectives: To evaluate the burn-out of medical professionals in medical oncology, to research the predisposing factors and to analyze the functional complaints and the behavior of the staff associated with this syndrome. Methods: A descriptive and analytical cross-sectional study among medical oncology professionals practicing in public hospitals in the Tunisian territory who exercise more than two years in oncology; with the Maslach Burnout Inventory (MBI). Results: Our study population was predominantly female (81%). 53% are doctors and 47% are paramedical health care professionals. A high degree of emotional exhaustion, depersonalization and personal achievement were found in 63%, 53% and 59% in our population, respectively. With 21% global high burn-out. The female sex was associated with high emotional exhaustion and low personal accomplishment as well as global burn-out. This burn-out was attributed to factors associated with working conditions and professional climate, mainly: overwork, poor organization of service, lack of resources and time, lack of recognition, lack of communication, lack of respect, conflicts with colleagues, report unsatisfactory salary effort and aggressions by patients and their families. Functional complaints and health care professional’s behavior associated with burn-out were: feelings of sadness, blockage, and irritability, sleep disorders, unexplained pain, epigastralgia, addictive behaviors, psychotropic consumption, suicidal thoughts, decreased performance and desire for a job transfer. Conclusions: By its impact on professionals, burn-out in medical oncology represents a major threat to the quality of health care. Its etiologies, although complex and intricate, are well known. Its prevention and its support are possible, but involve mobilization at all levels.

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Prognosticating futures and the human experience of hope

Palliative & Supportive Care ◽

10.1017/s1478951507000399 ◽

2007 ◽

Vol 5 (3) ◽

pp. 227-239 ◽

Cited By ~ 28

Author(s):

Sally Thorne ◽

Valerie Oglov ◽

Elizabeth-Anne Armstrong ◽

T. Gregory Hislop

Keyword(s):

Health Care ◽

Chronic Illness ◽

Health Care Providers ◽

Health Care Professionals ◽

Secondary Analysis ◽

Human Experience ◽

Clinical Encounter ◽

Care Providers ◽

Health Care Communication ◽

Patients With Cancer

Objectives: Communication between health care providers and patients with cancer and other chronic diseases typically references probabilities that certain future events will or will not occur. Beyond the context of diagnostic encounters and the transmission of “bad news,” such “prognostic” communications take place in various forms throughout the illness trajectory. It is well known that such information transmitted badly can have devastating psychosocial consequences for patients and their families and, conversely, that difficult information exchanged with sensitivity can lend tremendous support. This study aimed to extend our understanding of how such communications are received and interpreted by patients, so that we might optimally apply what we know about general principles of effective communication within the particularly challenging context of predicting futures.Methods: We conducted a combined secondary analysis of two prior qualitative studies into patient perceptions of helpful and unhelpful health care communication with 200 cancer patients and 30 persons with chronic illness. These data sets offered a rich resource for comparing perceptions across a range of contextual variables, and secondary analysis focused on future-oriented interactions, including both prognostication and prediction.Results: The accounts of patients with cancer and chronic illness reveal various ways in which health care communications involving future projections interact with their human experience of hope, powerfully shaping their capacity to make sense of and live with serious illness. They include a synthesis of what patients recommend health care professionals know and understand about this challenging dynamic.Significance of results: The findings of this study offer a distinct angle of vision onto the various communications that involve future predictions, illuminating a patient perspective with the potential to inform health care communication approaches that are both informative and therapeutic. As such, the study supports a dynamic understanding of the tenuous balance between hope and honesty in the clinical encounter.

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Training of Ultrasound in Neonatology: Global or Local?

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1303 ◽

2013 ◽

Vol 7 (3) ◽

pp. 338-345 ◽

Cited By ~ 1

Keyword(s):

Health Care ◽

Developing Countries ◽

Low Income ◽

Health Care Professionals ◽

Obstet Gynecol ◽

Developed Countries ◽

Basic Health ◽

The Developed Countries ◽

Training Opportunities

ABSTRACT From the beginning of its use in neonatology, ultrasound is used more frequently and for many indications. Number of indications is increasing from year to year, while the training opportunities and curricula are not following the same trend. Nowadays ultrasound has been used for determination of functional hemodynamics in critically sick neonates which increases educational burden on the young neonatologists. This only applies to the developed countries where neonatology is well developed, while in low income so called developing countries some basic health problems of neonates have not been solved and there is substantial lack of health care professionals and equipment as well. How to cite this article Stanojevic M. Training of Ultrasound in Neonatology: Global or Local? Donald School J Ultrasound Obstet Gynecol 2013;7(3):338-345.

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Lymphedema in Endometrial Cancer Survivor: A Nationwide Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10204647 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4647

Author(s):

Su-Jeong Lee ◽

Jun-Pyo Myong ◽

Yun-Hee Lee ◽

Eui-Jin Cho ◽

Sung-Jong Lee ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Endometrial Cancer ◽

Cohort Study ◽

Proportional Hazards ◽

Gynecological Cancer ◽

Risk Groups ◽

Developed Countries ◽

Cox Proportional Hazards ◽

Health Care Resources

Background: Endometrial cancer is the most common gynecological cancer in developed countries. Treatment-related lymphedema negatively affects the quality of life and function of patients. This study investigated the cumulative incidence and risk factors of, and utilization of health care resources for, lymphedema in patients with endometrial cancer. Methods: We conducted a nationwide, retrospective cohort study of women with endometrial cancer who underwent cancer-direct treatment using the Korean National Health Insurance Service (NHIS) database. Patients were categorized by age, region, income, and treatment modality. Cox proportional hazards regression models were used to analyze the incidence and risk factors of lymphedema. We also analyzed utilization of health care resources for lymphedema using diagnostic and treatment claim codes. Results: A total of 19,027 patients with endometrial cancer were evaluated between January 2004 and December 2017. Among them, 2493 (13.1%) developed lymphedema. Age (<40 years, adjusted odds ratio [aOR] = 1 vs. 40–59 years, aOR = 1.413; 95% confidence interval (CI) 1.203–1.66 vs. 60+ years, aOR = 1.472; 95% CI 1.239–1.748) and multimodal treatment (surgery only, aOR = 1 vs. surgery + radiation + chemotherapy, aOR = 2.571; 95% CI 2.27–2.912) are considered to be possible risk factors for lymphedema in patients with endometrial cancer (p < 0.001). The utilization of health care resources for the treatment of lymphedema has increased over the years. Conclusions: Lymphedema is a common complication affecting women with endometrial cancer and leads to an increase in national healthcare costs. Post-treatment surveillance of lymphedema, especially in high-risk groups, is needed.

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Knowledge, Beliefs, and Behaviors Related to Palliative Care Delivery Among Pediatric Oncology Health Care Providers

Journal of Pediatric Oncology Nursing ◽

10.1177/1043454218764885 ◽

2018 ◽

Vol 35 (4) ◽

pp. 247-256 ◽

Cited By ~ 2

Author(s):

Jessica L. Spruit ◽

Cynthia J. Bell ◽

Valerie B. Toly ◽

Maryjo Prince-Paul

Keyword(s):

Health Care ◽

Palliative Care ◽

Health Care Providers ◽

Pediatric Oncology ◽

Health Care Professionals ◽

Care Delivery ◽

Advanced Practice ◽

Care Providers ◽

The Public ◽

Patients With Cancer

The care of pediatric patients with cancer and their families is complex and rapidly evolving. Despite significant advances in outcomes, symptoms of the disease and complications of therapy continue to cause suffering that may improve with the involvement of pediatric palliative care (PPC) services. This descriptive study responds to the observation of great variability in PPC utilization within pediatric oncology. Data collected from 156 health care professionals (nurses, advanced practice professionals, and physicians) from a statewide hematology alliance evaluates the knowledge, beliefs, and perceived barriers to PPC involvement. Data analysis reveals significant variability when comparing respondents from professional roles and practice environments. Despite progress in PPC availability, care delivery remains incongruent with current recommendations. Knowledge gained from this study emphasizes the important role for all health care providers in advocating for support of PPC programs, educating the public, and committing to intentional involvement of PPC services while caring for pediatric oncology patients.

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Team Dynamics, Decision Making, and Attitudes Toward Multidisciplinary Cancer Meetings: Health Professionals' Perspectives

Journal of Oncology Practice ◽

10.1200/jop.2010.000023 ◽

2010 ◽

Vol 6 (6) ◽

pp. e17-e20 ◽

Cited By ~ 55

Author(s):

Bianca Devitt ◽

Jennifer Philip ◽

Sue-Anne McLachlan

Keyword(s):

Health Care ◽

Decision Making ◽

Cancer Treatment ◽

Health Professionals ◽

Health Care Professionals ◽

Team Dynamics ◽

Evidence Based ◽

Patients With Cancer ◽

Multidisciplinary Meetings ◽

Evidence Based Guidelines

As the complexity of cancer treatment increases so too has the need for coordination between health care professionals. Multidisciplinary meetings are a useful tool in treating patients with cancer and are shown to improve survival and adherence to evidence based-guidelines.

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Defining, Measuring and Preventing the Diagnosis of Cancer as an Emergency: A Critical Review of Current Evidence

Journal of Global Oncology ◽

10.1200/jgo.18.45300 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 48s-48s

Author(s):

Y. Zhou ◽

G. Abel ◽

W. Hamilton ◽

K. Pritchard-Jones ◽

C. Gross ◽

...

Keyword(s):

Health Care ◽

Developed Countries ◽

Health Care Use ◽

Current Evidence ◽

Cancer Type ◽

Patients With Cancer ◽

Emergency Presentation ◽

Combination Methods ◽

Patient Reported ◽

Diagnosis Of Cancer

Background: Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumor, patient and health-care factors, often in combination. Methods: We searched the literature to identify all population-based studies that examined emergency presentation as a diagnosis or independent variable. Results: Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. Conclusion: In this review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this underresearched aspect of cancer diagnosis.

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Development and Evaluation of a Digital Intervention for Fulfilling the Needs of Older Migrant Patients With Cancer: User-Centered Design Approach (Preprint)

10.2196/preprints.21238 ◽

2020 ◽

Author(s):

Hande Sungur ◽

Nida Gizem Yılmaz ◽

Brittany Ming Chu Chan ◽

Maria E T C van den Muijsenbergh ◽

Julia C M van Weert ◽

...

Keyword(s):

Health Care ◽

Clinical Trials ◽

Patient Education ◽

Patient Participation ◽

Health Care Professionals ◽

Psychosocial Support ◽

Mother Tongue ◽

Patient Rights ◽

Ease Of Use ◽

Patients With Cancer

BACKGROUND Older migrant patients with cancer face many language- and culture-related barriers to patient participation during medical consultations. To bridge these barriers, an eHealth tool called Health Communicator was developed in the Netherlands. Essentially used as a digital translator that can collect medical history information from patients, the Health Communicator did not include an oncological module so far, despite the fact that the prevalence of Dutch migrant patients with cancer is rising. OBJECTIVE This study aims to systematically develop, implement, and conduct a pilot evaluation of an oncological module that can be integrated into the Health Communicator to stimulate patient participation among older Turkish-Dutch and Moroccan-Dutch patients with cancer. METHODS The Spiral Technology Action Research model, which incorporates 5 cycles that engage key stakeholders in intervention development, was used as a framework. The listen phase consisted of a needs assessment. The plan phase consisted of developing the content of the oncological module, namely the question prompt lists (QPLs) and scripts for patient education videos. On the basis of pretests in the do phase, 6 audiovisual QPLs on patient rights, treatment, psychosocial support, lifestyle and access to health care services, patient preferences, and clinical trials were created. Additionally, 5 patient education videos were created about patient rights, psychosocial support, clinical trials, and patient-professional communication. In the study phase, the oncological module was pilot-tested among 27 older Turkish-Dutch and Moroccan-Dutch patients with cancer during their consultations. In the act phase, the oncological model was disseminated to practice. RESULTS The patient rights QPL was chosen most often during the pilot testing in the study phase. Patients and health care professionals perceived the QPLs as easy to understand and useful. There was a negative correlation between the tool’s ease of use and patient age. Patients reported that using the module impacted the consultations positively and thought they were more active compared with previous consultations. Health care professionals also found patients to be more active than usual. Health care professionals asked significantly more questions than patients during consultations. Patients requested to see the patients’ rights video most often. Patients rated the videos as easy to understand, useful, and informative. Most of the patients wanted to use the tool in the future. CONCLUSIONS Older migrant patients with cancer, survivors, and health care professionals found the oncological module to be a useful tool and have shown intentions to incorporate it into future consultation sessions. Both QPLs and videos were evaluated positively, the latter indicating that the use of narratives to inform older, low-literate migrant patients with cancer about health-related topics in their mother tongue is a viable approach to increase the effectiveness of health care communication with this target group.

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Development and Evaluation of a Digital Intervention for Fulfilling the Needs of Older Migrant Patients With Cancer: User-Centered Design Approach

Journal of Medical Internet Research ◽

10.2196/21238 ◽

2020 ◽

Vol 22 (10) ◽

pp. e21238

Author(s):

Hande Sungur ◽

Nida Gizem Yılmaz ◽

Brittany Ming Chu Chan ◽

Maria E T C van den Muijsenbergh ◽

Julia C M van Weert ◽

...

Keyword(s):

Health Care ◽

Clinical Trials ◽

Patient Education ◽

Patient Participation ◽

Health Care Professionals ◽

Psychosocial Support ◽

Mother Tongue ◽

Patient Rights ◽

Study Phase ◽

Patients With Cancer

Background Older migrant patients with cancer face many language- and culture-related barriers to patient participation during medical consultations. To bridge these barriers, an eHealth tool called Health Communicator was developed in the Netherlands. Essentially used as a digital translator that can collect medical history information from patients, the Health Communicator did not include an oncological module so far, despite the fact that the prevalence of Dutch migrant patients with cancer is rising. Objective This study aims to systematically develop, implement, and conduct a pilot evaluation of an oncological module that can be integrated into the Health Communicator to stimulate patient participation among older Turkish-Dutch and Moroccan-Dutch patients with cancer. Methods The Spiral Technology Action Research model, which incorporates 5 cycles that engage key stakeholders in intervention development, was used as a framework. The listen phase consisted of a needs assessment. The plan phase consisted of developing the content of the oncological module, namely the question prompt lists (QPLs) and scripts for patient education videos. On the basis of pretests in the do phase, 6 audiovisual QPLs on patient rights, treatment, psychosocial support, lifestyle and access to health care services, patient preferences, and clinical trials were created. Additionally, 5 patient education videos were created about patient rights, psychosocial support, clinical trials, and patient-professional communication. In the study phase, the oncological module was pilot-tested among 27 older Turkish-Dutch and Moroccan-Dutch patients with cancer during their consultations. In the act phase, the oncological model was disseminated to practice. Results The patient rights QPL was chosen most often during the pilot testing in the study phase. Patients and health care professionals perceived the QPLs as easy to understand and useful. There was a negative correlation between the tool’s ease of use and patient age. Patients reported that using the module impacted the consultations positively and thought they were more active compared with previous consultations. Health care professionals also found patients to be more active than usual. Health care professionals asked significantly more questions than patients during consultations. Patients requested to see the patients’ rights video most often. Patients rated the videos as easy to understand, useful, and informative. Most of the patients wanted to use the tool in the future. Conclusions Older migrant patients with cancer, survivors, and health care professionals found the oncological module to be a useful tool and have shown intentions to incorporate it into future consultation sessions. Both QPLs and videos were evaluated positively, the latter indicating that the use of narratives to inform older, low-literate migrant patients with cancer about health-related topics in their mother tongue is a viable approach to increase the effectiveness of health care communication with this target group.

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