scholarly journals Physical activity and breast cancer: Results of a focus group to devise novel exercise interventions for women with breast cancer

2017 ◽  
Vol 6 (2) ◽  
pp. 39 ◽  
Author(s):  
Jenna Smith-Turchyn ◽  
Julie Richardson ◽  
Richard Tozer ◽  
Lehana Thabane ◽  
Margaret McNeely
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Focus Group ◽  
Cancer Care ◽  
Health Care Team ◽  
Care Team ◽  
Exercise Interventions ◽  
Exercise Participation ◽  
Rehabilitation Professionals ◽  
Care Institution

Objective: To determine, from the diverse perspective of vested members of the health care team, novel exercise intervention strategies to implement within the cancer care institution in order to overcome barriers to exercise participation and promotion for women with breast cancer (BC).Methods: Design: Qualitative descriptive study. Setting: Cancer care institution. Participants: Health care professionals (HCPs) who work with women with BC. Intervention: A focus group was used to answer the research question. A moderator guided the focus group using a semi-structured script. Measurements: The focus group was recorded and transcribed. The transcript was coded independently using topic and analytical coding.Results: Three main issues came forth during analysis. These included a lack of (1) exercise programming and equipment available within the cancer care institution (2) communication with rehabilitation professionals, and (3) effective exercise education strategies available for patients with BC. Specific strategies were suggested to overcome each issue. Limitations: As purposeful sampling was used for recruitment, it is possible that participants agreed to be in this study because they had positive views on the need to incorporate exercise more effectively into practice.Conclusions: To our knowledge this is the first study to include a multidisciplinary team to come to a consensus on a knowledge translation exercise strategy. Findings show that future exercise interventions should implement active interventions within the cancer institution, include rehabilitation professionals as part of the health care team, and use technology to educate patients.

A Behavior-Modification, Clinical-Grade Mobile Application to Improve Breast Cancer Survivors' Accountability and Health Outcomes

2018 ◽  
pp. 1-11 ◽  
Author(s):  
Renee Stubbins ◽  
Tiancheng He ◽  
Xiaohui Yu ◽  
Mamta Puppala ◽  
Chika F. Ezeana ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Survivors ◽  
Behavior Modification ◽  
Technology Use ◽  
Breast Cancer Survivors ◽  
Health Care Team ◽  
Care Team ◽  
Feasibility Trial ◽  
System Usability Scale

Purpose Only 34% of breast cancer survivors engage in the recommended level of physical activity because of a lack of accountability and motivation. Methodist Hospital Cancer Health Application (MOCHA) is a smartphone tool created specifically for self-reinforcement for patients with cancer through the daily accounting of activity and nutrition and direct interaction with clinical dietitians. We hypothesize that use of MOCHA will improve the accountability of breast cancer survivors and help them reach their personalized goals. Patients and Methods Women with stages I to III breast cancer who were at least 6 months post–active treatment with a body mass index (BMI) greater than 25 kg/m2 were enrolled in a 4-week feasibility trial. The primary objective was to demonstrate adherence during weeks 2 and 3 of the 4-week study period (14 days total). The secondary objective was to determine the usability of MOCHA according to the system usability scale. The exploratory objective was to determine weight loss and dietitian-participant interaction. Results We enrolled 33 breast cancer survivors who had an average BMI of 31.6 kg/m2. Twenty-five survivors completed the study, and the average number of daily uses was approximately 3.5 (range, 0 to 12) times/day; participants lost an average of 2 lbs (+4 lbs to −10.6 lbs). The average score of usability (the second objective) was 77.4, which was greater than the acceptable level. More than 90% of patients found MOCHA easy to navigate, and 84% were motivated to use MOCHA daily. Conclusion This study emphasizes the importance of technology use to improve goal adherence for patients by providing real-time feedback and accountability with the health care team. MOCHA focuses on the engagement of the health care team and is integrated into clinical workflow. Future directions will use MOCHA in a long-term behavior modification study.

Provider-patient communication about cost of care: Results from a national patient education program.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9578-9578 ◽  
Author(s):  
Ivy A. Ahmed ◽  
Allison Harvey ◽  
Marni Amsellem ◽  
Thomas J. Smith
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Cancer Care ◽  
Health Care Team ◽  
Cost Of Care ◽  
Care Team ◽  
Cancer Support ◽  
Support Organizations ◽  
National Patient ◽  
The Cost

9578 Background: A 2010 NIH study indicates direct cancer care expenditures will reach $158 billion in the U.S. by 2020, impacting millions of Americans. The cost of insurance for a family of 4 has increased from $6000 (2000) to over $16,000 (2011). Medical debt is a significant cause of personal bankruptcy, even if insured. The financial realities posed by costs associated with cancer care greatly complicate a cancer diagnosis. The most recent American College of Physicians Ethics Manual recommends all parties must interact honestly, openly, and fairly. (Snyder L, et al. Ann Int Med 2012, p86) This analysis explores the occurrence and value of patient-provider communication surrounding costs associated with care in a national survey of those affected by cancer. Methods: From 2011-12, 505 individuals attending Frankly Speaking About Cancer: Coping with the Cost of Care workshops completed a survey assessing experiences about the costs of cancer care. This is a Cancer Support Community national evidence-based educational program. All attendees (n=708) were eligible to complete survey. Results: Most attendees (71.3%) responded. The majority (62.4%) were people with cancer/survivors; the remainder included spouses/partners, family members, and 8.7% were health care professionals. Most (80.8%) were Caucasian, and averaged 57.2 years. Of those with cancer, 89.9% were insured at diagnosis. 59.4% reported no one on their health care team initiated a discussion about the financial aspects of their care. Included in this figure, 22.7% actively sought information from health care team, and 36.7% received no information about cost. When topic was initiated, it was by social workers (16.2%), physicians (12.3%), nurses (6.3%) or financial specialists (8.2%). When information was provided, 72.1% found it somewhat or very useful. Also, regardless of provider discussion, respondents independently sought resources for managing costs, such as other patients (44.2%), the Internet (41.5%), and patient support organizations (38.1%). Conclusions: Patients want financial information but do not receive it. These data highlight the need and value of providers initiating a dialogue about the cost of cancer care with patients.

Steppe by steppe: gynecological oncology on the Mongolian plains

2005 ◽  
Vol 15 (2) ◽  
pp. 359-360
Author(s):  
L. Elit
Keyword(s):  
Health Care ◽  
Developing Countries ◽  
Cancer Care ◽  
Culturally Relevant ◽  
Gynecologic Cancer ◽  
Health Care Team ◽  
Care Team ◽  
Gynecological Oncology ◽  
Gynecologic Oncologist

The objective was to describe the experiences of one gynecologic oncologist in Mongolia. Gynecologic oncologists can contribute to the health of women in developing countries through education of the health care team and research into novel ways to deliver health care. Partnering with our colleagues in developing countries is a personally enriching experience. The development of gynecologic cancer care must ultimately be culturally relevant.

Financial toxicity and cancer-related distress among melanoma survivors.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9588-9588
Author(s):  
Joanne S Buzaglo ◽  
Melissa F Miller ◽  
Alexandra K Zaleta ◽  
Jamese Johnson ◽  
Niraj K. Gupta
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Cancer Care ◽  
Financial Burden ◽  
Health Care Team ◽  
Cost Of Care ◽  
Care Team ◽  
Financial Impact ◽  
Out Of Pocket Costs

9588 Background: Melanoma survivors are at risk for significant financial burden due to cancer care and out of pocket costs. We explored 1) the financial impact of melanoma and its relationship to cancer-related distress, and 2) survivors’ experiences discussing financial burden with their health care team. Methods: Of 110 melanoma survivors enrolled in the Cancer Support Community’s online Cancer Experience Registry, 56 completed questions about financial impact of cancer and cost of care communication. Participants rated concern (0 = not at all; 4 = very seriously) about 27 items encompassing psychological, emotional, physical and practical concerns; items were summed into a total distress score (mean = 33, SD = 21, range 0-88). Financial impact and overall distress were examined via regression analysis. Results: Participants were 71% female, 89% Caucasian, median age 54, and median time since diagnosis 2.5 years. Total annual income: 34% < $60K; 46% $60K+; 20% not reported. 24% spent $101-250/month on melanoma out of pocket costs; 20% spent $251-500; and 24% spent ≥$500. The top concern was health insurance/money worries (69% moderately to very seriously concerned). Due to medical costs, 57% depleted their savings, 20% borrowed against or used retirement money, 20% used pharmaceutical assistance programs, 13% skipped medicine dosages at least sometimes, and 17% postponed filling prescriptions. Only 28% reported that their health care team spoke to them about cost of care, and 28% were asked about financial distress; 42% desired financial assistance. Financial impact was associated with an increase in overall distress for those with income < $60K (p < .05; interaction p < 0.05). Conclusions: Substantial proportions of melanoma survivors experience financial burden that can impact quality of life, particularly lower income individuals. Although oncologists are encouraged to discuss treatment costs, most patients report they have not had these discussions with providers. These results support the development/evaluation of interventions to enhance doctor-patient communication, and financial counseling to minimize financial burden of melanoma and the risks it can confer for quality of life, course of cancer care, and health outcomes.

Cancer-related distress and unmet needs among members of a metastatic breast cancer registry.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 118-118
Author(s):  
Joanne S. Buzaglo ◽  
Melissa F Miller ◽  
Anne Morris ◽  
Allison Harvey ◽  
Mitch Golant
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Metastatic Breast Cancer ◽  
Metastatic Breast ◽  
Health Care Team ◽  
Cost Of Care ◽  
Care Team ◽  
Comprehensive Cancer Center ◽  
Community Based ◽  
Cancer Support

118 Background: An estimated 155,000 people are living with metastatic breast cancer (MBC) in the US. Emotional distress among people living with MBC is common; yet, little is known about the patient experience and distress screening. Methods: Since March 2013, the Cancer Support Community has registered 909 people living with MBC to the Cancer Experience Registry, an online initiative that is designed to raise awareness about the psychosocial impact of cancer. 599 registrants responded to questions about cancer related distress. This sample was 99% female, 91% Caucasian, and 69% with a college degree and median age 56. Median time since MBC diagnosis was 3 years. Results: The top sources of distress (% rated seriously or very seriously concerned) were: (1) worry about the future (44%); (2) fatigue (39%); (3) health insurance or money worries (38%). 49% reported fatigue was ‘quite a bit’ or ‘very much’ disruptive in their life and 46% reported intrusive ideation about the financial cost of care. Factors that were independently associated with greater overall distress included younger age (p<0.001), higher comorbidity (p<0.001), lower income (p=0.001). 43% of respondents were never asked about distress by their health care team. Those who received all or part of their treatment in an academic or comprehensive cancer center were significantly more likely to be asked about distress versus those receiving treatment anywhere else (65% vs. 50%, p=0.002). Among those who were asked about distress (n=340), 62% received referrals to manage distress within their health care system, and 19% at a community-based organization; 47% reported their health care team helped coordinated distress-related care. 20% of those asked about distress never received referrals for managing it. Conclusions: These findings support the need for integrated supportive care services and better side-effect management. Disturbingly, 20% of patients who asked for referrals never received them and only 19% of patients were referred to community-based organizations for treating their distress where these services are often provided at low or no-cost. There is an on-going need for coordinated care that integrates programs and services across health care systems.

Interventional multicenter study to assess the feasibility of an e-health system (ZEMY) designed to manage symptoms and treatment-related toxicities in patients with breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14107-e14107
Author(s):  
Luis Teixeira ◽  
Christelle Levy ◽  
David Coeffic ◽  
Rim Ghorbal ◽  
Julien Dupin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Treatment ◽  
Symptom Management ◽  
Locally Advanced ◽  
Health Care Team ◽  
Completion Rate ◽  
Care Team ◽  
Adult Women ◽  
Symptom Reports

e14107 Background: There is increasing interest in using e-health systems for symptom monitoring and alert triggering. ZEMY, a new software medical device, was developed to improve symptom management and enhance patient and health care team interactions. Methods: This was a three-month open-label, interventional, single arm study conducted at five French sites. Adult women with breast cancer (BC) initiating oral and/or parenteral cancer treatment received a smartphone with ZEMY installed and verbal training. Patients started cancer treatment on Day 1 and were followed for three months. Patients entered data for ten prespecified symptoms. The ZEMY software made recommendations to patients on the self-management of symptoms and transmitted automatic messages to the health care team. Primary outcome was patient feasibility response at 3 months (completion of ≥3 symptom reports and a report completion rate of ≥60% per patient). Secondary objectives included ZEMY symptom management, usability and satisfaction, and device deficiencies (DDs). Results: Overall, 54 patients were enrolled (Jun 2018 to Jan 2019) and 52 (96.3%) completed the study. Thirty-one (57.4%) patients were responders; this was not significantly higher than the predefined cut-off and ZEMY feasibility was not demonstrated. Forty-seven (87.0%) patients had ≥3 completed symptom reports and 33 (66.0%) patients had a report completion rate of ≥60% (missing: n = 4). In subgroup analyses, 22/30 (73.3%) patients with locally advanced BC and 24/36 (66.7%) patients aged 40–60 years were responders. ZEMY patient recommendations and health care team automatic messages were considered relevant at least once in > 74% of cases for five of the six symptoms that were reported at least once by more than 1/3 of patients (diarrhea, nausea, fatigue, cutaneous and mucosal toxicities, and anxiety/depression). Using a 0–10 visual analogue scale, mean ZEMY satisfaction score was higher for patients than investigators (6.3 ±2.9 vs 4.4 ±1.5). Overall, 95 DDs were reported in 37 (68.5%) patients. Main reasons for DDs were inappropriate recommendations (n = 51) and device malfunction (n = 36). Conclusions: The primary endpoint of the study was not reached; however, higher response rates were observed in subgroups versus the overall population, indicating that ZEMY may be useful in symptom management in these patients. Generally, patients had a favorable opinion of ZEMY. The DD rate observed indicates the need for better user support in the future. Clinical trial information: NCT03558490.

scholarly journals Type 2 diabetes management: Patient knowledge and health care team perceptions, South Africa

2012 ◽  
Vol 4 (1) ◽  
Author(s):  
Nombeko Mshunqane ◽  
Aimee V. Stewart ◽  
Allan D. Rothberg
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Chronic Disease ◽  
Focus Group ◽  
Behaviour Change ◽  
Health Care Professionals ◽  
Diabetes Management ◽  
Health Care Team ◽  
Care Team

Background: South African research indicates that the highest death rates between 2004 and 2005 were from diabetes mellitus. There is minimal research information on interactions between what patients know about their disease and what health professionals perceive that patients should know to control their disease well.Objectives: This study determined the knowledge that patients with type 2 diabetes have about the management of their disease, as well as the perceptions of the health care team about the services given to patients.Method: Qualitative data were collected using two focus groups and in-depth interviews. Patient focus group (n = 10) explored patients’ knowledge about management of type 2 diabetes. Patients were recruited from Dr George Mukhari Hospital outpatients’ diabetes clinic. Professional focus group (n = 8) explored the health care team’s experiences, barriers and facilitators in managing the disease. Professional focus group participants were recruited because of their expertise in chronic disease management, working in the community (public health) or working directly with patients with type 2 diabetes. Five health care professionals were interviewed using the same guide of questions as for the focus group.Results: Participants identified type 2 diabetes as a chronic disease that needs behaviour change for good control. Five major themes were identified: patients’ knowledge; education programmes; behaviour change; support; and a patient-centred approach.Conclusion: Management of type 2 diabetes may be enhanced by reinforcing patients’ knowledge, encouraging behaviour change whilst taking into consideration patients’ backgrounds. The health care team needs to utilise a patient-centred approach.

scholarly journals Financial Burden Is Associated with Postponing Care and Decreasing Physical and Emotional Quality of Life Among Patients with Multiple Myeloma and Chronic Lymphocytic Leukemia

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 45-45
Author(s):  
Erica E. Fortune ◽  
Melissa F. Miller ◽  
Elissa C. Kranzler ◽  
Jemeille Ackourey ◽  
Kelly Clark ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Cancer Care ◽  
Research Funding ◽  
Financial Burden ◽  
Health Care Team ◽  
Cost Of Care ◽  
Care Team ◽  
Oncology Research

Background: Numerous factors contribute to the financial burden experienced by the cancer population, including medical expenses and possible job disruption or loss. The financial burdens that accompany a cancer diagnosis can influence cancer-care decisions, including the delay of essential treatment or appointments, with deleterious effects on physical and mental quality of life (QOL). Further, certain sociodemographic groups face increased risk of financial burden. The aim of this study was to examine the relationships between financial burden, postponing care, and physical and emotional quality of life among patients with multiple myeloma (MM) and chronic lymphocytic leukemia (CLL). Methods: 435 patients (72% MM; 28% CLL) enrolled in the Cancer Support Community's online survey, the Cancer Experience Registry, answered questions related to financial burden (8 items; yes/no response), postponing care (6 items; 5-point Likert scale), and QOL assessed using Patient-Reported Outcomes Measurement Information System (PROMIS-29v2.0) subscales (Anxiety, Depression, Physical Function, and Fatigue) with transformed T scores. We applied Structural Equation Modeling (SEM) to understand the direct and indirect relationship of financial burden (tally of "yes" responses to the 8 financial cost variables) with latent constructs comprising postponing care, physical QOL, and emotional QOL, and sociodemographic and clinical predictor variables. Results: Sample characteristics: mean age=62 yrs (9.2); 88% non-Hispanic White; 6% non-Hispanic Black; mean time since diagnosis=5.2 yrs (4.3); 28% ISS Stage 3 for MM or Rai Stage 3-4 for CLL. Regarding financial status, 21% have an annual income &lt;$40k; 22% spent &gt;$500 in monthly out-of-pocket (OOP) costs to cover cancer care and an additional 23% spent over $250. Due to the financial costs of cancer care, 29% of participants depleted their savings, 19% borrowed against or used money from a retirement plan, 13% liquidated assets, 7% collected unemployment insurance, 4% took an extra job, 4% chose a less effective treatment, 4% cashed in a life insurance policy early, and 2% had their house foreclosed. While 41% were moderately to very seriously concerned about health insurance or money, 66% reported that no one from their health care team talked to them about costs. Based on the percent reporting sometimes, often, or always engaging in behaviors related to postponing care: 12% postponed doctor's appointments, 5% postponed follow-up screening or bloodwork, 6% postponed filling prescriptions, 5% skipped dosages of prescribed drugs, 12% delayed complementary treatment including therapy, and 16% postponed psychological counseling or support. SEM analyses demonstrate that age (standardized path coefficient β=-0.17), low income (β=0.24), OOP costs (β=0.18), time since diagnosis (β=0.11), and advanced stage (β=0.17) had a significant (p&lt;.05) effect on financial burden and financial burden, in turn, had a significant effect on postponing care (β=0.40)Further, financial burden had both a direct (β=-0.17) and indirect (β=-0.10) effect through postponing care on physical QOL, and both a direct (β=0.15) and indirect (β=0.12) effect through postponing care on emotional QOL. The χ2 of the final model was 454.2 (df=129, p&lt;.001) and was a reasonably good fit to the data (RMSEA=0.076). Conclusions: Findings highlight the significant effect of financial burden on postponing care and poorer QOL among MM and CLL patients. Financial burden was associated with patients' treatment decisions for both cancer and psychological care, and while many patients reported distress about money and health insurance, the majority did not discuss cost of care with their health care team. Thus, MM and CLL patients may benefit from access to no- or low-cost preventative and supportive psychosocial care, as well as financial counseling and assistance with health care team communication. Patient-focused organizations help address this need through no-cost resources, including distress screening tools, access to a financial counselor on a toll-free helpline, and information about treatment decision-making. Future research that incorporates cost of care into physician-patient communication is warranted. Disclosures Fortune: Boston Scientific Foundation: Research Funding; Genentech: Research Funding. Kranzler:Astellas Pharma US, Inc.: Research Funding; Pharmacyclics, Inc.: Research Funding; Jazz Pharmaceuticals: Research Funding; Takeda Oncology: Research Funding; Janssen Oncology: Research Funding. Leblanc:Agios, AbbVie, and Bristol Myers Squibb/Celgene: Speakers Bureau; AstraZeneca: Research Funding; AbbVie, Agios, Amgen, AstraZeneca, CareVive, BMS/Celgene, Daiichi-Sankyo, Flatiron, Helsinn, Heron, Otsuka, Medtronic, Pfizer, Seattle Genetics, Welvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; American Cancer Society, BMS, Duke University, NINR/NIH, Jazz Pharmaceuticals, Seattle Genetics: Research Funding; UpToDate: Patents & Royalties: Royalties. Zaleta:Athenex Oncology: Research Funding; Gilead Sciences, Inc: Research Funding; Pfizer, Inc.: Research Funding.

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