Colorectal Cancer Survivorship: Steps towards integrative oncology and patient-centered cancer care

Purpose High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer. Patients and Methods Patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center nationwide in 2008 were ascertained through the Veterans Affairs Central Cancer Registry and sent questionnaires assessing a variety of aspects of patient-centered cancer care. We received questionnaires from 63% of eligible patients (N = 1,109). Descriptive analyses characterizing patient experiences with supportive care and binary logistic regression models were used to examine predictors of receipt of help wanted for each of the five symptom categories. Results There were significant gaps in patient-centered quality of supportive care, beginning with symptom assessment. In multivariable modeling, the impact of clinical factors and patient race on odds of receiving wanted help varied by symptom. Coordination of care quality predicted receipt of wanted help for all symptoms, independent of patient demographic or clinical characteristics. Conclusion This study revealed substantial gaps in patient-centered quality of care, difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer.

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Modern, multidisciplinary colorectal cancer care in older patients: Striking a balance between cancer treatment and patient-centered care

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2020.01.021 ◽

2020 ◽

Vol 46 (3) ◽

pp. 299-300

Author(s):

Isacco Montroni ◽

Nicole M. Saur

Keyword(s):

Colorectal Cancer ◽

Cancer Treatment ◽

Cancer Care ◽

Older Patients ◽

Patient Centered Care ◽

Patient Centered ◽

Centered Care

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Individualized Integrative Cancer Care in Anthroposophic Medicine

Integrative Cancer Therapies ◽

10.1177/1534735416640091 ◽

2016 ◽

Vol 15 (4) ◽

pp. 478-494 ◽

Cited By ~ 14

Author(s):

Gunver S. Kienle ◽

Milena Mussler ◽

Dieter Fuchs ◽

Helmut Kiene

Keyword(s):

Cancer Care ◽

Qualitative Content Analysis ◽

Symptom Control ◽

Spiritual Needs ◽

Anthroposophic Medicine ◽

Integrative Oncology ◽

Patient Centered ◽

Therapeutic Goals ◽

Therapeutic Procedures ◽

Depth Interviews

Background. Cancer patients widely seek integrative oncology which embraces a wide variety of treatments and system approaches. Objective. To investigate the concepts, therapeutic goals, procedures, and working conditions of integrative oncology doctors in the field of anthroposophic medicine. Methods. This qualitative study was based on in-depth interviews with 35 highly experienced doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Results. The doctors integrated conventional and holistic cancer concepts. Their treatments aimed at both tumor and symptom control and at strengthening the patient on different levels: living with the disease, overcoming the disease, enabling emotional and cognitive development, and addressing spiritual or transcendental issues according to the patient’s wishes and initiatives. Therapeutic procedures were conventional anticancer and symptom-relieving treatments, herbal and mineral remedies, mistletoe therapy, art therapies, massages and other external applications, nutrition and lifestyle advice, psychological support, and multiple forms of empowerment. The approach emphasised good patient-doctor relationships and sufficient time for patient encounters and decision-making. Individualization appeared in several dimensions and was interwoven with standards and mindlines. The doctors often worked in teams and cooperated with other cancer care–related specialists. Conclusion. Integrative cancer care pursues an individualized and patient-centered approach, encompassing conventional and multimodal complementary interventions, and addressing, along with physical and functional needs, the emotional and spiritual needs of patients. This seems to be important for tumor and symptom control, and addresses major challenges and important goals of modern cancer care.

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