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Homeopathy is a controversial system of care that is practiced extensively in Europe, Asia, and South America primarily for functional and minor ailments. In this review, published studies on homeopathic remedies and cancer were examined. Data were obtained from multiple research disciplines, ranging from basic science to scientifically valid animal and clinical studies. The data from a few laboratory experiments in cancer models show some beneficial effect of homeopathic remedies on selected cancer cell lines. However, in the clinical arena, this effect is not clear. Several published outcome studies and some randomized controlled trials have shown that there may be a role for homeopathy in symptom relief and improving quality of life in patients touched by cancer. Such effects have not been demonstrated unequivocally, and specific antitumor effects have not been shown in any controlled clinical research to date, which raises the need for further clinical trials to investigate the use of homeopathy in cancer care.
Ferrell, Betty; Koczywas, Marianna; Grannis, Fred; Harrington, Annie
Advancements in the surgical and medical treatment of lung cancer have resulted in more favorable short-term survival outcomes. After initial treatment, lung cancer requires continued surveillance and follow-up for long-term side effects and possible recurrence. The integration of quality palliative care into routine clinical care of patients with lung cancer after surgical intervention is essential in preserving function and optimizing quality of life through survivorship. An interdisciplinary palliative care model can effectively link patients to the appropriate supportive care services in a timely fashion. This article describes the role of palliative care for patients with lung cancer.
Kamaludin, Kauthar Mohamad; Muhammad, Mazanah; Wahat, Nor Wahiza Abdul; Ibrahim, Rahimah
The involvement of non-government organizations (NGOs) and support groups has helped strengthen public health services in addressing cancer care burden. Owing to the contribution of volunteers in cancer care, this article documents a qualitative study that examined challenges in attracting and retaining cancer care volunteers as part of the effort to develop a volunteer recruitment model. Data were collected through three focus group discussions involving 19 cancer support group members in Malaysia. Findings of the study revealed that mobility and locality appeared to be significant in Malaysian context, while the need for financial support and time flexibility are challenges faced by cancer support groups to attract and retain volunteers. The findings imply that cancer care initiatives can benefit from more local volunteers but at the same time these volunteers require flexibility and financial support to sustain their engagement.
Smithies, R; Steeves, L
Flexible benefits plans have grown more slowly in Canada than in the United States, largely because of certain legal and regulatory considerations. Health care spending accounts (HCSAs) provide a cost-effective way for Canadian employers to address the health care benefit needs of a diverse workforce. A flexible health care spending account is a versatile and cost-effective instrument that can be used by Canadian employers that wish to provide a full range of health care benefits to employees. The health care alternatives available through an HCSA can provide employees with an opportunity to customize and optimize their benefits program. Regulatory requirements that an HCSA must meet in order to qualify for available tax advantages are discussed, as are the range of health care services that may be covered.
HIV/AIDS has devastated families in rural Lesotho, leaving many children orphaned. Families have adapted to the increase in the number of orphans and HIV-positive children in ways that provide children with the best possible care. Though local ideas about kinship and care are firmly rooted in patrilineal social organization, in practice, maternal caregivers, often grandmothers, are increasingly caring for orphaned children. Negotiations between affinal kin capitalize on flexible kinship practices in order to legitimate new patterns of care, which have shifted towards a model that often favours matrilocal practices of care in the context of idealized patrilineality. PMID:25866467
... chap 55. National Cancer Institute. Cancer genetics risk assessment and counseling. Updated July 28, 2016. Cancer.gov. www.cancer.gov/cancertopics/pdq/genetics/risk-assessment-and-counseling/HealthProfessional/page1 . Accessed August 3, 2016. ...
Wiggers, J H; Donovan, K O; Redman, S; Sanson-Fisher, R W
A diagnosis of cancer places considerable stress on patients and requires them to make major adjustments in many areas of their lives. As a consequence, considerable demands are placed on health care providers to satisfy the complex care needs of cancer patients. Currently, there is little available information to indicate the extent to which cancer patients are satisfied with the quality of care they receive. The present study assessed the perceptions of 232 ambulatory cancer patients about the importance of and satisfaction with the following aspects of care: doctors technical competence and interpersonal and communication skills, accessibility and continuity of care, hospital and clinic care, nonmedical care, family care, and finances. The results indicate that all 60 questionnaire items used were considered to reflect important aspects of care, but that greater importance was given to the technical quality of medical care, the interpersonal and communication skills of doctors, and the accessibility of care. Most patients were satisfied with the opportunities provided to discuss their needs with doctors, the interpersonal support of doctors, and the technical competence of doctors. However, few patients were satisfied with the provision of information concerning their disease, treatment, and symptom control and the provision of care in the home and to family and friends.
1. Cervical cancer is the most frequent cancer in females and also the most frequent among female genital cancers. 2. Ever though the modality of diagnostic procedures for early detection has improved, in fact most of the patients present in the late stages, so the disease is already incurable, and palliative care is really needed. 3. Palliative care is needed not only for the terminally ill patients, but can be started at the time the cancer is diagnosed. 4. Palliative care is a multidisciplinary approach requiring teamwork. 5. Palliative care in Indonesia, especially in Dr. Soetomo Hospital, is a new modality in the fight against cancer, so we suffer many disadvantages, e.g., disability, limitation, lack of experience. However, such problems will stimulate the team to learn more.
Guo, Ying; Fu, Jack B; Guo, Hong; Camp, Jennifer; Shin, Ki Y; Tu, Shi-Ming; Palmer, Lynn J; Yadav, Rajesh
Acute care is usually associated with disease progression, treatments for cancer, and medical comorbidities. Patients with cancer may develop sudden functional deficits that require rehabilitation. Some of these patients benefit from acute rehabilitation, others benefit from subacute rehabilitation. After acute rehabilitation, continuous care for these patients has not been well described. Three studies are presented to demonstrate that cancer rehabilitation is a continuous process. Rehabilitation professionals should know how to detect fall risk, monitor symptoms, and render symptom management. Patients with cancer often require rehabilitation services during their entire disease trajectory.
... treatment to end-of-life care is a key part of palliative care. A palliative care team can help patients and their loved ones prepare for physical changes that may occur near the end of life and address appropriate symptom management for this stage of care. The team can ...
Effective Practitioner is an educational initiative that supports nurses, midwives and allied health professionals to deliver person-centred, safe and effective care. It offers access to flexible work-based learning and development resources. This article describes the progress of the initiative and sets out the expected effects on service delivery, as well as exploring the Scottish context and the initiative's relevance to the rest of the UK and abroad.
Lima, Nádia Nara Rolim; do Nascimento, Vânia Barbosa; de Carvalho, Sionara Melo Figueiredo; Neto, Modesto Leite Rolim; Moreira, Marcial Moreno; Brasil, Aline Quental; Junior, Francisco Telésforo Celestino; de Oliveira, Gislene Farias; Reis, Alberto Olavo Advíncula
To deal with the suffering caused by childhood cancer, patients and their families use different coping strategies, among which, spirituality appears a way of minimizing possible damage. In this context, the purpose of the present study was to analyze the influence of spirituality in childhood cancer care, involving biopsychosocial aspects of the child, the family, and the health care team facing the disease. To accomplish this purpose, a nonsystematic review of literature of articles on national and international electronic databases (Scientific Electronic Library Online [SciELO], PubMed, and Latin American and Caribbean Health Sciences Literature [LILACS]) was conducted using the search terms “spirituality,” “child psychology,” “child,” and “cancer,” as well as on other available resources. After the search, 20 articles met the eligibility criteria and were included in the final sample. Our review showed that the relation between spirituality and health has lately become a subject of growing interest among researchers, as a positive influence of spirituality in the people’s welfare was noted. Studies that were retrieved using the mentioned search strategy in electronic databases, independently assessed by the authors according to the systematic review, showed that spirituality emerges as a driving force that helps pediatric patients and their families in coping with cancer. Health care workers have been increasingly attentive to this dimension of care. However, it is necessary to improve their knowledge regarding the subject. The search highlighted that spirituality is considered a source of comfort and hope, contributing to a better acceptance of his/her chronic condition by the child with cancer, as well as by the family. Further up-to-date studies facing the subject are, thus, needed. It is also necessary to better train health care practitioners, so as to provide humanized care to the child with cancer. PMID:24133371
Vickers, Andrew J
Prediction is ubiquitous across the spectrum of cancer care from screening to hospice. Indeed, oncology is often primarily a prediction problem; many of the early stage cancers cause no symptoms, and treatment is recommended because of a prediction that tumor progression would ultimately threaten a patient's quality of life or survival. Recent years have seen attempts to formalize risk prediction in cancer care. In place of qualitative and implicit prediction algorithms, such as cancer stage, researchers have developed statistical prediction tools that provide a quantitative estimate of the probability of a specific event for an individual patient. Prediction models generally have greater accuracy than reliance on stage or risk groupings, can incorporate novel predictors such as genomic data, and can be used more rationally to make treatment decisions. Several prediction models are now widely used in clinical practice, including the Gail model for breast cancer incidence or the Adjuvant! Online prediction model for breast cancer recurrence. Given the burgeoning complexity of diagnostic and prognostic information, there is simply no realistic alternative to incorporating multiple variables into a single prediction model. As such, the question should not be whether but how prediction models should be used to aid decision-making. Key issues will be integration of models into the electronic health record and more careful evaluation of models, particularly with respect to their effects on clinical outcomes.
Taplin, Stephen H.; Weaver, Sallie; Salas, Eduardo; Chollette, Veronica; Edwards, Heather M.; Bruinooge, Suanna S.; Kosty, Michael P.
Purpose: The management of cancer varies across its type, stage, and natural history. This necessitates involvement of a variety of individuals and groups across a number of provider types. Evidence from other fields suggests that a team-based approach helps organize and optimize tasks that involve individuals and groups, but team effectiveness has not been fully evaluated in oncology-related care. Methods: We undertook a systematic review of literature published between 2009 and 2014 to identify studies of all teams with clear membership, a comparator group, and patient-level metrics of cancer care. When those teams included two or more people with specialty training relevant to the care of patients with cancer, we called them multidisciplinary care teams (MDTs). After reviews and exclusions, 16 studies were thoroughly evaluated: two addressing screening and diagnosis, 11 addressing treatment, two addressing palliative care, and one addressing end-of-life care. The studies included a variety of end points (eg, adherence to quality indicators, patient satisfaction with care, mortality). Results: Teams for screening and its follow-up improved screening use and reduced time to follow-up colonoscopy after an abnormal screen. Discussion of cases within MDTs improved the planning of therapy, adherence to recommended preoperative assessment, pain control, and adherence to medications. We did not see convincing evidence that MDTs affect patient survival or cost of care, or studies of how or which MDT processes and structures were associated with success. Conclusion: Further research should focus on the association between team processes and structures, efficiency in delivery of care, and mortality. PMID:25873056
Bombard, Yvonne; Bach, Peter B; Offit, Kenneth
There is increasing enthusiasm for genomics and its promise in advancing personalized medicine. Genomic information has been used to personalize health care for decades, spanning the fields of cardiovascular disease, infectious disease, endocrinology, metabolic medicine, and hematology. However, oncology has often been the first test bed for the clinical translation of genomics for diagnostic, prognostic, and therapeutic applications. Notable hereditary cancer examples include testing for mutations in BRCA1 or BRCA2 in unaffected women to identify those at significantly elevated risk for developing breast and ovarian cancers, and screening patients with newly diagnosed colorectal cancer for mutations in 4 mismatch repair genes to reduce morbidity and mortality in their relatives. Somatic genomic testing is also increasingly used in oncology, with gene expression profiling of breast tumors and EGFR testing to predict treatment response representing commonly used examples. Health technology assessment provides a rigorous means to inform clinical and policy decision-making through systematic assessment of the evidentiary base, along with precepts of clinical effectiveness, cost-effectiveness, and consideration of risks and benefits for health care delivery and society. Although this evaluation is a fundamental step in the translation of any new therapeutic, procedure, or diagnostic test into clinical care, emerging developments may threaten this standard. These include "direct to consumer" genomic risk assessment services and the challenges posed by incidental results generated from next-generation sequencing (NGS) technologies. This article presents a review of the evidentiary standards and knowledge base supporting the translation of key cancer genomic technologies along the continuum of validity, utility, cost-effectiveness, health service impacts, and ethical and societal issues, and offers future research considerations to guide the responsible introduction of
Jabson, Jennifer M; Kamen, Charles S
Satisfaction with care is important to cancer survivors' health outcomes. Satisfaction with care is not equal for all cancer survivors, and sexual minority (i.e., lesbian, gay, and bisexual) cancer survivors may experience poor satisfaction with care. Data were drawn from the 2010 LIVESTRONG national survey. The final sample included 207 sexual minority cancer survivors and 4,899 heterosexual cancer survivors. Satisfaction with care was compared by sexual orientation, and a Poisson regression model was computed to test the associations between sexual orientation and satisfaction with care, controlling for other relevant variables. Sexual minority cancer survivors had lower satisfaction with care than did heterosexual cancer survivors (B = -0.12, SE = 0.04, Wald χ(2) = 9.25, p< .002), even controlling for demographic and clinical variables associated with care. Sexual minorities experience poorer satisfaction with care compared to heterosexual cancer survivors. Satisfaction with care is especially relevant to cancer survivorship in light of the cancer-related health disparities reported among sexual minority cancer survivors.
DiStasio, Susan A
Although yoga has been practiced in Eastern culture for thousands of years as part of life philosophy, classes in the United States only recently have been offered to people with cancer. The word yoga is derived from the Sanskrit root yuj, meaning to bind, join, and yoke. This reflection of the union of the body, mind, and spirit is what differentiates yoga from general exercise programs. Yoga classes in the United States generally consist of asanas (postures), which are designed to exercise every muscle, nerve, and gland in the body. The postures are combined with pranayama, or rhythmic control of the breath. As a complementary therapy, yoga integrates awareness of breath, relaxation, exercise, and social support--elements that are key to enhancing quality of life in patients with cancer. Yoga practice may assist cancer survivors in managing symptoms such as depression, anxiety, insomnia, pain, and fatigue. As with all exercise programs, participants need to be aware of potential risks and their own limitations. The purpose of this article is to familiarize nurses with yoga as a complementary therapy, including current research findings, types of yoga, potential benefits, safety concerns, teacher training, and ways to integrate yoga into cancer care.
Cohen-Mansfield, Jiska; Bester, Allan
Purpose: Flexibility is an essential ingredient of person-centered care. We illustrate the potential impact of flexibility by portraying a nursing home that uses flexibility in its approach to residents and staff members. Designs and Methods: The paper describes the management strategies, principles, and environmental features used by the Adards…
Survivorship care for children who have been treated for cancer is important. Get your child's treatment summary, survivorship plan, and recommendations on follow-up care clinics. Learn about long-term and late effects.
Jiang, Li; Lofters, Aisha; Moineddin, Rahim; Decker, Kathleen; Groome, Patti; Kendell, Cynthia; Krzyzanowska, Monika; Li, Dongdong; McBride, Mary L.; Mittmann, Nicole; Porter, Geoff; Turner, Donna; Urquhart, Robin; Winget, Marcy; Zhang, Yang; Grunfeld, Eva
Abstract Objective To describe primary care physician (PCP) use and continuity of PCP care across the breast cancer care continuum. Design Population-based, retrospective cohort study using provincial cancer registries linked to health administrative databases. Setting British Columbia, Manitoba, and Ontario. Participants All women with incident invasive breast cancer from 2007 to 2012 in Manitoba and Ontario and from 2007 to 2011 in British Columbia. Main outcome measures The number and proportions of visits to PCPs were determined. Continuity of care was measured using the Usual Provider of Care index calculated as the proportion of visits to the most-often-visited PCP in the 6 to 30 months before a breast cancer diagnosis (baseline) and from 1 to 3 years following a breast cancer diagnosis (survivorship). Results More than three-quarters of patients visited their PCPs 2 or more times during the breast cancer diagnostic period, and more than 80% of patients had at least 1 PCP visit during breast cancer adjuvant treatment. Contact with the PCP decreased over time during breast cancer survivorship. Of the 3 phases, women appeared to be most likely to not have PCP contact during adjuvant treatment, with 10.7% (Ontario) to 18.7% (British Columbia) of women having no PCP visits during this phase. However, a sizable minority of women had at least monthly visits during the treatment phase, particularly in Manitoba and Ontario, where approximately a quarter of women saw a PCP at least monthly. We observed higher continuity of care with PCPs in survivorship (compared with baseline) in all provinces. Conclusion Primary care physicians were generally involved throughout the breast cancer care continuum, but the level of involvement varied across care phases and by province. Future interventions will aim to further integrate primary and oncology care. PMID:27737994
Oral health is often not a priority during cancer treatment; however, patients with cancer are at increased risk for oral complications during and after treatment. This article focuses on the importance of oral health care before, during, and after cancer treatment using the head, eyes, ears, nose, oral cavity, and throat, or HEENOT, approach. AT A GLANCE: Oral health is linked to overall health, and healthcare providers must be cognizant of the oral-systemic connection with patients undergoing cancer treatment, which may cause acute and chronic oral health problems. Oral assessment, prevention, early recognition, and treatment of oral problems must be incorporated into cancer care, particularly with the aid of an interprofessional team to meet patients' oral care needs. The head, eyes, ears, nose, oral cavity, and throat, or HEENOT, approach integrates oral care into patients' history taking, physical examination, and plan of cancer care. .
Regeling, Bianca; Thies, Boris; Gerstner, Andreas O H; Westermann, Stephan; Müller, Nina A; Bendix, Jörg; Laffers, Wiebke
Hyperspectral imaging (HSI) is increasingly gaining acceptance in the medical field. Up until now, HSI has been used in conjunction with rigid endoscopy to detect cancer in vivo. The logical next step is to pair HSI with flexible endoscopy, since it improves access to hard-to-reach areas. While the flexible endoscope's fiber optic cables provide the advantage of flexibility, they also introduce an interfering honeycomb-like pattern onto images. Due to the substantial impact this pattern has on locating cancerous tissue, it must be removed before the HS data can be further processed. Thereby, the loss of information is to minimize avoiding the suppression of small-area variations of pixel values. We have developed a system that uses flexible endoscopy to record HS cubes of the larynx and designed a special filtering technique to remove the honeycomb-like pattern with minimal loss of information. We have confirmed its feasibility by comparing it to conventional filtering techniques using an objective metric and by applying unsupervised and supervised classifications to raw and pre-processed HS cubes. Compared to conventional techniques, our method successfully removes the honeycomb-like pattern and considerably improves classification performance, while preserving image details.
Regeling, Bianca; Thies, Boris; Gerstner, Andreas O. H.; Westermann, Stephan; Müller, Nina A.; Bendix, Jörg; Laffers, Wiebke
Hyperspectral imaging (HSI) is increasingly gaining acceptance in the medical field. Up until now, HSI has been used in conjunction with rigid endoscopy to detect cancer in vivo. The logical next step is to pair HSI with flexible endoscopy, since it improves access to hard-to-reach areas. While the flexible endoscope’s fiber optic cables provide the advantage of flexibility, they also introduce an interfering honeycomb-like pattern onto images. Due to the substantial impact this pattern has on locating cancerous tissue, it must be removed before the HS data can be further processed. Thereby, the loss of information is to minimize avoiding the suppression of small-area variations of pixel values. We have developed a system that uses flexible endoscopy to record HS cubes of the larynx and designed a special filtering technique to remove the honeycomb-like pattern with minimal loss of information. We have confirmed its feasibility by comparing it to conventional filtering techniques using an objective metric and by applying unsupervised and supervised classifications to raw and pre-processed HS cubes. Compared to conventional techniques, our method successfully removes the honeycomb-like pattern and considerably improves classification performance, while preserving image details. PMID:27529255
Clauser, Steven B.; Wagner, Edward H.; Bowles, Erin J. Aiello; Tuzzio, Leah; Greene, Sarah M.
The cancer care system is increasingly complex, marked by multiple hand-offs between primary care and specialty providers, inadequate communication among providers, and lack of clarity about a “medical home” (the ideal accountable care provider) for cancer patients. Patients and families often cite such difficulties as information deficits, uncoordinated care, and insufficient psychosocial support. This article presents a review of the challenges of delivering well coordinated, patient-centered cancer care in a complex modern healthcare system. An examination is made of the potential role of information technology (IT) advances to help both providers and patients. Using the published literature as background, a review is provided of selected work that is underway to improve communication, coordination, and quality of care. Also discussed are additional challenges and opportunities to advancing understanding of how patient data, provider and patient involvement, and informatics innovations can support high-quality cancer care. PMID:21521595
Humphrey, L. Dennis
Flexibility is an important aspect of all sports and recreational activities. Flexibility can be developed and maintained by stretching exercises. Exercises designed to develop flexibility in ankle joints, knees, hips, and the lower back are presented. (JN)
Nurses need up-to-date knowledge of colorectal cancer. This article provides an overview of the aetiology and risk factors for this disease, diagnostic and staging investigations, treatment options and future care. Managing colorectal cancer is complex. Patients can have a range of healthcare needs. Nurses play an increasingly important role in informing, supporting and coordinating care to improve patients' quality of life.
Adesoye, Taiwo; Greenberg, Caprice C.; Neuman, Heather B.
The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force, and rising costs. Engaging patients and incorporating evidence-based care into routine clinical practice are essential components of a high-quality cancer delivery system. However, a gap currently exists between the identification of beneficial research findings and the application in clinical practice. Implementation research strives to address this gap. In this review, we discuss key components of high-quality implementation research. We then apply these concepts to a current cancer care delivery challenge in women’s health, specifically the implementation of a surgery decision aid for women newly diagnosed with breast cancer. PMID:26858933
Cheng, Ju-Fen; Lin, Ya-Ching; Huang, Pai-Ho; Wei, Chih-Hsin; Sun, Jia-Ling
Providing spiritual care to patients with advanced cancer may improve the quality of life of these patients and help them experience a good death. Cancer patients are eager for additional spiritual care and for a sense of peace at the end of their life. However, spirituality is an abstract concept. The literature on spiritual care focuses primarily on elaborations of spirituality theory. Thus, first-line medical care professionals lack clear guidelines for managing the spiritual needs of terminal cancer patients. The purposes of this article were to: 1) introduce a spiritual care model based on the concept of repair and recovery of relationships that addresses the relationship between the self and God, others, id, and objects and 2) set out a four-step strategy for this model that consists of understanding, empathizing, guiding, and growing. This article provides operational guidelines for the spiritual care of terminal cancer patients.
Yang, Yang; Czernin, Johannes
Health care costs in the United States are increasing faster than the gross domestic product (GDP), and the growth rate of costs related to diagnostic imaging exceeds those of overall health care expenditures. Here we show that the contribution of imaging to cancer care costs pales in comparison to those of other key cost components, such as cancer drugs. Specifically, we estimate that (18)F-FDG PET or PET/CT accounted for approximately 1.5% of overall Medicare cancer care costs in 2009. Moreover, we propose that the appropriate use of (18)F-FDG PET or PET/CT could reduce the costs of cancer care. Because the U.S. health care system is complex and because it is difficult to find accurate data elsewhere, most cost and use assessments are based on published data from the U.S. Centers for Medicare & Medicaid Services.
Westfall, Matthew Y; Overholser, Linda; Zittleman, Linda; Westfall, John M
Long-term cancer survivorship care is a relatively new and rapidly advancing field of research. Increasing cancer survivorship rates have created a huge population of long-term cancer survivors whose cancer-specific needs challenge healthcare infrastructure and highlight a significant deficit of knowledge and guidelines in transitional care from treatment to normalcy/prolonged survivorship. As the paradigm of cancer care has changed from a fixation on the curative to the maintenance on long-term overall quality of life, so to, has the delineation of responsibility between oncologists and primary care physicians (PCPs). As more patients enjoy long-term survival, PCPs play a more comprehensive role in cancer care following acute treatment. To this end, this annotated bibliography was written to provide PCPs and other readers with an up-to-date and robust base of knowledge on long-term cancer survivorship, including definitions and epidemiological information as well as specific considerations and recommendations on physical, psychosocial, sexual, and comorbidity needs of survivors. Additionally, significant information is included on survivorship care, specifically Survivorship Care Plans (SPCs) and their evolution, utilization by oncologists and PCPs, and current gaps, as well as an introduction to patient navigation programs. Given rapid advancements in cancer research, this bibliography is meant to serve as current baseline reference outlining the state of the science.
Dancik, Garrett M.; Theodorescu, Dan
Summary Sir William Osler has been quoted as saying “If it were not for the great variability among individuals, medicine might as well be a science and not an art”. Molecular profiles, be they host or those providing insight into the genomic changes that define a cancerous cell, together possess the predictive ability required for the various aspects of individualized care: risk assessment, patient prognosis, and prediction of therapeutic responses. Such profiles, obtained by RNA, DNA and protein microarrays, SNP arrays, methylation screens, and high throughput or targeted gene sequencing can provide patient- and tumor-specific information that details the biological complexity of a particular cancer and can be exploited to understand its clinical implications and glean therapeutic insights. This knowledge is also being combined with host factors to begin formulating an understanding at the system level of how the tumor interacts with the host and how this relationship can be exploited therapeutically or for biomarker development. Here we discuss these advances and how they may relate to urologic oncology. PMID:22489325
Pašukonis, Andrius; Fitch, W. Tecumseh; Huber, Ludwig; Hödl, Walter; Ringler, Max
Parental care systems are shaped by costs and benefits to each sex of investing into current versus future progeny. Flexible compensatory parental care is mainly known in biparental species, particularly where parental desertion or reduction of care by 1 parent is common. The other parent can then compensate this loss by either switching parental roles and/or by increasing its own parental effort. In uniparental species, desertion of the caregiver usually leads to total brood loss. In the poison frog, Allobates femoralis, obligatory tadpole transport (TT) is generally performed by males, whereas females abandon their clutches after oviposition. Nevertheless, in a natural population we previously observed 7.8% of TT performed by females, which we could link to the absence of the respective fathers. In the following experiment, under laboratory conditions, all tested A. femoralis females flexibly took over parental duties, but only when their mates were removed. Our findings provide clear evidence for compensatory flexibility in a species with unisexual parental care. Contrary to the view of amphibian parental care as being stereotypical and fixed, these results demonstrate behavioral flexibility as an adaptive response to environmental and social uncertainty. Behavioral flexibility might actually represent a crucial step in the evolutionary transition from uniparental to biparental care in poison frogs. We suspect that across animal species flexible parental roles are much more common than previously thought and suggest the idea of a 3-dimensional continuum regarding flexibility, parental involvement, and timing, when thinking about the evolution of parental care. PMID:26167099
Ringler, Eva; Pašukonis, Andrius; Fitch, W Tecumseh; Huber, Ludwig; Hödl, Walter; Ringler, Max
Parental care systems are shaped by costs and benefits to each sex of investing into current versus future progeny. Flexible compensatory parental care is mainly known in biparental species, particularly where parental desertion or reduction of care by 1 parent is common. The other parent can then compensate this loss by either switching parental roles and/or by increasing its own parental effort. In uniparental species, desertion of the caregiver usually leads to total brood loss. In the poison frog, Allobates femoralis, obligatory tadpole transport (TT) is generally performed by males, whereas females abandon their clutches after oviposition. Nevertheless, in a natural population we previously observed 7.8% of TT performed by females, which we could link to the absence of the respective fathers. In the following experiment, under laboratory conditions, all tested A. femoralis females flexibly took over parental duties, but only when their mates were removed. Our findings provide clear evidence for compensatory flexibility in a species with unisexual parental care. Contrary to the view of amphibian parental care as being stereotypical and fixed, these results demonstrate behavioral flexibility as an adaptive response to environmental and social uncertainty. Behavioral flexibility might actually represent a crucial step in the evolutionary transition from uniparental to biparental care in poison frogs. We suspect that across animal species flexible parental roles are much more common than previously thought and suggest the idea of a 3-dimensional continuum regarding flexibility, parental involvement, and timing, when thinking about the evolution of parental care.
Irwin, Kelly E; Henderson, David C; Knight, Helen P; Pirl, William F
Individuals with schizophrenia are a vulnerable population that has been relatively neglected in health disparities research. Despite having an equivalent risk of developing most cancers, patients with schizophrenia are more likely to die of cancer than the general population. Cancer care disparities are likely the result of patient-, provider-, and systems-level factors and influenced by the pervasive stigma of mental illness. Individuals with schizophrenia have higher rates of health behaviors linked with cancer mortality including cigarette smoking. They also have significant medical comorbidity, are less likely to have up-to-date cancer screening, and may present at more advanced stages of illness. Patients with schizophrenia may be less likely to receive chemotherapy or radiotherapy, have more postoperative complications, and have less access to palliative care. However, opportunities exist for the interdisciplinary team, including medical, surgical, and radiation oncologists; psychiatrists; and primary care physicians, to intervene throughout the continuum of cancer care to promote survival and quality of life. This review summarizes data on overall and cancer-specific mortality for individuals with schizophrenia and reviews specific disparities across the cancer care continuum of screening, diagnosis, treatment, and end-of-life care. Using a case, the authors illustrate clinical challenges for this population including communication, informed consent, and risk of suicide, and provide suggestions for care. Finally, recommendations for research to address the disparities in cancer care for individuals with schizophrenia are discussed. Despite significant challenges, with collaboration between oncology and mental health teams, individuals with schizophrenia can receive high-quality cancer care.
Pesec, Madeline; Sherertz, Tracy
Cancer is now recognized as one of the four leading causes of morbidity and mortality worldwide, and incidence is expected to rise significantly in the next two decades. Unfortunately, low- and middle-income countries (LMIC) suffer disproportionately from the world's cancer cases. The growing burden of cancer and maldistribution of cancer care resources in LMIC warrant a massive re-evaluation of the structural inequalities that produce global oncological disparities and a worldwide commitment to improve both prevention and treatment strategies. Efforts to improve cancer care capacity should focus on horizontal strengthening of healthcare systems that provide safe, affordable, effective and sustainable care. In response to current deficiencies, many international organizations have started to partner with LMIC to create solutions. Telemedicine and international collaboration are also promising ways to effect change and improve global oncological care.
Skolarus, Ted A; Wolf, Andrew M D; Erb, Nicole L; Brooks, Durado D; Rivers, Brian M; Underwood, Willie; Salner, Andrew L; Zelefsky, Michael J; Aragon-Ching, Jeanny B; Slovin, Susan F; Wittmann, Daniela A; Hoyt, Michael A; Sinibaldi, Victoria J; Chodak, Gerald; Pratt-Chapman, Mandi L; Cowens-Alvarado, Rebecca L
Prostate cancer survivors approach 2.8 million in number and represent 1 in 5 of all cancer survivors in the United States. While guidelines exist for timely treatment and surveillance for recurrent disease, there is limited availability of guidelines that facilitate the provision of posttreatment clinical follow-up care to address the myriad of long-term and late effects that survivors may face. Based on recommendations set forth by a National Cancer Survivorship Resource Center expert panel, the American Cancer Society developed clinical follow-up care guidelines to facilitate the provision of posttreatment care by primary care clinicians. These guidelines were developed using a combined approach of evidence synthesis and expert consensus. Existing guidelines for health promotion, surveillance, and screening for second primary cancers were referenced when available. To promote comprehensive follow-up care and optimal health and quality of life for the posttreatment survivor, the guidelines address health promotion, surveillance for prostate cancer recurrence, screening for second primary cancers, long-term and late effects assessment and management, psychosocial issues, and care coordination among the oncology team, primary care clinicians, and nononcology specialists. A key challenge to the development of these guidelines was the limited availability of published evidence for management of prostate cancer survivors after treatment. Much of the evidence relies on studies with small sample sizes and retrospective analyses of facility-specific and population databases.
Odeh, Bassel; Kayyali, Reem; Nabhani-Gebara, Shereen; Philip, Nada
The survival rates for patients living with cancer are increasing, due to recent advances in detection, prevention and treatment. It has been estimated that there were 28 million cancer survivors around the world in 2012. In the UK, for patients diagnosed in 2007, it is predicted that more than half of them will survive their cancer for 5 years or more. A large majority of cancer survivors report unmet supportive care needs and distressing symptoms and adverse long-term consequences related to their cancer. Cancer management could be optimized to better meet patients demand through technology, including mobile health (m-Health). m-Health is defined as the use of mobile communications and network technologies for health care. m-Health can help both patients and health-care professionals and play an important part in managing and delivering cancer care including managing side effects, supporting drug adherence, providing cancer information, planning and follow up and detecting and diagnosing cancer. Health authorities have already published guidelines regulating m-Health to insure patient safety and improve the accountability of its applications.
... a cancer information system that offers access to electronic mailing lists and websites, provides a list of ... primary care providers. Journey Forward also provides an electronic tool, the Medical History Builder, to help patients ...
Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.
Easley, Julie; Miedema, Baukje; Carroll, June C.; Manca, Donna P.; O’Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva
Abstract Objective To explore health care provider (HCP) perspectives on the coordination of cancer care between FPs and cancer specialists. Design Qualitative study using semistructured telephone interviews. Setting Canada. Participants A total of 58 HCPs, comprising 21 FPs, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 GPs in oncology. Methods This qualitative study is nested within a larger mixed-methods program of research, CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum), focused on improving the coordination of cancer care between FPs and cancer specialists. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care. Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location (urban or rural). A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review. Main findings Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles. Conclusion Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still
Stanczyk, Malgorzata Monika
The purpose of this paper is to show some aspects of music therapy application in cancer care and to present the integration of music therapy program into a continuous supportive cancer care for inpatients. A cancer diagnosis is one of the most feared and serious life events that causes stress in individuals and families. Cancer disrupts social, physical and emotional well-being and results in a range of emotions, including anger, fear, sadness, guilt, embarrassment and shame. Music therapy is a part of a complementary medicine program in supportive cancer care which accompanies medical treatment. There are many benefits of music therapy for cancer patients-interactive music therapy techniques (instrumental improvisation, singing) as well as receptive music therapy techniques (listening to recorded or live music, music and imaginary) can be used to improve mood, decrease stress, pain, anxiety level and enhance relaxation. Music therapy is an effective form of supporting cancer care for patients during the treatment process. It may be also basic for planning effective programs of rehabilitation to promote wellness, improve physical and emotional well-being and the quality of life.
Stanczyk, Malgorzata Monika
The purpose of this paper is to show some aspects of music therapy application in cancer care and to present the integration of music therapy program into a continuous supportive cancer care for inpatients. A cancer diagnosis is one of the most feared and serious life events that causes stress in individuals and families. Cancer disrupts social, physical and emotional well-being and results in a range of emotions, including anger, fear, sadness, guilt, embarrassment and shame. Music therapy is a part of a complementary medicine program in supportive cancer care which accompanies medical treatment. There are many benefits of music therapy for cancer patients—interactive music therapy techniques (instrumental improvisation, singing) as well as receptive music therapy techniques (listening to recorded or live music, music and imaginary) can be used to improve mood, decrease stress, pain, anxiety level and enhance relaxation. Music therapy is an effective form of supporting cancer care for patients during the treatment process. It may be also basic for planning effective programs of rehabilitation to promote wellness, improve physical and emotional well-being and the quality of life. PMID:24376975
Cohen, Ezra E W; LaMonte, Samuel J; Erb, Nicole L; Beckman, Kerry L; Sadeghi, Nader; Hutcheson, Katherine A; Stubblefield, Michael D; Abbott, Dennis M; Fisher, Penelope S; Stein, Kevin D; Lyman, Gary H; Pratt-Chapman, Mandi L
Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society.
Maddocks, Matthew; Hopkinson, Jane; Conibear, John; Reeves, Annie; Shaw, Clare; Fearon, Ken C.H.
Purpose of review Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory. Recent findings Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments. Summary We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care. PMID:27635765
Iglesias, David A.; Bodurka, Diane C.
Endometrial cancer typically presents at an early stage when surgery alone, with or without radiotherapy, is often curative. However, in women who present with advanced disease or who develop disease recurrence, long-term prognosis is poor. While surgical cytoreduction remains the mainstay of initial therapy, over the last several decades, the roles of cytotoxic chemotherapy, radiotherapy, and hormonal therapy have been evaluated in both the adjuvant and recurrent setting in an attempt to improve long-term survival while also minimizing associated toxicities. Unfortunately, response rates remain poor and survival is limited in these settings. More recently, with the introduction of personalized cancer treatment, several biologic agents have been developed that target specific pathways critical to tumor initiation and growth. Molecular studies have found that many endometrial cancers are driven by some of these tumorigenic pathways, which has led to early clinical studies evaluating the role of these targeted agents in patients with advanced or recurrent endometrial cancer. This review describes existing treatment options for patients with early and advanced endometrioid endometrial cancer, as well as for patients with uterine serous cancers. Furthermore, this review examines the growing body of literature involving targeted biologic agents as treatment for patients with advanced or recurrent endometrial cancer. PMID:23271352
Ahmad, Muayyad M; Dardas, Latefa; Dardas, Lubna; Ahmad, Huthaifa
The aim of this study was to describe the knowledge, attitudes, and practices toward colorectal cancer prevention and care in Jordan. A survey was designed to produce reliable estimates for the population's knowledge, attitudes, and practices in all 12 governorates of Jordan by using stratified random sampling. A representative sample of the adult population in Jordan completed a comprehensive tool which explored participants' knowledge about the risk factors associated with colorectal cancer, cancer prevention through lifestyle changes, and early cancer diagnosis and screening. According to the participants (n = 3196), colorectal cancer had the second highest percentage of screening recommendation (12.6%) after breast cancer (57.3%). Only 340 individuals (11%) reported ever screening for cancer. About 20% of the participants had heard of one of the screening tests for colorectal cancer. In fact, only 290 (9.1%) participants had performed the colorectal cancer screening tests. This study provides data that will help colorectal cancer prevention and treatment programs and may enhance the efficiency of colorectal cancer-controlling programs. The findings confirm the necessity of starting colorectal screening intervention that targets the most vulnerable individuals.
Kumar, Saurabh; Sen, Anindita; Kumar, Suveen; Augustine, Shine; Yadav, Birendra K.; Mishra, Sandeep; Malhotra, Bansi D.
We report results of studies relating to the fabrication of a flexible, disposable, and label free biosensing platform for detection of the cancer biomarker (carcinoembryonic antigen, CEA). Polyaniline (PANI) has been electrochemically deposited over gold sputtered paper (Au@paper) for covalent immobilization of monoclonal carcinoembryonic antibodies (anti-CEA). The bovine serum albumin (BSA) has been used for blocking nonspecific binding sites at the anti-CEA conjugated PANI/Au@Paper. The PANI/Au@Paper, anti-CEA/PANI/Au@Paper, and BSA/anti-CEA/PANI/Au@Paper platforms have been characterized using scanning electron microscopy, X-ray diffraction, Fourier transmission infrared spectroscopy, chronoamperometry, and electrochemical impedance techniques. The results of the electrochemical response studies indicate that this BSA/anti-CEA/PANI/Au@paper electrode has sensitivity of 13.9 μA ng-1 ml cm2, shelf life of 22 days, and can be used to estimate CEA in the range of 2-20 ng ml-1. This paper sensor has been validated by detection of CEA in serum samples of cancer patients via immunoassay technique.
Kircher, Moritz F; Hricak, Hedvig; Larson, Steven M
Molecular imaging is rapidly gaining recognition as a tool with the capacity to improve every facet of cancer care. Molecular imaging in oncology can be defined as in vivo characterization and measurement of the key biomolecules and molecularly based events that are fundamental to the malignant state. This article outlines the basic principles of molecular imaging as applied in oncology with both established and emerging techniques. It provides examples of the advantages that current molecular imaging techniques offer for improving clinical cancer care as well as drug development. It also discusses the importance of molecular imaging for the emerging field of theranostics and offers a vision of how molecular imaging may one day be integrated with other diagnostic techniques to dramatically increase the efficiency and effectiveness of cancer care.
Braun, Kathryn L.; Kagawa-Singer, Marjorie; Holden, Alan E. C.; Burhansstipanov, Linda; Tran, Jacqueline H.; Seals, Brenda F.; Corbie-Smith, Giselle; Tsark, JoAnn U.; Harjo, Lisa; Foo, Mary Anne; Ramirez, Amelie G.
Cancer patient navigation (PN) programs have been shown to increase access to and utilization of cancer care for poor and underserved individuals. Despite mounting evidence of its value, cancer patient navigation is not universally understood or provided. We describe five PN programs and the range of tasks their navigators provide across the cancer care continuum (education and outreach, screening, diagnosis and staging, treatment, survivorship, and end-of-life). Tasks are organized by their potential to make cancer services understandable, available, accessible, affordable, appropriate, and accountable. Although navigators perform similar tasks across the five programs, their specific approaches reflect differences in community culture, context, program setting, and funding. Task lists can inform the development of programs, job descriptions, training, and evaluation. They also may be useful in the move to certify navigators and establish mechanisms for reimbursement for navigation services. PMID:22423178
El-Shami, Khaled; Oeffinger, Kevin C; Erb, Nicole L; Willis, Anne; Bretsch, Jennifer K; Pratt-Chapman, Mandi L; Cannady, Rachel S; Wong, Sandra L; Rose, Johnie; Barbour, April L; Stein, Kevin D; Sharpe, Katherine B; Brooks, Durado D; Cowens-Alvarado, Rebecca L
Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two-thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short-term and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.
Mohammadzadeh, Niloofar; Safdari, Reza; Rahimi, Azin
Greater use of mobile phone devices seems inevitable because the health industry and cancer care are facing challenges such as resource constraints, rising care costs, the need for immediate access to healthcare data of types such as audio video texts for early detection and treatment of patients and increasing remote aids in telemedicine. Physicians, in order to study the causes of cancer, detect cancer earlier, act in prevention measures, determine the effectiveness of treatment and specify the reasons for the treatment ineffectiveness, need to access accurate, comprehensive and timely cancer data. Mobile devices provide opportunities and can play an important role in consulting, diagnosis, treatment, and quick access to health information. There easy carriage make them perfect tools for healthcare providers in cancer care management. Key factors in cancer care management systems through a mobile phone health approach must be considered such as human resources, confidentiality and privacy, legal and ethical issues, appropriate ICT and provider infrastructure and costs in general aspects and interoperability, human relationships, types of mobile devices and telecommunication related points in specific aspects. The successful implementation of mobile-based systems in cancer care management will constantly face many challenges. Hence, in applying mobile cancer care, involvement of users and considering their needs in all phases of project, providing adequate bandwidth, preparation of standard tools that provide maximum mobility and flexibility for users, decreasing obstacles to interrupt network communications, and using suitable communication protocols are essential. It is obvious that identifying and reducing barriers and strengthening the positive points will have a significant role in appropriate planning and promoting the achievements of mobile cancer care systems. The aim of this article is to explain key points which should be considered in designing
Waldman, Elisha; Wolfe, Joanne
Over the past two decades, paediatric palliative care has emerged as both a primary approach and as its own medical subspecialty, the overall aim of which is to ease suffering for children with life-threatening illness and their families through a concurrent model of care. However, most discussions have been focused on the transition to palliative care when no realistic hope for cure exists. We believe that, because the course of cancer is so unpredictable, this idea is misleading. Indeed, palliative care is increasingly being recognized as being about not just how to cope with the process of dying, but also about how to engage in living when faced with a life-threatening illness. This article will examine our current understanding of several areas of palliative care, with the ultimate message that palliative care is simply a novel term for the total care of a child and family, an approach that should be applied consistently and concurrently regardless of disease status. By improving familiarity with palliative care and building relationships with palliative care specialists, the paediatric oncology clinician will ensure that the best care possible for children and families is provided, regardless of outcome.
Koomen, John M.; Haura, Eric B.; Bepler, Gerold; Sutphen, Rebecca; Remily-Wood, Elizabeth R.; Benson, Kaaron; Hussein, Mohamad; Hazlehurst, Lori A.; Yeatman, Timothy J.; Hildreth, Lynne T.; Sellers, Thomas A.; Jacobsen, Paul B.; Fenstermacher, David A.; Dalton, William S.
Cancer impacts each patient and family differently. Our current understanding of the disease is primarily limited to clinical hallmarks of cancer, but many specific molecular mechanisms remain elusive. Genetic markers can be used to determine predisposition to tumor development, but molecularly targeted treatment strategies that improve patient prognosis are not widely available for most cancers. Individualized care plans, also described as personalized medicine, still must be developed by understanding and implementing basic science research into clinical treatment. Proteomics holds great promise in contributing to the prevention and cure of cancer because it provides unique tools for discovery of biomarkers and therapeutic targets. As such, proteomics can help translate basic science discoveries into the clinical practice of personalized medicine. Here we describe how biological mass spectrometry and proteome analysis interact with other major patient care and research initiatives and present vignettes illustrating efforts in discovery of diagnostic biomarkers for ovarian cancer, development of treatment strategies in lung cancer, and monitoring prognosis and relapse in multiple myeloma patients. PMID:18664563
0802 TITLE: Racial Disparities in Palliative Care for Prostate Cancer PRINCIPAL INVESTIGATOR: Alfred I. Neugut, MD, PhD...Disparities in Palliative Care for Prostate Cancer 5b. GRANT NUMBER W81XWH-10-1-0802 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S... palliative treatments. 15. SUBJECT TERMS Prostate cancer, palliative care , ureteral obstruction, cord compression 16. SECURITY CLASSIFICATION OF
Bladder cancer is the second most common urological cancer after prostate cancer in the UK. This article aims to update nurses knowledge about the disease, focusing on diagnosis, treatment and nursing care.
Oeffinger, Kevin C; Argenbright, Keith E; Levitt, Gill A; McCabe, Mary S; Anderson, Paula R; Berry, Emily; Maher, Jane; Merrill, Janette; Wollins, Dana S
The population of cancer survivors in the United States and worldwide is rapidly increasing. Many survivors will develop health conditions as a direct or indirect consequence of their cancer therapy. Thus, models to deliver high-quality care for cancer survivors are evolving. We provide examples of three different models of survivorship care from a cancer center, a community setting, and a country-wide health care system, followed by a description of the ASCO Cancer Survivorship Compendium, a tool to help providers understand the various models of survivorship care available and integrate survivorship care into their practices in a way that fits their unique needs.
Johansen, May-Lill; Holtedahl, Knut Arne; Rudebeck, Carl Edvard
Objective To explore GPs’ own views on their role in cancer care. Design Qualitative study based on semi-structured interviews. Setting Norwegian primary care. Methods The stories of 14 GPs concerning 18 patients were analyzed for core content and abstracted into general ideas, to create a broader sense of the experienced professional role. Results The GPs claimed to have an important role in cancer care. In our analysis, three main aspects of GPs’ work emerged: first, as a flexible mediator, e.g. between the patient and the clinic, interpreting and translating; second, as an efficient “handyman”, solving practical problems locally; and third, as a personal companion for the patient throughout the illness. Conclusion The interviewed GPs see their place in cancer care as being close to their patients. In their many tasks we found three main aspects: the mediating, the practical, and the personal. PMID:20950124
Wang, ShuQi; Chinnasamy, Thiruppathiraja; Lifson, Mark A; Inci, Fatih; Demirci, Utkan
Point-of-care (POC) diagnostics play an important role in delivering healthcare, particularly for clinical management and disease surveillance in both developed and developing countries. Currently, the majority of POC diagnostics utilize paper substrates owing to affordability, disposability, and mass production capability. Recently, flexible polymer substrates have been investigated due to their enhanced physicochemical properties, potential to be integrated into wearable devices with wireless communications for personalized health monitoring, and ability to be customized for POC diagnostics. Here, we focus on the latest advances in developing flexible substrate-based diagnostic devices, including paper and polymers, and their clinical applications.
Easley, Julie; Miedema, Baukje; Carroll, June C.; O’Brien, Mary Ann; Manca, Donna P.; Grunfeld, Eva
Abstract Objective To explore patient perspectives on and experiences with the coordination and continuity of cancer care. Design Qualitative study using semistructured telephone interviews. Setting Canada. Participants Thirty-eight breast and colorectal cancer survivors 1 to 4 years after diagnosis. Methods Using a constructivist grounded theory approach, semistructured telephone interviews were conducted with the participants. The interviews were digitally recorded, transcribed verbatim, and proofread. Transcripts were reviewed to create a focused coding scheme that was used to develop categories for participants’ experiences. Main findings Although this study focused on the continuity of cancer care, patients described their experiences with cancer care in general, concentrating predominantly on their relationships with individual health care providers (HCPs). Based on patients’ experiences, several themes were identified as the core components of providing good continuity and well coordinated care. The most important overarching theme was communication, which overlapped with 4 other themes: patient-HCP relationships, the role of HCPs, lack of access to care, and timely and tailored information. Conclusion Patients believed that good communication between HCPs and patients was key to improving the overall continuity of cancer care. Continuity of care is an important theoretical concept in cancer care, but it is not easily recognized by patients. They perceive the cancer care continuum and continuity of care as cancer care in general, which is typically framed by the individual relationships with their HCPs. Future research and interventions need to focus on finding and testing ways to improve communication to enhance continuity of cancer care. PMID:27737982
Cultural competence in oncology requires the acquisition of specific knowledge, clinical skills, and attitudes that facilitate effective cross-cultural negotiation in the clinical setting, thus, leading to improved therapeutic outcomes and decreased disparities in cancer care. Cultural competence in oncology entails a basic knowledge of different cultural attitudes and practices of communication of the truth and of decision-making styles throughout the world. Cultural competence always presupposes oncology professionals' awareness of their own cultural beliefs and values. To be able to communicate with cancer patients in culturally sensitive ways, oncologists should have knowledge of the concept of culture in its complexity and of the risks of racism, classism, sexism, ageism, and stereotyping that must be avoided in clinical practice. Oncologists should develop a sense of appreciation for differences in health care values, based on the recognition that no culture can claim hegemony over others and that cultures are evolving under their reciprocal influence on each other. Medical schools and oncology training can teach communication skills and cultural competence, while fostering in all students and young doctors those attitudes of humility, empathy, curiosity, respect, sensitivity, and awareness that are needed to deliver effective and culturally sensitive cancer care.
Lung cancer accounts for 12% of all cancers and has the highest annual rate of mortality in men and women. The overall aim is cure or prolongation of life without evidence of disease. Almost 60% of patients at the moment of diagnosis are not eligible for radical treatment. Therefore soothing and supportive treatment is the only treatment of choice. Patients with lung cancer who have symptoms of dyspnea, chronic cough, severe pain, exhaustion and cachexia syndrome, fear and depression and significantly reduced physical and intellectual activities are qualified for inpatient or home palliative care. Knowledge about various methods used in palliative treatment allows one to alleviate symptoms that occur in an advanced stage of disease with an expected short survival period. Methods of oncological treatment that are often used in patients with advanced lung cancer include radiotherapy and chemotherapy. Drawing attention to the earlier implementation of palliative care is an objective of research carried out during recent years. Advances in surgical and conservative treatment of these patients have contributed to better outcomes and longer survival time. PMID:24596508
Hussain, Tanvir; Chang, Hsien-Yen; Luu, Ngoc-Phuong; Pollack, Craig Evan
Background Improving continuity between primary care and cancer care is critical for improving cancer outcomes and curbing cancer costs. A dimension of continuity, we investigated how regularly patients receive their primary care and surgical care for colon cancer from the same hospital and whether this affects mortality and costs. Methods Using Surveillance, Epidemiology, and End Results Program Registry (SEER)-Medicare data, we performed a retrospective cohort study of stage I-III colon cancer patients diagnosed between 2000 and 2009. There were 23,305 stage I-III colon cancer patients who received primary care in the year prior to diagnosis and underwent operative care for colon cancer. Patients were assigned to the hospital where they had their surgery and to their primary care provider’s main hospital, and then classified according to whether these two hospitals were same or different. Outcomes examined were hazards for all-cause mortality, subhazard for colon cancer specific mortality, and generalized linear estimate for costs at 12 months, from propensity score matched models. Results Fifty-two percent of stage I-III colon patients received primary care and surgical care from the same hospital. Primary care and surgical care from the same hospital was not associated with reduced all-cause or colon cancer specific mortality, but was associated with lower inpatient, outpatient, and total costs of care. Total cost difference was $8,836 (95% CI $2,746–$14,577), a 20% reduction in total median cost of care at 12 months. Conclusions Receiving primary care and surgical care at the same hospital, compared to different hospitals, was associated with lower costs but still similar survival among stage I-III colon cancer patients. Nonetheless, health care policy which encourages further integration between primary care and cancer care in order to improve outcomes and decrease costs will need to address the significant proportion of patients receiving health care
Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care, a 2010 workshop sponsored by the Epidemiology and Genomics Research Program.
Mohammadzadeh, Niloofar; Safdari, Reza
Studies of the causes of cancer, early detection, prevention or treatment need accurate, comprehensive, and timely cancer data. The clinical laboratory provides important cancer information needed for physicians which influence clinical decisions regarding treatment, diagnosis and patient monitoring. Poor communication between health care providers and clinical laboratory personnel can lead to medical errors and wrong decisions in providing cancer care. Because of the key impact of laboratory information on cancer diagnosis and treatment the quality of the tests, lab reports, and appropriate lab management are very important. A laboratory information management system (LIMS) can have an important role in diagnosis, fast and effective access to cancer data, decrease redundancy and costs, and facilitate the integration and collection of data from different types of instruments and systems. In spite of significant advantages LIMS is limited by factors such as problems in adaption to new instruments that may change existing work processes. Applications of intelligent software simultaneously with existing information systems, in addition to remove these restrictions, have important benefits including adding additional non-laboratory-generated information to the reports, facilitating decision making, and improving quality and productivity of cancer care services. Laboratory systems must have flexibility to change and have the capability to develop and benefit from intelligent devices. Intelligent laboratory information management systems need to benefit from informatics tools and latest technologies like open sources. The aim of this commentary is to survey application, opportunities and necessity of intelligent clinical laboratory as a tool to increase cancer care management productivity.
El-Shami, Khaled; Oeffinger, Kevin C.; Erb, Nicole L.; Willis, Anne; Bretsch, Jennifer; Pratt-Chapman, Mandi L.; Cannady, Rachel; Wong, Sandra L.; Rose, Johnie; Barbour, April; Stein, Kevin; Sharpe, Katherine; Brooks, Durado D.; Cowens-Alvarado, Rebecca L.
Colorectal cancer (CRC) is the third most common malignant disease in the United States (U.S.). Almost two-thirds of CRC survivors are living 5 years following diagnosis. The prevalence of CRC survivors is likely to increase dramatically over the coming decades with further advances in early detection and treatment and the aging and growth of the U.S. population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns following treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The following guidelines are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy. PMID:26348643
Cancer is increasing in incidence and prevalence worldwide, and the WHO has recently included cancer and its treatments as a health priority in developed and developing countries. The cultural diversity of oncology patients is bound to increase, and cultural sensitivity and competence are now required of all oncology professionals. A culturally competent cancer care leads to improved therapeutic outcome and it may decrease disparities in medical care. Cultural competence in medicine is a complex multilayered accomplishment, requiring knowledge, skills and attitudes whose acquisition is needed for effective cross-cultural negotiation in the clinical setting. Effective cultural competence is based on knowledge of the notion of culture; on awareness of possible biases and prejudices related to stereotyping, racism, classism, sexism; on nurturing appreciation for differences in health care values; and on fostering the attitudes of humility, empathy, curiosity, respect, sensitivity and awareness. Cultural competence in healthcare relates to individual professionals, but also to organizations and systems. A culturally competent healthcare system must consider in their separateness and yet in there reciprocal influences social, racial and cultural factors. By providing a framework of reference to interpret the external world and relate to it, culture affects patients' perceptions of disease, disability and suffering; degrees and expressions of concern about them; their responses to treatments and their relationship to individual physicians and to the healthcare system. Culture also influences the interpretation of ethical norms and principles, and especially of individual autonomy, which can be perceived either as synonymous with freedom or with isolation depending on the cultural context. This, in turn, determines the variability of truth-telling attitudes and practices worldwide as well as the different roles of family in the information and decision-making process of
Yamamoto, Yuki; Harada, Shingo; Yamamoto, Daisuke; Honda, Wataru; Arie, Takayuki; Akita, Seiji; Takei, Kuniharu
Real-time health care monitoring may enable prediction and prevention of disease or improve treatment by diagnosing illnesses in the early stages. Wearable, comfortable, sensing devices are required to allow continuous monitoring of a person's health; other important considerations for this technology are device flexibility, low-cost components and processing, and multifunctionality. To address these criteria, we present a flexible, multifunctional printed health care sensor equipped with a three-axis acceleration sensor to monitor physical movement and motion. Because the device is designed to be attached directly onto the skin, it has a modular design with two detachable components: One device component is nondisposable, whereas the other one is disposable and designed to be worn in contact with the skin. The design of this disposable sensing sheet takes into account hygiene concerns and low-cost materials and fabrication methods as well as features integrated, printed sensors to monitor for temperature, acceleration, electrocardiograms, and a kirigami structure, which allows for stretching on skin. The reusable component of the device contains more expensive device components, features an ultraviolet light sensor that is controlled by carbon nanotube thin-film transistors, and has a mechanically flexible and stable liquid metal contact for connection to the disposable sensing sheet. After characterizing the electrical properties of the transistors and flexible sensors, we demonstrate a proof-of-concept device that is capable of health care monitoring combined with detection of physical activity, showing that this device provides an excellent platform for the development of commercially viable, wearable health care monitors.
Yamamoto, Yuki; Harada, Shingo; Yamamoto, Daisuke; Honda, Wataru; Arie, Takayuki; Akita, Seiji; Takei, Kuniharu
Real-time health care monitoring may enable prediction and prevention of disease or improve treatment by diagnosing illnesses in the early stages. Wearable, comfortable, sensing devices are required to allow continuous monitoring of a person’s health; other important considerations for this technology are device flexibility, low-cost components and processing, and multifunctionality. To address these criteria, we present a flexible, multifunctional printed health care sensor equipped with a three-axis acceleration sensor to monitor physical movement and motion. Because the device is designed to be attached directly onto the skin, it has a modular design with two detachable components: One device component is nondisposable, whereas the other one is disposable and designed to be worn in contact with the skin. The design of this disposable sensing sheet takes into account hygiene concerns and low-cost materials and fabrication methods as well as features integrated, printed sensors to monitor for temperature, acceleration, electrocardiograms, and a kirigami structure, which allows for stretching on skin. The reusable component of the device contains more expensive device components, features an ultraviolet light sensor that is controlled by carbon nanotube thin-film transistors, and has a mechanically flexible and stable liquid metal contact for connection to the disposable sensing sheet. After characterizing the electrical properties of the transistors and flexible sensors, we demonstrate a proof-of-concept device that is capable of health care monitoring combined with detection of physical activity, showing that this device provides an excellent platform for the development of commercially viable, wearable health care monitors. PMID:28138532
The growing number of cancer survivors challenges healthcare organizations to develop programs that support survivors' transition from active treatments to survivorship care. Many individuals and families continue to face complicated care issues resulting from cancer diagnosis and side effects long after completion of their treatments. This article describes a model of a survivorship care plan, Cancer Treatment Summary and Follow-Up Care Plan, piloted in an outpatient clinical setting in a community hospital for patients with breast cancer. The plan can be expanded to include other cancer types. The intent of the survivorship care plan is to strengthen the care connections and coordination of services for survivors of breast cancer to ensure that continuing care needs are met during the survivorship phase of the cancer trajectory. The survivorship care plan is a unique opportunity for oncology nurses to be catalysts for the interdisciplinary interactions that are required to develop survivorship care plans and to implement a change in oncology nursing practice. The intervention shifts the paradigm of cancer survivorship care from an acute care medical model to a wellness model for cancer survivors in the clinical setting.
Although many patients with cancer report positively on their experience of care, others claim they are not receiving the information and support they need at different stages of their care pathway. The national cancer patient survey (Department of Health, 2002), for example, showed wide variations in the quality of care delivered across the country.
Shell, Renee; Tudiver, Fred
Rural Appalachia has significantly higher overall cancer mortality compared with national rates, and lack of cancer screening is believed to be one of the contributing factors. Reducing the cancer disparity in this region must include strategies to address suboptimal cancer screening practices by rural Appalachian primary care providers (PCPs). To…
Sheldon, Lisa Kennedy
Comprehensive cancer care continues to improve in the United States, but many developing countries carry a high cancer burden. With limited resources, nurses in such countries often are unable to improve cancer detection and treatment or relieve patient suffering. The Oncology Nursing Society has developed collaborative relationships with many international organizations to educate nurses around the world. Global partnerships have the potential to improve cancer care internationally and encourage more oncology nurses to use their expertise and become "citizens of the world."
Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Thomaz, Erika Bárbara Abreu Fonseca; Queiroz, Rejane Christine de Sousa; de Souza, Marta Rovery; Lein, Adriana; Alvares, Viviane; de Almeida, Dante Grapiuna; Barbosa, Allan Claudius Queiroz; Thumé, Elaine; Staton, Catherine; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto
Cervical cancer is a common neoplasm that is responsible for nearly 230 000 deaths annually in Brazil. Despite this burden, cervical cancer is considered preventable with appropriate care. We conducted a longitudinal ecological study from 2002 to 2012 to examine the relationship between the delivery of preventive primary care and cervical cancer mortality rates in Brazil. Brazilian states and the federal district were the unit of analysis (N = 27). Results suggest that primary health care has contributed to reducing cervical cancer mortality rates in Brazil; however, the full potential of preventive care has yet to be realized. PMID:28252500
Kleiman, Devra G
Benson Ginsburg's early studies of canid socialization and wolf social and reproductive behavior were focused, in part, on the degree to which there was flexibility in social development and specifically whether there was a critical period during development after which wolf pups could not be socialized to humans. My focus was the degree to which differences in canid ecology and social structure were correlated with differences in the plasticity of social and reproductive behavior, including development. Canid species are unusual among the Mammalia in being primarily monogamous. Males may play an indirect or direct role in parental care, depending on a species degree of sociality. Canid species also differ in developmental parameters, and reproductive suppression is common in the group-living pack hunters. I review comparative studies of the social and reproductive behavior of three South American canids which vary in their degree of sociality and explore the degree to which the species are ecologically and socially flexible.
Ashing, Kimlin; Napoles, Anna
Introduction Receiving quality cancer follow-up care influences survivorship outcomes. Among Latinas, breast cancer is the number one cause of cancer death; yet Latinas do not receive adequate follow-up care. This study examined quality of cancer follow-up care among Latina breast cancer survivors (BCS) and whether it differs by participant language and healthcare system variables (provider specialty, and medical setting). Methods Two hundred thirty-two (95 English-speaking Latina and 137 Spanish-speaking) Latina BCS were recruited from the California Cancer Registry, hospital cancer registries, and community agencies. Results English-speaking Latina BCS were more likely to report receiving cancer follow-up care at a doctor’s office (p<0.001). BCS without a regular place for cancer follow-up care were more likely to report not seeing a primary care provider (p<0.05) or cancer specialist (p<0.001) in the past 12 months. English-speaking Latina BCS (p<0.001), BCS who saw a cancer specialist in the past 12 months (p<0.001), and received follow-up care at a doctor’s office (p<0.05) reported higher quality of care. Speaking English, having seen a cancer specialist, and receiving follow-up care at a doctor’s office were independently associated with higher quality of care, explaining 44 % of the variance. Conclusions Our study findings suggest that examining the influence of ethnic and linguistic factors on quality of cancer follow-up care is necessary to address health disparities. Improved access to cancer follow-up care for Spanish-speaking Latina BCS is of particular concern. Implication of Cancer Survivors Identifying follow-up care needs of Latina BCS may contribute to providing high-quality care and improved survivorship outcomes. PMID:24563169
to invasive beast cancer ratio, a pattern previously demonstrated for cervical cancer (9). This decline in the ratio of invasive to non- invasive...cervical carcinoma. Int. J Cancer 1978; 21:418-25. 10. Guzik DS. Efficacy of screening for cervical cancer : A review. Am J Public Health 1978; 68:125-34...and Cervical Cancer Screening in Low Income Managed Care Sample: The Efficacy of Physician Letters and Phone Calls. Am J of Public health. 85(6): 834
Jones, C; Gordon, G
A pilot study at a large metropolitan hospital in Auckland identified a specific group of patients that can be safely monitored outside the Coronary Care Unit using Flexible Monitoring technology. This article describes the project management processes used to further develop the remote monitoring system into a hospital network of remote monitoring. The educational and staff support resources required throughout the project are described as are the strategies adopted to meet those needs including the utilization of online learning. Outcomes from the introduction of the system include improved electrokardiogram interpretation by nursing staff and improved ECG resource allocation.
Flood, Ann B; Fennell, Mary L; Devers, Kelly J
To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.
Fennell, Mary L.; Devers, Kelly J.
To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation’s health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform. PMID:22623600
Skin cancer screening (SCS) promotes early detection and improves treatment. Primary care providers are strategically positioned to provide screenings, yet the frequency is low. Strategies to improve SCS include increasing skin cancer awareness, targeting high-risk patient populations, and advocating for primary care providers to conduct screenings.
... 163535.html Cancer Survivors Gain From Web-Based Health Care But some patients reported missing face-to-face ... 10, 2017 (HealthDay News) -- Online- and phone-based health care offers a number of benefits for cancer survivors, ...
Grant, Marcia; Economou, Denice
As a result of earlier diagnosis and improved treatment, the number of cancer survivors is steadily increasing, with over 11 million in the US today. These survivors face a multitude of long-term and late effects as a result of their cancer and its treatment. It is increasingly recognized that this group has complex and ongoing needs for medical care education, surveillance, screening, and support. Many organizations have helped to advance survivorship care; key among them are the National Coalition for Cancer Survivorship, the Institute of Medicine, the Lance Armstrong Foundation, and the Office of Cancer Survivorship of the National Cancer Institute. Important reports have defined goals of care; identified interventions to improve outcomes among survivors; and recognized the need for posttreatment surveillance, healthy lifestyle behaviors, and continued research in all of these areas. With these advances, survivorship care is emerging as a distinct component of the continuum of care in oncology.
Alexander, Koshy; Goldberg, Jessica; Korc-Grodzicki, Beatriz
Older patients with cancer are best served by a multidisciplinary approach with palliative care (PC) playing an integral role. PC focuses on symptom control irrespective of its cause and should not be associated only with terminal care. It provides an additional layer of support in the care of patients with cancer with an emphasis on quality of life. This article discusses the evaluation and management of pain and other common nonpain symptoms that occur in elderly patients with cancer, as well as end-of-life care.
Alexander, Koshy; Goldberg, Jessica; Korc-Grodzicki, Beatriz
SYNOPSIS Older cancer patients are best served by a multidisciplinary approach with Palliative Care (PC) playing an integral role. PC focuses on symptom control irrespective of its cause and should not be associated only with terminal care. It provides an additional layer of support in the care of the cancer patient with an emphasis on quality of life. In this article, we discuss the evaluation and management of pain and other common non-pain symptoms that occur in the elderly cancer patient, as well as end of life care. PMID:26614860
Kwon, Harry T; Ma, Grace X; Gold, Robert S; Atkinson, Nancy L; Wang, Min Qi
Asian Americans experience disproportionate incidence and mortality rates of certain cancers, compared to other racial/ethnic groups. Primary care physicians are a critical source for cancer screening recommendations and play a significant role in increasing cancer screening of their patients. This study assessed primary care physicians' perceptions of cancer risk in Asians and screening recommendation practices. Primary care physicians practicing in New Jersey and New York City (n=100) completed a 30-question survey on medical practice characteristics, Asian patient communication, cancer screening guidelines, and Asian cancer risk. Liver cancer and stomach cancer were perceived as higher cancer risks among Asian Americans than among the general population, and breast and prostate cancer were perceived as lower risks. Physicians are integral public health liaisons who can be both influential and resourceful toward educating Asian Americans about specific cancer awareness and screening information.
Joly, Caroline; Jacqueline-Ravel, Nathalie; Pugliesi-Rinaldi, Angela; Bigler-Perrotin, Lucienne; Chikhi, Marinette; Dietrich, Pierre-Yves; Dulguerov, Pavel; Miralbell, Raymond; Picard-Kossovsky, Michel; Seium, Yodit; Thériault, Michel; Pichard, Claude
Progresses in cancer treatment transformed cancer into a chronic disease associated with growing nutritional problems. Poor nutritional status of cancer patients worsens morbidity, mortality, overall cost of care and decreases patients' quality of life, oncologic treatments tolerance and efficacy. These adverse effects lead to treatment modifications or interruptions, reducing the chances to control or cure cancer. Implementation of an interdisciplinary and longitudinal integration of nutritional care and nutritional information into cancer treatment (The OncoNut Program) could prevent or treat poor nutritional status and its adversely side effects.
whether the quality of care received by minority men with locally advanced prostate cancer differs from the care received by white men controlling for...Award Number: W81XWH-11-1-0540 TITLE: Racial Disparities in the Quality of Prostate Cancer Care PRINCIPAL INVESTIGATOR: Nina Bickell CONTRACTING...to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE
Ghandourh, Wsam A
Advanced cancer patients commonly have misunderstandings about the intentions of treatment and their overall prognosis. Several studies have shown that large numbers of patients receiving palliative radiation or chemotherapy hold unrealistic hopes of their cancer being cured by such therapies, which can affect their ability to make well-informed decisions about treatment options. This review aimed to explore this discrepancy between patients' and physicians' expectations by investigating three primary issues: (1) the factors associated with patients developing unrealistic expectations; (2) the implications of having unrealistic hopes and the effects of raising patients' awareness about prognosis; and (3) patients' and caregivers' perspective on disclosure and their preferences for communication styles. Relevant studies were identified by searching electronic databases including Pubmed, EMBASE and ScienceDirect using multiple combinations of keywords, which yielded a total of 65 articles meeting the inclusion criteria. The discrepancy between patients' and doctors' expectations was associated with many factors including doctors' reluctance to disclose terminal prognoses and patients' ability to understand or accept such information. The majority of patients and caregivers expressed a desire for detailed prognostic information; however, varied responses have been reported on the preferred style of conveying such information. Communication styles have profound effects on patients' experience and treatment choices. Patients' views on disclosure are influenced by many cultural, psychological and illness-related factors, therefore individuals' needs must be considered when conveying prognostic information. More research is needed to identify communication barriers and the interventions that could be used to increase patients' satisfaction with palliative care.
Ekstedt, Mirjam; Stenberg, Una; Olsson, Mariann; Ruland, Cornelia M
Being a family member of a patient who is being treated in an acute care setting for cancer often involves a number of challenges. Our study describes Norwegian cancer care health professionals' perceptions of family members who served as family caregivers (FCs) and their need for support during the in-hospital cancer treatment of their ill family member. Focus group discussions were conducted with a multidisciplinary team of 24 experienced social workers, physicians, and nurses who were closely involved in the patients' in-hospital cancer treatment and care. Drawing on qualitative hermeneutic analysis, four main themes describe health professionals' perceptions of FCs during the patient's in-hospital cancer care: an asset and additional burden, infinitely strong and struggling with helplessness, being an outsider in the center of care, and being in different temporalities. We conclude that it is a challenge for health care professionals to support the family and create room for FC's needs in acute cancer care. System changes are needed in health care, so that the patient/FC dyad is viewed as a unit of care in a dual process of caregiving, which would enable FCs to be given space and inclusion in care, with their own needs simultaneously considered alongside those of the patient.
Hui, David; Bruera, Eduardo
Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We end by discussing how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available. PMID:26598947
Eggermont, Alexander M M; Caldas, Carlos; Ringborg, Ulrik; Medema, René; Tabernero, Josep; Wiestler, Otmar
European cancer research for a transformative initiative by creating a consortium of six leading excellent comprehensive cancer centres that will work together to address the cancer care-cancer research continuum. Prerequisites for joint translational and clinical research programs are very demanding. These require the creation of a virtual single 'e-hospital' and a powerful translational platform, inter-compatible clinical molecular profiling laboratories with a robust underlying computational biology pipeline, standardised functional and molecular imaging, commonly agreed Standard Operating Procedures (SOPs) for liquid and tissue biopsy procurement, storage and processing, for molecular diagnostics, 'omics', functional genetics, immune-monitoring and other assessments. Importantly also it requires a culture of data collection and data storage that provides complete longitudinal data sets to allow for: effective data sharing and common database building, and to achieve a level of completeness of data that is required for conducting outcome research, taking into account our current understanding of cancers as communities of evolving clones. Cutting edge basic research and technology development serve as an important driving force for innovative translational and clinical studies. Given the excellent track records of the six participants in these areas, Cancer Core Europe will be able to support the full spectrum of research required to address the cancer research- cancer care continuum. Cancer Core Europe also constitutes a unique environment to train the next generation of talents in innovative translational and clinical oncology.
Twycross, R. G.
Lung cancer is the commonest form of malignant disease seen at St Christopher's Hospice. More than 35% of the male and about 8% of the female cancer patients are admitted with this diagnosis. This means that each year approximately 100 patients with lung cancer are amitted and cared for at the hospice. The more common symptoms experienced by 185 consecutive terminal lung cancer patients admitted to St Christopher's Hospice are listed in Table 1. PMID:4132166
Conran, Carly A; Brendler, Charles B; Xu, Jianfeng
Unprecedented progress has been made in genomic personalized medicine in the last several years, allowing for more individualized healthcare assessments and recommendations than ever before. However, most of this progress in prostate cancer (PCa) care has focused on developing and selecting therapies for late-stage disease. To address this issue of limited focus, we propose a model for incorporating genomic-based personalized medicine into all levels of PCa care, from prevention and screening to diagnosis, and ultimately to the treatment of both early-stage and late-stage cancers. We have termed this strategy the “Pyramid Model” of personalized cancer care. In this perspective paper, our objective is to demonstrate the potential application of the Pyramid Model to PCa care. This proactive and comprehensive personalized cancer care approach has the potential to achieve three important medical goals: reducing mortality, improving quality of life and decreasing both individual and societal healthcare costs. PMID:27184548
Economou, Denice; Ferrell, Betty; Uman, Gwen
The Institute of Medicine (IOM) 2006 report, From Cancer Patient to Cancer Survivor: Lost in Transition (In M. Hewitt, S. Greenfield and E. Stovall (Eds.), (pp. 9–186). Washington DC: The National Academies Press, 2006) identifies the key components of care that contribute to quality of life for the cancer survivor. As cancer survivorship care becomes an important part of quality cancer care oncology professionals need education to prepare themselves to provide this care. Survivorship care requires a varied approach depending on the survivor population, treatment regimens and care settings. The goal of this program was to encourage institutional changes that would integrate survivorship care into participating centers. An NCI-funded educational program: Survivorship Education for Quality Cancer Care provided multidiscipline two-person teams an opportunity to gain this important knowledge using a goal-directed, team approach. Educational programs were funded for yearly courses from 2006 to 2009. Survivorship care curriculum was developed using the Quality of Life Model as the core around the IOM recommendations. Baseline data was collected for all participants. Teams were followed-up at 6, 12 and 18 months postcourse for goal achievement and institutional evaluations. Comparison data from baseline to 18 months provided information on the 204 multidiscipline teams that participated over 4 years. Teams attended including administrators, social workers, nurse practitioners, registered nurses, physicians and others. Participating centers included primarily community cancer centers and academic centers followed by pediatric centers, ambulatory/physician offices and free standing cancer centers. Statistically significant changes at p=<0.05 levels were seen by 12 months postcourse related to the effectiveness, receptiveness and comfort of survivorship care in participant settings. Institutional assessments found improvement in seven domains of care that related to
Urra, Félix A; Weiss-López, Boris; Araya-Maturana, Ramiro
Recent evidence highlights that energy requirements of cancer cells vary greatly from normal cells and they exhibit different metabolic phenotypes with variable participation of both glycolysis and oxidative phosphorylation (OXPHOS). Interestingly, mitochondrial electron transport chain (ETC) has been identified as an essential component in bioenergetics, biosynthesis and redox control during proliferation and metastasis of cancer cells. This dependence converts ETC of cancer cells in a promising target to design small molecules with anti-cancer actions. Several small molecules have been described as ETC inhibitors with different consequences on mitochondrial bioenergetics, viability and proliferation of cancer cells, when the substrate availability is controlled to favor either the glycolytic or OXPHOS pathway. These ETC inhibitors can be grouped as 1) inhibitors of a respiratory complex (e.g. rotenoids, vanilloids, alkaloids, biguanides and polyphenols), 2) inhibitors of several respiratory complexes (e.g. capsaicin, ME-344 and epigallocatechin-3 gallate) and 3) inhibitors of ETC activity (e.g. elesclomol and VLX600). Although pharmacological ETC inhibition may produce cell death and a decrease of proliferation of cancer cells, factors such as degree of inhibition of ETC activity by small molecules, bioenergetic profile and metabolic flexibility of different cancer types or subpopulations of cells in a particular cancer type, can affect the impact of the anti-cancer actions. Particularly interesting are the adaptive mechanisms induced by ETC inhibition, such as induction of glutamine-dependent reductive carboxylation, which may offer a strategy to sensitize cancer cells to inhibitors of glutamine metabolism.
Unlike in other nations, in Canada palliative care has its origins in university hospitals. It has subsequently developed in a few Canadian schools as an academic discipline closely linked with oncology programs. Although this model is successful, other faculties of medicine and cancer centres have been slow to emulate it. Today, the situation is rapidly changing, and both palliative care and oncology professionals are re-examining the manifest need for collaborative efforts in patient care, research and education. Palliative care must be regarded as an essential component of cancer care, its principles must be applied throughout the course of the illness and, as in other phases of cancer control, palliative care should be regarded as an exercise in prevention--prevention of suffering. This article discusses practical applications that flow from acceptance of these concepts. PMID:9676548
Altman, Brian A; Gulley, Kelly H; Rossi, Carlo; Strauss-Riggs, Kandra; Schor, Kenneth
The National Center for Disaster Medicine and Public Health (NCDMPH), in collaboration with over 20 subject matter experts, created a competency-based curriculum titled Caring for Older Adults in Disasters: A Curriculum for Health Professionals. Educators and trainers of health professionals are the target audience for this curriculum. The curriculum was designed to provide breadth of content yet flexibility for trainers to tailor lessons, or select particular lessons, for the needs of their learners and organizations. The curriculum covers conditions present in the older adult population that may affect their disaster preparedness, response, and recovery; issues related to specific types of disasters; considerations for the care of older adults throughout the disaster cycle; topics related to specific settings in which older adults receive care; and ethical and legal considerations. An excerpt of the final capstone lesson is included. These capstone activities can be used in conjunction with the curriculum or as part of stand-alone preparedness training. This article describes the development process, elements of each lesson, the content covered, and options for use of the curriculum in education and training for health professionals. The curriculum is freely available online at the NCDMPH website at http://ncdmph.usuhs.edu (Disaster Med Public Health Preparedness. 2016;10:633-637).
Frenkel, Moshe; Abrams, Donald I; Ladas, Elena J; Deng, Gary; Hardy, Mary; Capodice, Jillian L; Winegardner, Mary F; Gubili, J K; Yeung, K Simon; Kussmann, Heidi; Block, Keith I
Many studies confirm that a majority of patients undergoing cancer therapy use self-selected forms of complementary therapies, mainly dietary supplements. Unfortunately, patients often do not report their use of supplements to their providers. The failure of physicians to communicate effectively with patients on this use may result in a loss of trust within the therapeutic relationship and in the selection by patients of harmful, useless, or ineffective and costly nonconventional therapies when effective integrative interventions may exist. Poor communication may also lead to diminishment of patient autonomy and self-efficacy and thereby interfere with the healing response. To be open to the patient's perspective, and sensitive to his or her need for autonomy and empowerment, physicians may need a shift in their own perspectives. Perhaps the optimal approach is to discuss both the facts and the uncertainty with the patient, in order to reach a mutually informed decision. Today's informed patients truly value physicians who appreciate them as equal participants in making their own health care choices. To reach a mutually informed decision about the use of these supplements, the Clinical Practice Committee of The Society of Integrative Oncology undertook the challenge of providing basic information to physicians who wish to discuss these issues with their patients. A list of leading supplements that have the best suggestions of benefit was constructed by leading researchers and clinicians who have experience in using these supplements. This list includes curcumin, glutamine, vitamin D, Maitake mushrooms, fish oil, green tea, milk thistle, Astragalus, melatonin, and probiotics. The list includes basic information on each supplement, such as evidence on effectiveness and clinical trials, adverse effects, and interactions with medications. The information was constructed to provide an up-to-date base of knowledge, so that physicians and other health care providers would
van Uden-Kraan, Cornelia F; Peek, Niels; Cuijpers, Pim; Leemans, C René; Verdonck-de Leeuw, Irma M
Background Although many cancer survivors could benefit from supportive care, they often do not utilize such services. Previous studies have shown that patient-reported outcomes (PROs) could be a solution to meet cancer survivors’ needs, for example through an eHealth application that monitors quality of life and provides personalized advice and supportive care options. In order to develop an effective application that can successfully be implemented in current health care, it is important to include health care professionals in the development process. Objective The aim of this study was to investigate health care professionals’ perspectives toward follow-up care and an eHealth application, OncoKompas, in follow-up cancer care that monitors quality of life via PROs, followed by automatically generated tailored feedback and personalized advice on supportive care. Methods Health care professionals involved in head and neck cancer care (N=11) were interviewed on current follow-up care and the anticipated value of the proposed eHealth application (Step 1). A prototype of the eHealth application, OncoKompas, was developed (Step 2). Cognitive walkthroughs were conducted among health care professionals (N=21) to investigate perceived usability (Step 3). Interviews were recorded, transcribed verbatim, and analyzed by 2 coders. Results Health care professionals indicated several barriers in current follow-up care including difficulties in detecting symptoms, patients’ perceived need for supportive care, and a lack of time to encourage survivors to obtain supportive care. Health care professionals expected the eHealth application to be of added value. The cognitive walkthroughs demonstrated that health care professionals emphasized the importance of tailoring care. They considered the navigation structure of OncoKompas to be complex. Health care professionals differed in their opinion toward the best strategy to implement the application in clinical practice but
MacLaughlin, Kathy L.; Long, Margaret E.; Pruthi, Sandhya; Casey, Petra M.
Abstract Background: Care of the gynecologic cancer survivor extends beyond cancer treatment to encompass promotion of sexual, cardiovascular, bone, and brain health; management of fertility, contraception, and vasomotor symptoms; and genetic counseling. Methods: This is a narrative review of the data and guidelines regarding care and surveillance of the gynecologic cancer survivor. We searched databases including PubMed, Cochrane, and Scopus using the search terms gynecologic cancer, cancer surveillance, and cancer survivor and reached a consensus for articles chosen for inclusion in the review based on availability in the English language and publication since 2001, as well as key older articles, consensus statements, and practice guidelines from professional societies. However, we did not undertake an extensive systematic search of the literature to identify all potentially relevant studies, nor did we utilize statistical methods to summarize data. We offer clinical recommendations for the management of gynecologic cancer survivors based on review of evidence and our collective clinical experience. Results: Key messages include the limitations of laboratory studies, including CA-125, and imaging in the setting of gynecologic cancer surveillance, hormonal and non-hormonal management of treatment-related vasomotor symptoms and genitourinary syndrome of menopause, as well as recommendations for general health screening, fertility preservation, and contraception. Conclusions: A holistic approach to care extending beyond cancer treatment alone benefits gynecologic cancer survivors. In addition to surveillance for cancer recurrence and late treatment side effects, survivors benefit from guidance on hormonal, contraceptive, and fertility management and promotion of cardiovascular, bone, brain, and sexual health. PMID:26208166
Aksoy, Yakup; Kaydu, Ayhan; Sahin, Omer Fatih; Kacar, Cem Kivilcim
OBJECTIVE: The present study is an analysis of cancer patients who received follow-up treatment for either cancer-related complications or treatment-associated side effects while hospitalized in the intensive care unit (ICU). METHODS: Records of cancer patients treated at Dr. Lütfi Kırdar Kartal Training and Research Hospital ICU between January 1, 2011 and December 31, 2012 were retrospectively reviewed. Demographic data and type of cancer were recorded in prepared forms and subsequently analyzed. RESULTS: Among 2240 ICU patients treated and hospitalized between January 1, 2011 and December 31, 2012, 482 cancer patients were identified and included in the study. Percentage of cancer patients in ICU was 23.9%. Male to female ratio was determined to be 1.55. First 3 most common cancers found were colorectal (19.7%), lung (15.7%), and stomach cancers (11.6%). Mortality rate of cancer patients hospitalized in ICU was 46.6%. Larynx, lung, urinary bladder, skin, rectosigmoid, hematological, and kidney cancer were more prevalent in male patients, whereas esophageal cancer was seen in more female patients than male patients. Incidence of stomach, brain, and pancreatic cancers, as well as unclassified tumors, was found to be unrelated to gender. CONCLUSION: Rectosigmoid cancer was most common type of cancer observed in our ICU. Esophageal cancer was observed in more females than males, while larynx cancer was more frequently present in males. PMID:28275754
Fennell, Mary L; Das, Irene Prabhu; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew
Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care.
Klabunde, C N; Haggstrom, D; Kahn, K L; Gray, S W; Kim, B; Liu, B; Eisenstein, J; Keating, N L
Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment.
Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan
At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients.
Cowens-Alvarado, Rebecca; Sharpe, Katherine; Pratt-Chapman, Mandi; Willis, Anne; Gansler, Ted; Ganz, Patricia A; Edge, Stephen B; McCabe, Mary S; Stein, Kevin
The National Cancer Survivorship Resource Center (The Survivorship Center) began in 2010 as a collaboration between the American Cancer Society and the George Washington University Cancer Institute and was funded by the Centers for Disease Control and Prevention. The Survivorship Center aims to improve the overall health and quality of life of posttreatment cancer survivors. One key to addressing the needs of this ever-growing population is to develop clinical follow-up care guidelines that emphasize not only the importance of surveillance for cancer recurrence, but also address the assessment and management of the physical and psychosocial long-term and late effects that may result from having cancer and undergoing cancer treatment as well as highlight the importance of healthy behaviors that can reduce the risk of cancer recurrence, second primary cancers, and other chronic diseases. Currently, The Survivorship Center is coordinating the work of experts in oncology, primary care, and other health care professions to develop follow-up care guidelines for 10 priority cancer sites.
Cucciniello, Maria; Guerrazzi, Claudia
Background Health care systems are gradually moving toward new models of care based on integrated care processes shared by different care givers and on an empowered role of the patient. Mobile technologies are assuming an emerging role in this scenario. This is particularly true in care processes where the patient has a particularly enhanced role, as is the case of cancer supportive care. Objective This paper aims to review existing studies on the actual role and use of mobile technology during the different stages of care processes, with particular reference to cancer supportive care. Methods We carried out a review of literature with the aim of identifying studies related to the use of mHealth in cancer care and cancer supportive care. The final sample size consists of 106 records. Results There is scant literature concerning the use of mHealth in cancer supportive care. Looking more generally at cancer care, we found that mHealth is mainly used for self-management activities carried out by patients. The main tools used are mobile devices like mobile phones and tablets, but remote monitoring devices also play an important role. Text messaging technologies (short message service, SMS) have a minor role, with the exception of middle income countries where text messaging plays a major role. Telehealth technologies are still rarely used in cancer care processes. If we look at the different stages of health care processes, we can see that mHealth is mainly used during the treatment of patients, especially for self-management activities. It is also used for prevention and diagnosis, although to a lesser extent, whereas it appears rarely used for decision-making and follow-up activities. Conclusions Since mHealth seems to be employed only for limited uses and during limited phases of the care process, it is unlikely that it can really contribute to the creation of new care models. This under-utilization may depend on many issues, including the need for it to be embedded
McRae, Michael. P.; Simmons, Glennon. W.; Wong, Jorge; Shadfan, Basil; Gopalkrishnan, Sanjiv; Christodoulides, Nicolaos
The development of integrated instrumentation for universal bioassay systems serves as a key goal for the lab-on-a-chip community. The programmable bio-nano-chip (p-BNC) system is a versatile multiplexed and multiclass chemical- and bio-sensing system for bioscience and clinical measurements. The system is comprised of two main components, a disposable cartridge and a portable analyzer. The customizable single-use plastic cartridges, which now can be manufactured in high volumes using injection molding, are designed for analytical performance, ease of use, reproducibility, and low cost. These labcard devices implement high surface area nano-structured biomarker capture elements that enable high performance signaling and are index matched to real-world biological specimens. This detection modality, along with the convenience of on-chip fluid storage in blisters and self-contained waste, represents a standard process to digitize biological signatures at the point-of-care. A companion portable analyzer prototype has been developed to integrate fluid motivation, optical detection, and automated data analysis, and it serves as the human interface for complete assay automation. In this report, we provide a systems-level perspective of the p-BNC universal biosensing platform with an emphasis on flow control, device integration, and automation. To demonstrate the flexibility of the p-BNC, we distinguish diseased and non-case patients across three significant disease applications: prostate cancer, ovarian cancer, and acute myocardial infarction. Progress towards developing a rapid 7 minute myoglobin assay is presented using the fully automated p-BNC system. PMID:26308851
McRae, Michael P; Simmons, Glennon W; Wong, Jorge; Shadfan, Basil; Gopalkrishnan, Sanjiv; Christodoulides, Nicolaos; McDevitt, John T
The development of integrated instrumentation for universal bioassay systems serves as a key goal for the lab-on-a-chip community. The programmable bio-nano-chip (p-BNC) system is a versatile multiplexed and multiclass chemical- and bio-sensing system for bioscience and clinical measurements. The system is comprised of two main components, a disposable cartridge and a portable analyzer. The customizable single-use plastic cartridges, which now can be manufactured in high volumes using injection molding, are designed for analytical performance, ease of use, reproducibility, and low cost. These labcard devices implement high surface area nano-structured biomarker capture elements that enable high performance signaling and are index-matched to real-world biological specimens. This detection modality, along with the convenience of on-chip fluid storage in blisters and self-contained waste, represents a standard process to digitize biological signatures at the point-of-care. A companion portable analyzer prototype has been developed to integrate fluid motivation, optical detection, and automated data analysis, and it serves as the human interface for complete assay automation. In this report, we provide a systems-level perspective of the p-BNC universal biosensing platform with an emphasis on flow control, device integration, and automation. To demonstrate the flexibility of the p-BNC, we distinguish diseased and non-case patients across three significant disease applications: prostate cancer, ovarian cancer, and acute myocardial infarction. Progress towards developing a rapid 7 minute myoglobin assay is presented using the fully automated p-BNC system.
Brawley, Otis W
The U.S. health care system is in critical condition. Costs are rising to the point that the high price of health care is a threat to the U.S. economy. In 2010, health care was more than 17% of the gross domestic product, and if it continues to rise at current rates, health care will become more than 25% of the overall U.S. economy. This growth rate is not sustainable. While U.S. per capita costs are the highest of any country worldwide, quality is varied. Indeed, American health care outcomes for cancer and other diseases are inferior to several European countries with far lower per capita costs. The truth is many Americans cannot afford adequate health care, and health care is rationed in the U.S. While many do not get the health care they need, some are actually harmed by overconsumption of unnecessary health care. These Americans are treated outside of established guidelines and get unnecessary procedures and take unnecessary medications. A substantial number of Americans are supportive of health care reform with the goal of getting needed, high-quality health care to those Americans who currently do not get it. The American Cancer Society is committed to using the established scientific methods of epidemiology to define the problems and identify possible solutions. We are committed proponents of the rational, evidence-based use of health care to avoid the wasteful and inefficient rationing of health care.
Burhansstipanov, L.; Gilbert, A.; LaMarca, K.; Krebs, L. U.
The Native American Cancer Survivors' Support Network is an innovative public health program designed to improve survival from cancer and the quality of life after a cancer diagnosis for American Indians, Alaska Natives, and Canadian Aboriginal patients and their loved ones. The Network, initiated in 1999, now has more than 300 survivors enrolled as members. This article briefly describes the process that led to its formation and preliminary findings, primarily for breast cancer survivors, of ongoing qualitative and quantitative research. Network data show patterns of cancer care that are partially responsible for poor survivorship outcomes. PMID:12042607
Hussain, Tanvir; Chang, Hsien-Yen; Veenstra, Christine M.; Pollack, Craig Evan
Background Patients with cancer frequently transition between different types of specialists and across care settings. We explored how frequently the medical and surgical oncologic care of stage III colon cancer patients occurs across more than one hospital and whether this is associated with mortality and costs. Methods This is a retrospective SEER-Medicare cohort study of 9,075 stage III colon cancer patients diagnosed between 2000 and 2009 receiving both surgical and medical oncologic care within one year of diagnosis. Patients were assigned to the hospital where they had their cancer surgery and to their oncologist's primary hospital, and then characterized according to whether these hospitals were same or different. Outcomes included all-cause mortality, subhazards for colon cancer specific mortality, and cost of care at 12 months. Results 37% of patients received their surgical and medical oncologic care from different hospitals. Rural patients were less likely than urban patients to receive medical oncologic care from the same hospital (OR 0.62, 95%CI 0.43-0.90). Care from the same hospital was not associated with reduced all-cause or colon cancer specific mortality but resulted in lower costs at 12 months (dollars saved $5493, 95%CI $1799, $9525), 8% of median cost. Conclusions Delivery of surgical and medical oncology care at the same hospital was associated with lower costs; however, reforms which seek to improve outcomes and cost through integrating complex care will need to address the significant proportion of patients receiving care across more than one hospital. PMID:26043368
Gralow, Julie R; Biermann, J Sybil; Farooki, Azeez; Fornier, Monica N; Gagel, Robert F; Kumar, Rashmi; Litsas, Georgia; McKay, Rana; Podoloff, Donald A; Srinivas, Sandy; Van Poznak, Catherine H
Bone health and maintenance of bone integrity are important components of comprehensive cancer care. Many patients with cancer are at risk for therapy-induced bone loss, with resultant osteoporotic fractures, or skeletal metastases, which may result in pathologic fractures, hypercalcemia, bone pain, and decline in motility and performance status. Effective screening and timely interventions are essential for reducing bone-related morbidity. Management of long-term bone health requires a broad knowledge base. A multidisciplinary health care team may be needed for optimal assessment and treatment of bone-related issues in patients with cancer. Since publication of the previous NCCN Task Force Report: Bone Health in Cancer Care in 2009, new data have emerged on bone health and treatment, prompting NCCN to convene this multidisciplinary task force to discuss the progress made in optimizing bone health in patients with cancer. In December 2012, the panel members provided didactic presentations on various topics, integrating expert judgment with a review of the key literature. This report summarizes issues surrounding bone health in cancer care presented and discussed during this NCCN Bone Health in Cancer Care Task Force meeting.
Pramesh, C S; Badwe, Rajendra A; Borthakur, Bibhuti B; Chandra, Madhu; Raj, Elluswami Hemanth; Kannan, T; Kalwar, Ashok; Kapoor, Sanjay; Malhotra, Hemant; Nayak, Sukdev; Rath, Goura K; Sagar, T G; Sebastian, Paul; Sarin, Rajiv; Shanta, V; Sharma, Suresh C; Shukla, Shilin; Vijayakumar, Manavalan; Vijaykumar, D K; Aggarwal, Ajay; Purushotham, Arnie; Sullivan, Richard
The delivery of affordable and equitable cancer care is one of India's greatest public health challenges. Public expenditure on cancer in India remains below US$10 per person (compared with more than US$100 per person in high-income countries), and overall public expenditure on health care is still only slightly above 1% of gross domestic product. Out-of-pocket payments, which account for more than three-quarters of cancer expenditures in India, are one of the greatest threats to patients and families, and a cancer diagnosis is increasingly responsible for catastrophic expenditures that negatively affect not only the patient but also the welfare and education of several generations of their family. We explore the complex nature of cancer care systems across India, from state to government levels, and address the crucial issues of infrastructure, manpower shortages, and the pressing need to develop cross-state solutions to prevention and early detection of cancer, in addition to governance of the largely unregulated private sector and the cost of new technologies and drugs. We discuss the role of public insurance schemes, the need to develop new political mandates and authority to set priorities, the necessity to greatly improve the quality of care, and the drive to understand and deliver cost-effective cancer care programmes.
Provost, Sylvie; Pineault, Raynald; Tousignant, Pierre; Roberge, Danièle; Tremblay, Dominique; Breton, Mylaine; Benhadj, Lynda; Diop, Mamadou; Fournier, Michel; Brousselle, Astrid
Objective. To analyze the impact of patients' experience of care at their usual source of primary care on their choice of point of entry into cancer investigation process, time to diagnosis, and presence of metastatic cancer at time of diagnosis. Method. A questionnaire was administered to 438 patients with cancer (breast, lung, and colorectal) between 2011 and 2013 in four oncology clinics of Quebec (Canada). Multiple regression analyses (logistic and Cox models) were conducted. Results. Among patients with symptoms leading to investigation of cancer (n = 307), 47% used their usual source of primary care as the point of entry for investigation. Greater comprehensiveness of care was associated with the decision to use this source as point of entry (OR = 1.25; CI 90% = 1.06–1.46), as well as with shorter times between first symptoms and investigation (HR = 1.11; p = 0.05), while greater accessibility was associated with shorter times between investigation and diagnosis (HR = 1.13; p < 0.01). Conclusion. Experience of care at the usual source of primary care has a slight influence on the choice of point of entry for cancer investigation and on time to diagnosis. This influence appears to be more related to patients' perceptions of the accessibility and comprehensiveness of their usual source of primary care. PMID:26504599
Saunders, Christobel M
Globally, an increasing and aging population is contributing to the prevalence of cancer. To be effective, cancer care needs to involve the coordination of multidisciplinary specialties, and also needs to be affordable, accessible, and capable of producing optimal patient outcomes. Porter and Teisberg (2006) have postulated that shifting current healthcare strategies from volume-based to patient-centric care redirects economic competition to providing treatments which promote the best patient outcomes while driving down costs. Therefore, the value in value-based healthcare (VBH) is defined as patient outcome per currency spent on providing care. Based on the experiences of healthcare organizations currently transitioning to the value-based system, this review details actionable guidelines to transition current cancer care practices to the value-based system in four main steps: by defining universal clinical and patient-reported measures, creating cancer-specific units that provide the full care cycle, establishing a data capture model to routinely determine the value of the care delivered, and continually improving treatment strategies through research. As healthcare providers in more developed countries move to value-based care, those located in less developed countries should also be assisted in their transition to relieve the cancer burden globally. PMID:28357171
Muñoz-Antonia, Teresita; Ung, Danielle; Montiel-Ishino, F Alejandro; Nelson, Alison; Canales, Jorge; Quinn, Gwendolyn P
Few studies have reported on African American and Hispanic (AA and H) populations' informational needs when seeking cancer care at an institution that offers clinical trials. Moffitt Cancer Center (MCC) sought to identify and examine the decision making process, the perceptions, and the preferred channels of communication about cancer care services for AA and H communities in order to develop a list of marketing recommendations. Five focus groups (N = 45) consisting of two AA and three H were conducted in four counties of the MCC catchment area in Tampa, FL. Participants were asked about their perceptions, knowledge, attitudes, and beliefs about cancer care and MCC. Focus groups were audio-recorded and verbatim transcripts were analyzed using content analysis. Similarities in responses were found between AA and H participants. Participants received general health and cancer information from media sources and word of mouth and preferred to hear patient testimonials. There were concerns about costs, insurance coverage, and the actual geographic location of the cancer center. In general, H participants were not opposed to participating in cancer clinical trials/research, whereas, AA participants were more hesitant. A majority of participants highly favored an institution that offered standard care and clinical trials. AA and H participants shared similar concerns and preferences in communication channels, but each group had specific informational needs. The perceptions and preferences of AA and H must be explored in order to successfully and efficiently increase cancer clinical trial participation.
Supportive and palliative care research includes studies to prevent or treat the acute and chronic symptoms and morbidities related to cancer and its treatment, and to examine the effects of cancer and its treatment on quality of life and psychosocial issues and treatment strategies at the end of life. Active Projects can range from caregiver issues to geriatrics, physical functioning to cognitive dysfunction. | Examining symptoms and morbidities related to cancer, its treatment, quality of life and end of life.
Lagman, Ruth; Walsh, Declan
Because of the advent of disease-modifying agents for patients with malignancies, cancer is now a chronic illness. However, most cancer patients will experience significant symptoms and complications during the course of their illness or its treatment. In addition to their physical symptoms, patient and families are burdened with psychological, social, and spiritual difficulties. Palliative medicine addresses all these issues and complements attempts to cure the disease; it is an essential part of modern comprehensive cancer care.
Reville, Barbara; Foxwell, Anessa M
All persons have a right to palliative care during cancer treatment and at the end-of-life. The World Health Organization (WHO) defines palliative care as a medical specialty that addresses physical, psychological, social, legal, and spiritual domains of care by an interdisciplinary team of professional and lay health care providers. Widespread adoption of this universal definition will aid policy development and educational initiatives on a national level. The need for palliative care is expanding due to the aging of the world's population and the increase in the rate of cancer in both developed and developing countries. However, in one third of the world there is no access to palliative care for persons with serious or terminal illness. Palliative care improves symptoms, most frequently pain, and improves quality of life for patients and their families, especially in the terminal disease phase. Accessibility to palliative care services, adequately trained health care professionals, availability of essential medicines, and gaps in education vary greatly throughout the world. Pain management is an integral concept in the practice of palliative care; however, opioiphobia, insufficient supply of opioids, and regulatory restrictions contribute to undue suffering for millions. Ongoing advocacy efforts call for increased awareness, palliative care integration with cancer care, and public and professional education. Enacting necessary change will require the engagement of health ministries and the recognition of the unique needs and resources of each country. The aim of this review is to examine progress in palliative care development and explore some of the barriers influencing cancer care across the globe.
Rassouli, Maryam; Sajjadi, Moosa
Cancer is the third leading cause of death in Iran and its incidence has been increasing in recent years. Patients' quality of life is altered rather enormously due to cancer, which doubles the importance of and the need for providing palliative care in Iran. Although many steps have been taken toward the development and providing of palliative care in Iran, there is still a large gap between the status quo and the desirable state. This study presents the current state of palliative care for cancer patients and discusses the barriers, challenges and outlook of palliative care in Iran. If infrastructural projects that have recently been launched prove successful, proper advancement toward the providing of palliative care services in Iran will then not far on the horizon.
Aizer, Ayal A; Paly, Jonathan J; Efstathiou, Jason A
The management of prostate cancer is complicated by the multitude of treatment options, the lack of proven superiority of one modality of management, and the presence of physician bias. Care at a multidisciplinary prostate cancer clinic offers patients the relative convenience of consultation with physicians of multiple specialties within the confines of a single visit and appears to serve as a venue in which patients can be counseled regarding the risks and benefits of available therapies in an open and interactive environment. Physician bias may be minimized in such an environment, and patient satisfaction rates are high. Available data suggest that low-risk patients who are seen at a multidisciplinary prostate cancer clinic appear to select active surveillance in greater proportion. However, relatively few studies have investigated the other added value that multidisciplinary clinics provide to the patient or health care system, and therefore, additional studies assessing the impact of multidisciplinary care in the management of patients with prostate cancer are needed.
Selby, Peter; Lawler, Mark; Baird, Richard; Banks, Ian; Johnston, Patrick; Nurse, Paul
Following the UK “Brexit” vote in June 2016, there are many uncertainties and risks for cancer research and cancer care in the UK. These are summarised and the importance of sustained engagement and influence from the cancer community on UK governments is emphasised. PMID:28275394
Selby, Peter; Lawler, Mark; Baird, Richard; Banks, Ian; Johnston, Patrick; Nurse, Paul
Following the UK "Brexit" vote in June 2016, there are many uncertainties and risks for cancer research and cancer care in the UK. These are summarised and the importance of sustained engagement and influence from the cancer community on UK governments is emphasised.
Luctkar-Flude, Marian; Aiken, Alice; McColl, Mary Ann; Tranmer, Joan; Langley, Hugh
Abstract Objective To describe the implementation of key best practice guideline recommendations for posttreatment breast cancer survivorship care by primary care providers (PCPs). Design Descriptive cross-sectional survey. Setting Southeastern Ontario. Participants Eighty-two PCPs: 62 family physicians (FPs) and 20 primary health care nurse practitioners (PHCNPs). Main outcome measures Twenty-one “need-to-know” breast cancer survivorship care guideline recommendations rated by participants as “implemented routinely,” “aware of guideline recommendation but not implemented routinely,” or “not aware of guideline recommendation.” Results Overall, FPs and PHCNPs in our sample reported similar practice patterns in terms of implementation of breast cancer survivorship guideline recommendations. The PCPs reported routinely implementing approximately half (46.4%, 9.7 of 21) of the key guideline recommendations with breast cancer survivors in their practices. Implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care, such as mammography and weight management. Knowledge and practice gaps were highest for recommendations related to screening for and management of long-term effects such as fatigue and distress. There were only a few minor differences reported between FPs and PHCNPs. Conclusion There are knowledge and practice gaps related to implementation of the key guideline recommendations for breast cancer survivorship care in the primary care setting that could be targeted for improvement through educational or other interventions. PMID:26889509
Wilson, Kate; Lydon, Anne; Amir, Ziv
Abstract Background Over recent years, several initiatives have impacted on the referral of patients to secondary care, most notably targets for urgent referral in suspected cancer and the patient choice agenda. At the same time, improved long‐term survival in cancer has increased numbers attending follow‐up, doubts about the effectiveness of specialist follow‐up have emerged, and alternative models of follow‐up have been tested. Aim The aim of the study was to explore patient and carer perspectives on the flexibility and responsiveness of cancer services. This article focuses on findings relating to referral, subsequent outpatient appointments and cessation of outpatient follow‐up. Methods Issues were explored in a qualitative study using face‐to‐face interviews with a purposive sample of 54 people affected by cancer. Data were analysed concurrently with data collection, using qualitative analysis software. Findings The study gave rise to a number of salient themes. Links were identified between three of these: choice and responsiveness during referral; the flexibility and responsiveness of outpatient appointment systems; and negotiating cessation of follow‐up. It appeared that policy on urgent referrals might be adversely affecting practice relating to appointment systems and the continuance of follow‐up. Discussion and conclusions Hospital‐based cancer follow‐up is being given decreasing priority because of doubts about effectiveness and a target‐driven focus on referral. This is impacting on patients, who may value outpatient follow‐up as a ‘safety net’ but have difficulties in obtaining appointments, and may be discharged without negotiation or adequate support. For these reasons, new forms of flexible/responsive aftercare are urgently needed. PMID:21615642
The Cancer Trends Progress Report, first issued in 2001, summarizes our nation's advances against cancer in relation to Healthy People targets set forth by the Department of Health and Human Services.
Leminen, Arto; Auranen, Annika; Bützow, Ralf; Hietanen, Sakari; Komulainen, Marja; Kuoppala, Tapio; Mäenpää, Johanna; Puistola, Ulla; Vuento, Maarit; Vuorela, Piia; Yliskoski, Merja
Ovarian cancer is the most lethal gynaecological cancer. It appears that seemingly ovarian or primary peritoneal carcinomas, in fact, originate from fimbriae. BRCA1/2 mutation carriers are recommended for the removal of ovaries and fimbriae, to reduce the risk of cancer. Treatment of epithelial ovarian cancer is based on the combination of surgery and chemotherapy. The residual tumour volume at the primary operation is the most important predictive factor of survival. The best response at the primary treatment is observed with combination chemotherapy with taxane and platinum. Adding bevacitzumab to first line chemotherapy may improve survival.
Spinks, Tracy; Albright, Heidi W; Feeley, Thomas W; Walters, Ron; Burke, Thomas W; Aloia, Thomas; Bruera, Eduardo; Buzdar, Aman; Foxhall, Lewis; Hui, David; Summers, Barbara; Rodriguez, Alma; Dubois, Raymond; Shine, Kenneth I
Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US health care system in the late 1990s. The National Cancer Policy Board (NCPB), a 20-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system in which patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. The report outlined 10 recommendations, which, when implemented, would: 1) improve the quality of cancer care, 2) increase the current understanding of quality cancer care, and 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating health care costs, has prompted national efforts to reform the health care system. These efforts by health care providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States.
Ferrell, Betty; Sun, Virginia; Hurria, Arti; Cristea, Mihaela; Raz, Dan J.; Kim, Jae Y.; Reckamp, Karen; Williams, Anna Cathy; Borneman, Tami; Uman, Gwen; Koczywas, Marianna
Context Palliative care, including symptom management and attention to quality of life (QOL) concerns, should be addressed throughout the trajectory of a serious illness such as lung cancer. Objectives This study tested the effectiveness of an interdisciplinary palliative care intervention for patients with stage I–IV non-small cell lung cancer (NSCLC). Methods Patients undergoing treatments for NSCLC were enrolled in a prospective, quasi-experimental study whereby the usual care group was accrued first followed by the intervention group. Patients in the intervention group were presented at interdisciplinary care meetings, and appropriate supportive care referrals were made. They also received four educational sessions. In both groups, QOL, symptoms, and psychological distress were assessed at baseline and 12 weeks using surveys which included the Functional Assessment of Cancer Therapy-Lung and the lung cancer subscale, the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, and the Distress Thermometer. Results A total of 491 patients were included in the primary analysis. Patients who received the intervention had significantly better scores for QOL (109.1 vs. 101.4; P<0.001), symptoms (25.8 vs. 23.9; P<0.001) spiritual well-being (38.1 vs. 36.2; P=0.001), and lower psychological distress (2.2 vs. 3.3; P<0.001) at 12 weeks, after controlling for baseline scores, compared to patients in the usual care group. Patients in the intervention group also had significantly higher numbers of completed advance care directives (44% vs. 9%; P<0.001), and overall supportive care referrals (61% vs. 28%; P<0.001). The benefits were seen primarily in the earlier stage patients versus those with stage IV disease. Conclusion Interdisciplinary palliative care in the ambulatory care setting resulted in significant improvements in QOL, symptoms, and distress for NSCLC patients. PMID:26296261
Wiener, Lori; Weaver, Meaghann Shaw; Bell, Cynthia J; Sansom-Daly, Ursula M
Medical providers are trained to investigate, diagnose, and treat cancer. Their primary goal is to maximize the chances of curing the patient, with less training provided on palliative care concepts and the unique developmental needs inherent in this population. Early, systematic integration of palliative care into standard oncology practice represents a valuable, imperative approach to improving the overall cancer experience for adolescents and young adults (AYAs). The importance of competent, confident, and compassionate providers for AYAs warrants the development of effective educational strategies for teaching AYA palliative care. Just as palliative care should be integrated early in the disease trajectory of AYA patients, palliative care training should be integrated early in professional development of trainees. As the AYA age spectrum represents sequential transitions through developmental stages, trainees experience changes in their learning needs during their progression through sequential phases of training. This article reviews unique epidemiologic, developmental, and psychosocial factors that make the provision of palliative care especially challenging in AYAs. A conceptual framework is provided for AYA palliative care education. Critical instructional strategies including experiential learning, group didactic opportunity, shared learning among care disciplines, bereaved family members as educators, and online learning are reviewed. Educational issues for provider training are addressed from the perspective of the trainer, trainee, and AYA. Goals and objectives for an AYA palliative care cancer rotation are presented. Guidance is also provided on ways to support an AYA's quality of life as end of life nears. PMID:25750863
McGrath, Jayne; LeGare, Anne; Hermanson, Leigh; Repplinger, Michael D.
Introduction Crowding in emergency departments is a multifaceted problem. We hypothesized that implementing an on-call “Flexible Care Area” (FCA), utilizing multiple front-end throughput solutions, would reduce emergency department (ED) length of stay (LOS). Methods This retrospective study evaluates the impact of an FCA on ED throughput at one hospital over a two-year period (2011–2012). The average arrival-to-room time, arrival-to-physician time, LOS, number of inpatient admissions, and number of discharges during FCA hours were collected, comparing days with and without FCA functionality. Results The FCA was open 165 days in 2011 and 252 days in 2012. The mean daily ED census as well as number of ED visits and inpatient admissions during FCA hours were higher on days with FCA functionality than without. Total ED LOS was shorter for Emergency Severity Index (ESI) 3 patients on days with FCA than days without it in 2011, but this finding was not repeated in 2012. ESI 4 patients had shorter LOS on FCA days in both years. The arrival-to-room and arrival-to-physician times showed variable improvement for ESI 3 and 4 patients over the study period. There was no statistically significant difference for these measures when evaluating ESI levels 2 and 5. Discussion Implementing upfront throughput solutions through use of the FCA correlated with reduced ED LOS for all ESI 3–4 patients, not just those who were seen in FCA. PMID:26296717
Mátrai, Zoltán; Tóth, László; Sávolt, Akos; Péley, Gábor; Tínusz, Anikó; Palla, Eva; Bartal, Alexandra; Horti, Ildikó; Kásler, Miklós
The uniform European structure and professional standards for high quality breast cancer care were established in conjunction with the European Organisation for Research and Treatment, the European Society of Mastology and the European Breast Cancer Coalition with the support of the European Parliament. Well-prepared professional teams including a new member called the breast care nurse serve as ground for special breast cancer centers with international accreditation that provide modern, evidence based, patient centered multidisciplinary oncological care. The responsibilities of the new qualified professional staff member include the psycho-social support of the patient and carers from the moment of diagnosis throughout the whole oncological treatment, the fostering of delivering information and communication between patients and specialists. As a result of the curriculum founded by the European Oncology Nursing Society, breast care nurses have become key members of the practice of holistic breast cancer care in countries where the European recommendations have already been implemented. Considering the expected rearrangement of national oncological care, the new sub-specialty is outlined for the first time in the light of the experiences gained at the National Institute of Oncology, Budapest, a comprehensive cancer center.
Zweigenhaft, Burt; Bosserman, Linda; Kenney, James T.; Lawless, Grant D.; Marsland, Thomas A.; Deligdish, Craig K.; Burgoyne, Douglas S.; Knopf, Kevin B.; Long, Douglas M.; McKercher, Patrick; Owens, Gary M.; Hennessy, John E.; Lang, James R.; Malin, Jennifer; Natelson, Leonard; Palmgren, Matthew C.; Slotnik, Jayson; Shockney, Lillie D.; Vogenberg, F. Randy
The AVBCC Annual Meeting experiences exponential growth in attendance and participation as oncologists, payers, employers, managed care executives, patient advocates, and drug manufacturers convened in Hollywood, FL, on May 2–5, 2013, for the Third Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The conference presented an all-inclusive open forum for stakeholder dialogue and integration across the cancer care continuum, facilitating an open dialogue among the various healthcare stakeholders to align their perspectives around the urgent need to address value in cancer care, costs, patient education, safety, outcomes, and quality. The AVBCC 2013 Steering Committee was held on the first day of the conference to define value in cancer care. The committee was divided into 7 groups, each representing a key stakeholder in oncology. The goal of the Steering Committee was to define value from the particular point of view of each of the stakeholder groups and to suggest how that particular perspective can contribute to the value proposition in oncology, by balancing cost, quality, and access to care to improve overall patient outcomes. The following summary highlights the major points addressed by each group. PMID:24991360
Runowicz, Carolyn D; Leach, Corinne R; Henry, N Lynn; Henry, Karen S; Mackey, Heather T; Cowens-Alvarado, Rebecca L; Cannady, Rachel S; Pratt-Chapman, Mandi L; Edge, Stephen B; Jacobs, Linda A; Hurria, Arti; Marks, Lawrence B; LaMonte, Samuel J; Warner, Ellen; Lyman, Gary H; Ganz, Patricia A
Answer questions and earn CME/CNE The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.
... Cancer Care AGENCY: Agency for Healthcare Research and Quality, HHS. ACTION: Notice of request. SUMMARY... respondents to assess the care delivered by cancer care providers. AHRQ is seeking these items and measures from researchers, survey firms, cancer care providers, patient advocacy groups, individual...
... HUMAN SERVICES Announcement of Requirements and Registration for Cancer Care Video Challenge AGENCY... Cancer Care Video Challenge is an opportunity for members of the public to create short, erin.poetter@hhs... ability manage care. The Cancer Care Video Challenge is an ] opportunity for members of the public...
Chen, Sung-Lang; Wang, Shao-Chuan; Ho, Cheng-Ju; Kao, Yu-Lin; Hsieh, Tzuo-Yi; Chen, Wen-Jung; Chen, Chih-Jung; Wu, Pei-Ru; Ko, Jiunn-Liang; Lee, Huei; Sung, Wen-Wei
The variation in mortality-to-incidence ratios (MIRs) among countries reflects the clinical outcomes and the available interventions for colorectal cancer treatments. The association between MIR of prostate cancer and cancer care disparities among countries is an interesting issue that is rarely investigated. For the present study, cancer incidence and mortality rates were obtained from the GLOBOCAN 2012 database. The rankings and total expenditures on health of various countries were obtained from the World Health Organization (WHO). The association between variables was analyzed by linear regression analyses. In this study, we estimated the role of MIRs from 35 countries that had a prostate cancer incidence greater than 5,000 cases per year. As expected, high prostate cancer incidence and mortality rates were observed in more developed regions, such as Europe and the Americas. However, the MIRs were 2.5 times higher in the less developed regions. Regarding the association between MIR and cancer care disparities, countries with good WHO ranking and high total expenditures on health/gross domestic product (GDP) were significant correlated with low MIR. The MIR variation for prostate cancer correlates with cancer care disparities among countries further support the role of cancer care disparities in clinical outcome. PMID:28051150
Spiritual care started worldwide in the late 1960s with the development of the hospice movement and death studies. Why did spiritual care start duringthis time in history ? In some Christian societies, of that time,"pastoral care" evolved into an interfaith "spiritual care" where in the caretaker was the main agent instead of the caregiver. On the other hand, the importance of palliative care for cancer patients was gradually acknowledged. In addition, this progress was accompanied by the academic development of "death studies" which is called "death and life studies" in Japan. The Japanese hospice care and death studies movement started in the late 1970s. In the precedingperiod, the spiritual quest of cancer patients facingdeath was already gaining public attention. A scholar of religious studies, Hideo Kishimoto of the University of Tokyo, was diagnosed with cancer in 1954; he survived many operations until his death in 1964. Duringthose years, he wrote about his personal experience of acceptinghis approachingdeath. Although he did not believe in any specific faith, he had studied various religious teachings. It is important to understand his perception of his own death. His book, On Facing Death, was published immediately after his death. Therefore, it provided a prominent discourse on copingwith spiritual pain of approachingdeath even before the growth of spiritual care in Japan.
Kumar, Pallavi; Wright, Alexi A; Hatfield, Laura A; Temel, Jennifer S; Keating, Nancy L
Purpose To determine whether hospice use by patients with cancer is associated with their families' perceptions of patients' symptoms, goal attainment, and quality of end-of-life (EOL) care. Methods We interviewed 2,307 families of deceased patients with advanced lung or colorectal cancer who were enrolled in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) and died by 2011. We used propensity-score matching to compare family-reported outcomes for patients who did and did not receive hospice care, including the presence and relief of common symptoms (ie, pain, dyspnea), concordance with patients' wishes for EOL care and place of death, and quality of EOL care. We also examined associations between hospice length of stay and these outcomes among hospice enrollees. Results In a propensity-score-matched sample of 1,970 individuals, families of patients enrolled in hospice reported more pain in their patient compared with those not enrolled in hospice. However, families of patients enrolled in hospice more often reported that patients received "just the right amount" of pain medicine (80% v 73%; adjusted difference, 7 percentage points; 95% confidence interval [CI], 1 to 12 percentage points) and help with dyspnea (78% v 70%; adjusted difference, 8 percentage points; 95% CI, 2 to 13 percentage points). Families of patients enrolled in hospice also more often reported that patients' EOL wishes were followed (80% v 74%; adjusted difference, 6 percentage points; 95% CI, 2 to 11 percentage points) and "excellent" quality EOL care (57% v 42%; adjusted difference, 15 percentage points; 95% CI, 11 to 20). Families of patients who received > 30 days of hospice care reported the highest quality EOL outcomes. Conclusion Hospice care is associated with better symptom relief, patient-goal attainment, and quality of EOL care. Encouraging earlier and increased hospice enrollment may improve EOL experiences for patients with
The present study aimed to examine the relationships among barriers to cancer care, perceived social support, and patient navigation services (PNS) for Korean breast cancer patients. For Korean breast cancer patients, PNS are comprised of five services, including emotional, financial, information, transportation, and disease management. The study findings demonstrated that transportation and disease management barriers were directly associated with PNS, whereas emotional and financial barriers were indirectly associated with PNS through perceived social support. The current study provides a preliminary Korean patient navigation model to identify how barriers to cancer care can be reduced through social support and PNS.
Kim, Jae Young; Kim, Sung-O; Wei Yanzhang; Li Jinhua
This paper describes a flexible microplasma jet device using a Tygon S-54-HL tube as a biocompatible tube and its potential in developing cancer therapies. The optical and physical properties of the plasma jets and preliminary apoptosis data of cultured murine tumor cells and nontumor fibroblast cells treated with these plasma jets are presented. Microplasma jets were observed to induce apoptosis in cultured murine cells in a dose-dependent manner. The murine melanoma tumor cells were more sensitive to plasma treatment than fibroblast cells. These features allow the direct and precise application of this microplasma jet device to tumor cells.
Rabeneck, L; Rumble, RB; Axler, J; Smith, A; Armstrong, D; Vinden, C; Belliveau, P; Rhodes, K; Zwaal, C; Mai, V; Dixon, P
Colorectal cancer (CRC) is the most common cause of non-tobacco-related cancer deaths in Canadian men and women, accounting for 10% of all cancer deaths. An estimated 7800 men and women will be diagnosed with CRC, and 3250 will die from the disease in Ontario in 2007. Given that CRC incidence and mortality rates in Ontario are among the highest in the world, the best opportunity to reduce this burden of disease would be through screening. The present report describes the findings and recommendations of Cancer Care Ontario’s Colonoscopy Standards Expert Panel, which was convened in March 2006 by the Program in Evidence-Based Care. The recommendations will form the basis of the quality assurance program for colonoscopy delivered in support of Ontario’s CRC screening program. PMID:18026582
Smith, Tenbroeck; de Moor, Janet S.; Glasgow, Russell E.; Khoury, Muin J.; Hawkins, Nikki A.; Stein, Kevin D.; Rechis, Ruth; Parry,, Carla; Leach, Corinne R.; Padgett, Lynne; Rowland, Julia H.
To meet the complex needs of a growing number of cancer survivors, it is essential to accelerate the translation of survivorship research into evidence-based interventions and, as appropriate, recommendations for care that may be implemented in a wide variety of settings. Current progress in translating research into care is stymied, with results of many studies un- or underutilized. To better understand this problem and identify strategies to encourage the translation of survivorship research findings into practice, four agencies (American Cancer Society, Centers for Disease Control and Prevention, LIVE STRONG Foundation, National Cancer Institute) hosted a meeting in June, 2012, titled: “Biennial Cancer Survivorship Research Conference: Translating Science to Care.” Meeting participants concluded that accelerating science into care will require a coordinated, collaborative effort by individuals from diverse settings, including researchers and clinicians, survivors and families, public health professionals, and policy makers. This commentary describes an approach stemming from that meeting to facilitate translating research into care by changing the process of conducting research—improving communication, collaboration, evaluation, and feedback through true and ongoing partnerships. We apply the T0-T4 translational process model to survivorship research and provide illustrations of its use. The resultant framework is intended to orient stakeholders to the role of their work in the translational process and facilitate the transdisciplinary collaboration needed to translate basic discoveries into best practices regarding clinical care, self-care/management, and community programs for cancer survivors. Finally, we discuss barriers to implementing translational survivorship science identified at the meeting, along with future directions to accelerate this process. PMID:25249551
Hammarberg, K; Sullivan, E; Javid, N; Duncombe, G; Halliday, L; Boyle, F; Saunders, C; Ives, A; Dickinson, J E; Fisher, J
Gestational breast cancer (GBC) presents many challenges for women and the clinicians who care for them. The aim of this study was to explore the health care experiences of women diagnosed with GBC to inform and improve clinical care of women in this predicament. Semi-structured interviews were conducted with 17 women who had been diagnosed with GBC in the previous 5 years. The overarching themes for perceived quality of care were "communication" and "comprehensive care." "Communication" had two sub themes: "interdisciplinary communication" (the way health professionals from different disciplines communicated with each other about the management of the woman's care) and "patient communication" (how they communicated this to the woman). The "comprehensive care" theme incorporated three sub themes: "the spirit" (psychological care); "the mind" (information provision); and "the body" (management of treatment side effects). Women's own accounts of positive and negative experiences of GBC care provide unique and specific insights which improve understanding of their concerns and needs. The findings can inform advances in quality and efficacy of clinical care; offer guidance for obstetricians, oncologists and allied health professionals about the needs of women diagnosed with GBC and how care can be optimised; and inform the development of resources to assist women and their families.
Ramphal, R.; Aubin, S.; Czaykowski, P.; De Pauw, S.; Johnson, A.; McKillop, S.; Szwajcer, D.; Wilkins, K.; Rogers, P.
Adolescents and young adults (ayas) with cancer in active treatment face a number of barriers to optimal care. In the present article, we focus on the 3 critical domains of care for ayas—medical, psychosocial, and research—and how changes to the system could overcome barriers. We summarize the current literature, outline recommended principles of care, raise awareness of barriers to optimal care, and suggest specific changes to the system to overcome those barriers in the Canadian context. Many of the recommendations can nevertheless be applied universally. These recommendations are endorsed by the Canadian Task Force on Adolescents and Young Adults with Cancer and build on outcomes from two international workshops held by that group. PMID:27330350
Jamwal, Nisha Rani; Kumar, Senthil P
Smartphones are technologically advanced mobile phone devices which use software similar to computer-based devices as a user-friendly interface. This review article is aimed to inform the palliative care professionals, cancer patients and their caregivers about the role of smartphone applications (apps) in the delivery of palliative care services, through a brief review of existing literature on the development, feasibility, analysis, and effectiveness of such apps. There is a dearth need for sincere palliative care clinicians to work together with software professionals to develop the suitable smartphone apps in accordance with the family/caregivers’ necessities and patients’ biopsychosocial characteristics that influence the technology driven evidence informed palliative cancer care. PMID:26962291
Zafar, S Yousuf
Evidence suggests that a considerably large proportion of cancer patients are affected by treatment-related financial harm. As medical debt grows for some with cancer, the downstream effects can be catastrophic, with a recent study suggesting a link between extreme financial distress and worse mortality. At least three factors might explain the relationship between extreme financial distress and greater risk of mortality: 1) overall poorer well-being, 2) impaired health-related quality of life, and 3) sub-par quality of care. While research has described the financial harm associated with cancer treatment, little has been done to effectively intervene on the problem. Long-term solutions must focus on policy changes to reduce unsustainable drug prices and promote innovative insurance models. In the mean time, patients continue to struggle with high out-of-pocket costs. For more immediate solutions, we should look to the oncologist and patient. Oncologists should focus on the value of care delivered, encourage patient engagement on the topic of costs, and be better educated on financial resources available to patients. For their part, patients need improved cost-related health literacy so they are aware of potential costs and resources, and research should focus on how patients define high-value care. With a growing list of financial side effects induced by cancer treatment, the time has come to intervene on the "financial toxicity" of cancer care.
Homan, Sherri G.; Yun, Shumei; Stewart, Bob R.; Armer, Jane M.
Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups’ questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy. PMID:26258794
Homan, Sherri G; Yun, Shumei; Stewart, Bob R; Armer, Jane M
Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups' questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy.
Cheon, Soyeon; Zhang, Xiuyu; Lee, In-Seon; Cho, Seung-Hun; Chae, Younbyoung; Lee, Hyangsook
Background. Pharmacopuncture, injection to acupoints with pharmacological medication or herbal medicine, is a new acupuncture therapy widely available in Korea and China for cancer-related symptoms. However, the evidence is yet to be clear. Objective. To determine pharmacopuncture's effectiveness on cancer-related symptoms. Methods. Eleven databases were searched for randomized controlled trials of pharmacopuncture in cancer patients. The Cochrane risk of bias (ROB) assessment tool was used for quality assessment. Results. Twenty-two studies involving 2,459 patients were included. Five trials of chemotherapy-induced nausea and vomiting (CINV) underwent meta-analysis. Pharmacopuncture significantly relieved severity of CINV compared with control group (3 trials, risk ratio (RR) 1.28, 95% confidence interval (CI) = 1.14-1.44). The frequency of CINV was also significantly reduced with pharmacopuncture (2 trials, RR 2.47, 95% CI = 2.12-2.89). Seventeen trials studied various symptoms, and in most studies, pharmacopuncture significantly relieved pain, ileus, hiccup, fever, and gastrointestinal symptoms and improved quality of life in various cancer patients. ROB was generally high. Conclusion. It may be suggested with caution that pharmacopuncture may help various symptom relief in cancer patients, but it is hard to draw a firm conclusion due to clinical heterogeneity and high ROB of the included studies, hence warranting further investigation.
Sardarinejad, A.; Maurya, D. K.; Tay, C. Y.; Marshall, B. J.; Alameh, K.
Accurate pH monitoring is crucial for many applications, such as, water quality monitoring, blood monitoring, chemical and biological analyses, environmental monitoring and clinical diagnostic. The most common technique for pH measurement is based on the use of conventional glass pH electrodes. Glass electrodes have several limitations, such as mechanical fragility, large size, limited shapes and high cost, making them impractical for implementation as Lab-onchips and pH sensor capsules. Various metal oxides, such as RuO2, IrO2, TiO2, SnO2, Ta2O5 and PdO have recently been proposed for the realization of pH sensing electrodes. Specifically, ruthenium oxide exhibits unique properties including thermal stability, excellent corrosion resistance, low hysteresis high sensitivity, and low resistivity. In this paper, we demonstrate the concept of a miniaturized ion selective electrode (ISE) based pH sensor for point-of-care urease monitoring. The sensor comprises a thin film RuO2 on platinum sensing electrode, deposited using E-beam and R.F. magnetron sputtering, in conjunction with an integrated Ag/AgCl reference electrode. The performance and characterization of the developed pH/urea sensors in terms of sensitivity, resolution, reversibility and hysteresis are investigated. Experimental results show a linear potential-versus-urea-concentration response for urea concentrations in the range 0 - 180 mg/ml. Experimental results demonstrate super-Nernstian slopes in the range of 64.33 mV/pH - 73.83 mV/pH for RF sputtered RuO2 on platinum sensing electrode using a 80%:20% Ar:O2 gas ratio. The RuO2 sensor exhibits stable operation and fast dynamic response, making it attractive for in vivo use, wearable and flexible biomedical sensing applications.
Choi, Y Y; Cheong, J-H
Gastric cancer is one of the leading causes of cancer-related deaths worldwide. Despite the high disease prevalence, gastric cancer research has not gained much attention. Recently, genome-scale technology has made it possible to explore the characteristics of gastric cancer at the molecular level. Accordingly, gastric cancer can be classified into molecular subtypes that convey more detailed information of tumor than histopathological characteristics, and these subtypes are associated with clinical outcomes. Furthermore, this molecular knowledge helps to identify new actionable targets and develop novel therapeutic strategies. To advance the concept of precision patient care in the clinic, patient-derived xenograft (PDX) models have recently been developed. PDX models not only represent histology and genomic features, but also predict responsiveness to investigational drugs in patient tumors. Molecularly curated PDX cohorts will be instrumental in hypothesis generation, biomarker discovery, and drug screening and testing in proof-of-concept preclinical trials for precision therapy. In the era of precision medicine, molecularly tailored therapeutic strategies should be individualized for cancer patients. To improve the overall clinical outcome, a multimodal approach is indispensable for advanced cancer patients. Careful, oncological principle-based surgery, combined with a molecularly guided multidisciplinary approach, will open new horizons in surgical oncology.
Zauber, Ann G.; Levin, Theodore R; Jaffe, C. Carl; Galen, Barbara A.; Ransohoff, David F.; Brown, Martin L.
Colorectal cancer (CRC) screening reduces the risk of CRC mortality but is currently not well utilized, with adherence only 50% in the eligible U.S. population and rates that lag behind those for breast and cervical cancer. The primary care physician has the pivotal role of facilitating patient adherence to CRC screening by informed choice of the screening tests, follow up of positive tests, and coordination of medical resources when diagnostic intervention is required. Consequently, the primary care setting is where significant improvements can be made in CRC screening adherence. This article provides a summary of the newer CRC screening technologies that can be used by primary care physicians in shared decision making with their patients. There are now multiple CRC screening tests which vary in their ability to detect the different stages in the adenoma to carcinoma sequence. Current guidelines of the Multi-Society (Gastroenterology) Task Force (1997, 2003, 2006, 2008), the American Cancer Society (2001, 2003, 2007, 2008), and the United States Preventive Services Task Force (2002) recommend a menu of CRC screening options, including fecal occult blood tests (FOBT) (Hemoccult II, Hemoccult SENSA, fecal immunochemical tests (FIT)), double contrast barium enema (DCBE), flexible sigmoidoscopy with or without annual FOBT’s, and colonoscopy. In this report, we assess the options of fecal immunochemical tests, colonoscopy, CT-colonography (CTC or virtual colonoscopy), and fecal DNA tests. The tests are discussed with respect to the evidence in support of their use and within the context of how they could be managed and implemented in primary care practice. Primary care physicians will want to understand the tradeoffs among accuracy, costs, and patient preferences for the current and emerging CRC tests. PMID:18725826
Butow, Phyllis; Tattersall, Martin
Cancer treatment outcomes have improved over the past 20 years, but treatment decision making in this context remains complex. There are often a number of reasonable treatment alternatives, including no treatment in some circumstances. Patients and doctors often have to weigh up uncertain benefits against uncertain costs. Shared decision making…
Begg C, Glicksman A, et al. 20. Greene MG, Adelman R, Charon R, Hoffman S. Ageism inThe effect of age on the care of women with breast cancer in the...713-8. 11. Greene MG, Adelman R, Charon R, Hoffman S. Ageism in the medical encounter: An exp loratory study of the doctor-elderly patient
Runowicz, Carolyn D; Leach, Corinne R; Henry, N Lynn; Henry, Karen S; Mackey, Heather T; Cowens-Alvarado, Rebecca L; Cannady, Rachel S; Pratt-Chapman, Mandi L; Edge, Stephen B; Jacobs, Linda A; Hurria, Arti; Marks, Lawrence B; LaMonte, Samuel J; Warner, Ellen; Lyman, Gary H; Ganz, Patricia A
The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for
Stokman, M A; Vissink, A; Spijkervet, F K L
Radiation therapy in the head and neck area and treatment with high dose chemotherapy entail damage to healthy tissue in the mouth. In order to reduce to a minimum the chances of these side effects of cancer treatment developing, it is necessary to carry out oral foci tests prior to oncological therapy. In addition supplementary oral and dental care measures seem to be important in order to limit the side effects of oncological therapy on the teeth, salivary glands and jaw as much as possible. This supportive oral care is not only necessary during, but also for years after the oncology treatment. Therefore not only dental professionals affiliated to oncology teams will have to take care of cancer patients, but also family dentists and dental hygienists.
Álvarez-Hernández, C; Brusint, B; Vich, P; Díaz-García, N; Cuadrado-Rouco, C; Hernández-García, M
Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians must thoroughly understand this pathology in order to optimize the health care services and make the best use of available resources, for these patients. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. This fourth article deals with the treatment of the disease, the role of the primary care physician, and management of major complications. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors and helping them to support their patients and care for them throughout their illness.
Brown, E; Gorman, D; Knowles, G; Taylor, F; Jere, Y; Bates, J; Masamba, L
In response to the growing incidence of cancer in Malawi, a new oncology unit was established at the Queen Elizabeth Central Hospital, Blantyre. The unit opened in 2010, the first in the country, and is led by a single consultant oncologist. In 2012, a healthcare partnership was formed between the oncology and palliative care unit at Queen Elizabeth Central Hospital and the Edinburgh Cancer Centre, UK. The principal objective of the partnership is to help develop high quality multidisciplinary cancer care in Malawi. Methods A needs assessment identified three priority areas for further improvement of cancer services: nurse-led treatment delivery; management of clinical data; and multidisciplinary working. The partnership received grant funding from the Scottish Government Malawi Development Programme in 2013 and a three year project plan was implemented. This has been conducted through a series of reciprocal training visits. Results Key achievements have been completion of a programme of oncology nursing education attended by 32 oncology nurses and other healthcare professionals, which has resulted in increased experience in cancer practice and standardisation of chemotherapy delivery procedures; development of a clinical database that enables prospective collection of data of all new patients with cancer and which links to the Malawi Cancer Registry; development of weekly multidisciplinary meetings involving oncology, gynaecology and surgery that has enabled a cross-specialty approach to patient care. Conclusion The Edinburgh Malawi Cancer Partnership is supporting nursing education, data use and cross-specialty collaboration that we are confident will improve cancer care in Malawi. Future work will focus on the further development of multidisciplinary breast cancer care and the development of a radiotherapy service for patients in Malawi.
Abdulrahman, Ganiy Opeyemi
Over the past 15 years, the multidisciplinary team management of many medical conditions especially cancers has increasingly taken a prominent role in patient management in many hospitals and medical centres in the developed countries. In the United Kingdom, it began to gain prominence following the Calman-Heine report in 1995 which suggested that each Cancer Unit in a hospital should have in place arrangements for non-surgical oncological input into services, with a role for a non-surgical oncologist. The report further suggested that a lead clinician with a well established interest in cancer care should be appointed to organise and coordinate the whole range of cancer services provided within the Cancer Unit. Many people have argued that the multidisciplinary team management of patients has resulted in better care and improved survival. However, there are barriers to the optimal effectiveness of the multidisciplinary team. This paper aims to review various studies on the effectiveness of the multidisciplinary team in the management of cancer patients and also discuss some of the barriers to the multidisciplinary team.
Veenstra, Christine M.; Epstein, Andrew J.; Liao, Kaijun; Morris, Arden M.; Pollack, Craig E.; Armstrong, Katrina A.
BACKGROUND The effect of care setting on value of colon cancer care is unknown. METHODS A Surveillance, Epidemiology, and End Results (SEER)-Medicare cohort study of 6544 patients aged ≥66 years with stage IV colon cancer (based on the American Joint Committee on Cancer staging system) who were diagnosed between 1996 and 2005 was performed. All patients were followed through December 31, 2007. Using outpatient and carrier claims, patients were assigned to a treating hospital based on the hospital affiliation of the primary oncologist. Hospitals were classified academic or nonacademic using the SEER-Medicare National Cancer Institute Hospital File. RESULTS Of the 6544 patients, 1605 (25%) received care from providers affiliated with academic medical centers. The unadjusted median cancer-specific survival was 16.0 months at academic medical centers versus 13.9 months at nonacademic medical centers (P<.001). After adjustment, treatment at academic hospitals remained significantly associated with a reduced risk of death from cancer (hazard ratio, 0.87; 95% confidence interval [95% CI], 0.82–0.93 [P<.001]). Adjusted mean 12-month Medicare spending was $8571 higher at academic medical centers (95% CI, $2340–$14,802; P =.007). The adjusted median cost was $1559 higher at academic medical centers; this difference was not found to be statistically significant (95% CI, −$5239 to $2122; P =.41). A small percentage of patients who received very expensive care skewed the difference in mean cost; the only statistically significant difference in adjusted costs in quantile regressions was at the 99.9th percentile of costs (P<.001). CONCLUSIONS Among Medicare beneficiaries with stage IV colon cancer, treatment by a provider affiliated with an academic medical center was associated with a 2 month improvement in overall survival. Except for patients in the 99.9th percentile of the cost distribution, costs at academic medical centers were not found to be significantly
Lokich, J J; Silvers, S; Brereton, H; Byfield, J; Bick, R
Free-standing cancer centers (FSCC) represent a growing trend in cancer care delivery within community practice. The critical components to FSCC are multidisciplinary cancer care, a complete menu of direct care and support services, a commitment to clinical trials and clinical investigation, and a comprehensive program for quality assurance. The advantages of FSCC to the community, to hospital programs, to the practicing surgical, medical, and radiation oncologists, and to the third-party carriers, including health maintenance organizations, are detailed. The development of an FSCC depends on the resolution of issues of (a) competition (between hospitals, hospitals and physicians, therapeutic disciplines, regional comprehensive cancer centers and FSCCs) and (b) concerns about conflict of interest. The ideal model of FSCC may well be represented by the joint venture of community hospital(s) and the community oncologists.
Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Chen, Tzeng-Ji; Tsai, Shu-Lin; Cheng, Shao-Yi; Chiu, Tai-Yuan; Tsai, Shih-Tzu; Hwang, Shinn-Jang
Although there are 3 hospice care programs for terminal cancer patients in Taiwan, the medical utilization and expenses for these patients by programs have not been well-explored. The aim of this study was to examine the medical utilization and expenses of terminal cancer patients under different programs of hospice care in the last 90, 30, and 14 days of life.This was a retrospective observational study by secondary data analysis. By using the National Health Insurance claim database and Hospice Shared Care Databases. We identified cancer descents from these databases and classified them into nonhospice care and hospice care groups based on different combination of hospice care received. We then analyzed medical utilization including inpatient care, outpatient care, emergency room visits, and medical expenses by patient groups in the last 90, 30, and 14 days of life.Among 118,376 cancer descents, 46.9% ever received hospice care. Patients had ever received hospice care had significantly lower average medical utilization and expenses in their last 90, 30, and 14 days of life (all P < 0.001) compared to nonhospice care group. Each hospice care group had significantly less medical utilization and expenses in the last 90, 30, and 14 days of life (all P < 0.01).Different kinds of hospice care program have different effects on medical care utilization reduction and cost-saving at different stage of the end of life of terminal cancer patients.
Araújo, Sarah Nilkece Mesquita; Luz, Maria Helena Barros Araújo; da Silva, Grazielle Roberta Freitas; Andrade, Elaine Maria Leite Rangel; Nunes, Lívio César Cunha; Moura, Renata Oliveira
OBJECTIVE: to analyze nursing care provided to cancer patients with oral mucositis based on the Nursing Process (NP). METHOD: this exploratory, descriptive, cross-sectional and quantitative study was conducted with 213 patients undergoing chemotherapy and/or radiotherapy in two cancer facilities: one philanthropic and one private service. RESULTS: the participants were mainly female, aged 45.8 years old on average, with up to 11 years of schooling and income of up to one times the minimum wage. Severe mucositis was related to chemotherapy associated with radiotherapy. Only 25.3% of the patients reported having received guidance from nurses during their treatment concerning self-care. The perceptions of patients regarding quality of care did not significantly differ between the private and public facilities. The basic human needs mainly affected were comfort, eating, and hygiene. Based on this finding, one NP was established listing the diagnoses, interventions and expected results to establish an ideal, though individualized, standard of nursing care to be provided to these patients. CONCLUSION: to understand oral mucositis is crucial to establish nursing care that includes prevention based on the implementation of an oral care plan. PMID:26039297
Andersson, Therese M-L; Dickman, Paul W; Eloranta, Sandra; Lambe, Mats; Lambert, Paul C
A useful summary measure for survival data is the expectation of life, which is calculated by obtaining the area under a survival curve. The loss in expectation of life due to a certain type of cancer is the difference between the expectation of life in the general population and the expectation of life among the cancer patients. This measure is used little in practice as its estimation generally requires extrapolation of both the expected and observed survival. A parametric distribution can be used for extrapolation of the observed survival, but it is difficult to find a distribution that captures the underlying shape of the survival function after the end of follow-up. In this paper, we base our extrapolation on relative survival, because it is more stable and reliable. Relative survival is defined as the observed survival divided by the expected survival, and the mortality analogue is excess mortality. Approaches have been suggested for extrapolation of relative survival within life-table data, by assuming that the excess mortality has reached zero (statistical cure) or has stabilized to a constant. We propose the use of flexible parametric survival models for relative survival, which enables estimating the loss in expectation of life on individual level data by making these assumptions or by extrapolating the estimated linear trend at the end of follow-up. We have evaluated the extrapolation from this model using data on four types of cancer, and the results agree well with observed data.
Reyna, Chantal; Lee, Marie Catherine
Breast cancer is one of the most prevalent cancers in females, and 5%–7% of breast cancer cases occur in women under 40 years of age. Breast cancer in the young has gained increased attention with an attempt to improve diagnosis and prognosis. Young patients tend to have different epidemiology, presenting with later stages and more aggressive phenotypes. Diagnostic imaging is also more difficult in this age group. Multidisciplinary care generally encompasses surgeons, medical oncologists, radiation oncologists, radiologists, and social workers. Other special considerations include reconstruction options, fertility, genetics, and psychosocial issues. These concerns enlarge the already diverse multidisciplinary team to incorporate new expertise, such as reproductive specialists and genetic counselors. This review encompasses an overview of the current multimodal treatment regimens and the unique challenges in treating this special population. Integration of diagnosis, treatment, and quality of life issues should be addressed and understood by each member in the interdisciplinary team in order to optimize outcomes. PMID:25300196
Díaz García, Noiva; Cuadrado Rouco, Carmen; Vich, Pilar; Alvarez-Hernandez, Cristina; Brusint, Begoña; Redondo Margüello, Esther
Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians ought to know thoroughly this pathology to optimize the health care services for these patients making the best use of available resources. A series of five articles on breast cancer is presented below. It is based on a review of the scientific literature over the last ten years. In this final section, the social, psychological, occupational and family issues related to the disease will be reviewed, as well as presenting some special situations of breast cancer, including breast cancer in men, during pregnancy and last stages of life. This summary report aims to provide a current and practical review about this disease, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness.
Karadeniz, G; Yanikkerem, E; Altiparmak, S; Sevil, U; Ertem, G; Esen, A
The aim of the present study was to identify what hospitalized cancer patients expect from nurses in terms of the care they receive. The specific aims of this study were: (i) to identify those individuals to whom the patients felt closest in the hospital setting and (ii) to evaluate nurses' management of cancer patients during their stay in the hospital. The sample included patients hospitalized at Ege University Hospital and Suat Seren District Hospital, Izmir, Turkey. We found significant differences between the scores of satisfaction and dissatisfaction and gender age, education, occupation, type of cancer and the mode of treatment (p < 0.05). The majority of the cancer patients reported that nursing management was unsatisfactory. Some demographic factors such as cultural and social status affected patients' expectations.
Primary Stage IV Hepatobiliary; Esophageal; Colorectal Cancer; Glioblastoma; Cancer of Stomach; Cancer of Pancreas; Melanoma; Head or Neck Cancer; Stage III; Stage IV; Lung Cancers; Pancreatic Cancers
Chung, Vincent C.H.; Wu, Xinyin; Lu, Ping; Hui, Edwin P.; Zhang, Yan; Zhang, Anthony L.; Lau, Alexander Y.L.; Zhao, Junkai; Fan, Min; Ziea, Eric T.C.; Ng, Bacon F.L.; Wong, Samuel Y.S.; Wu, Justin C.Y.
Abstract Use of Chinese herbal medicines (CHM) in symptom management for cancer palliative care is very common in Chinese populations but clinical evidence on their effectiveness is yet to be synthesized. To conduct a systematic review with meta-analysis to summarize results from CHM randomized controlled trials (RCTs) focusing on symptoms that are undertreated in conventional cancer palliative care. Five international and 3 Chinese databases were searched. RCTs evaluating CHM, either in combination with conventional treatments or used alone, in managing cancer-related symptoms were considered eligible. Effectiveness was quantified by using weighted mean difference (WMD) using random effect model meta-analysis. Fourteen RCTs were included. Compared with conventional intervention alone, meta-analysis showed that combined CHM and conventional treatment significantly reduced pain (3 studies, pooled WMD: −0.90, 95% CI: −1.69 to −0.11). Six trials comparing CHM with conventional medications demonstrated similar effect in reducing constipation. One RCT showed significant positive effect of CHM plus chemotherapy for managing fatigue, but not in the remaining 3 RCTs. The additional use of CHM to chemotherapy does not improve anorexia when compared to chemotherapy alone, but the result was concluded from 2 small trials only. Adverse events were infrequent and mild. CHM may be considered as an add-on to conventional care in the management of pain in cancer patients. CHM could also be considered as an alternative to conventional care for reducing constipation. Evidence on the use of CHM for treating anorexia and fatigue in cancer patients is uncertain, warranting further research. PMID:26886628
Nishino, Takeshi; Takizawa, Hiromitsu; Yoshida, Takahiro; Inui, Tomohiro; Takasugi, Haruka; Matsumoto, Daisuke; Kawakita, Naoya; Inoue, Seiya; Sakiyama, Shoji; Tangoku, Akira; Azuma, Masayuki; Yamamura, Yoshiko
The effectiveness of perioperative oral health care management to decrease the risk of postoperative pneumonia have been reported lately. Since 2014, we introduced perioperative oral health care management for lung cancer and esophageal cancer patients. We report current status and effectiveness of perioperative oral health care management for lung cancer and esophageal cancer patients. Every 100 cases of lung cancer and esophageal cancer patients treated by surgery were classified 2 group with or without perioperative oral health care management and compared about postoperative complications retrospectively. In the lung cancer patients, the group with oral health care management could prevent postoperative pneumonia significantly and had shorter length of hospital stay than the group without oral health care management. In the esophageal cancer patients, there was little occurrence of postoperative pneumonia without significant difference between both group with or without oral health care management. A large number of esophageal cancer patients received neo-adjuvant chemotherapy and some patients developed oral mucositis and received oral care treatment before surgery. Treatment for oral mucositis probably improved oral environment and affected prevention of postoperative pneumonia. Perioperative oral health care management can prevent postoperative pneumonia of lung cancer and esophageal cancer patients by improvement of oral hygiene.
Haase, Rachel; Michie, Marsha; Skinner, Debra
Genomic research has rapidly expanded its scope and ambition over the past decade, promoted by both public and private sectors as having the potential to revolutionize clinical medicine. This promissory bioeconomy of genomic research and technology is generated by, and in turn generates, the hopes and expectations shared by investors, researchers and clinicians, patients, and the general public alike. Examinations of such bioeconomies have often focused on the public discourse, media representations, and capital investments that fuel these "regimes of hope," but also crucial are the more intimate contexts of small-scale medical research, and the private hopes, dreams, and disappointments of those involved. Here we examine one local site of production in a university-based clinical research project that sought to identify novel cancer predisposition genes through whole genome sequencing in individuals at high risk for cancer. In-depth interviews with 24 adults who donated samples to the study revealed an ability to shift flexibly between positioning themselves as research participants on the one hand, and as patients or as family members of patients, on the other. Similarly, interviews with members of the research team highlighted the dual nature of their positions as researchers and as clinicians. For both parties, this dual positioning shaped their investment in the project and valuing of its possible outcomes. In their narratives, all parties shifted between these different relational positions as they managed hopes and expectations for the research project. We suggest that this flexibility facilitated study implementation and participation in the face of potential and probable disappointment on one or more fronts, and acted as a key element in the resilience of this local promissory bioeconomy. We conclude that these multiple dimensions of relationality and positionality are inherent and essential in the creation of any complex economy, "bio" or otherwise.
Haase, Rachel; Michie, Marsha; Skinner, Debra
Genomic research has rapidly expanded its scope and ambition over the past decade, promoted by both public and private sectors as having the potential to revolutionize clinical medicine. This promissory bioeconomy of genomic research and technology is generated by, and in turn generates, the hopes and expectations shared by investors, researchers and clinicians, patients, and the general public alike. Examinations of such bioeconomies have often focused on the public discourse, media representations, and capital investments that fuel these “regimes of hope,” but also crucial are the more intimate contexts of small-scale medical research, and the private hopes, dreams, and disappointments of those involved. Here we examine one local site of production in a university-based clinical research project that sought to identify novel cancer predisposition genes through whole genome sequencing in individuals at high risk for cancer. In-depth interviews with 24 adults who donated samples to the study revealed an ability to shift flexibly between positioning themselves as research participants on the one hand, and as patients or as family members of patients, on the other. Similarly, interviews with members of the research team highlighted the dual nature of their positions as researchers and as clinicians. For both parties, this dual positioning shaped their investment in the project and valuing of its possible outcomes. In their narratives, all parties shifted between these different relational positions as they managed hopes and expectations for the research project. We suggest that this flexibility facilitated study implementation and participation in the face of potential and probable disappointment on one or more fronts, and acted as a key element in the resilience of this local promissory bioeconomy. We conclude that these multiple dimensions of relationality and positionality are inherent and essential in the creation of any complex economy, “bio” or
Pandya, Hardik J; Park, Kihan; Desai, Jaydev P
The use of flexible micro-electro-mechanical systems (MEMS) based device provides a unique opportunity in bio-medical robotics such as characterization of normal and malignant tissues. This paper reports on design and development of a flexible MEMS-based sensor array integrating mechanical and electrical sensors on the same platform to enable the study of the change in electro-mechanical properties of the benign and cancerous breast tissues. In this work, we present the analysis for the electrical characterization of the tissue specimens and also demonstrate the feasibility of using the sensor for mechanical characterization of the tissue specimens. Eight strain gauges acting as mechanical sensors were fabricated using poly(3,4-ethylenedioxythiophene) poly(styrenesulfonate) (PEDOT:PSS) conducting polymer on poly(dimethylsiloxane) (PDMS) as the substrate material. Eight electrical sensors were fabricated using SU-8 pillars on gold (Au) pads which were patterned on the strain gauges separated by a thin insulator (SiO2 1.0μm). These pillars were coated with gold to make it conducting. The electromechanical sensors are integrated on the same substrate. The sensor array covers 180μm × 180μm area and the size of the complete device is 20mm in diameter. The diameter of each breast tissue core used in the present study was 1mm and the thickness was 8μm. The region of interest was 200μm × 200μm. Microindentation technique was used to characterize the mechanical properties of the breast tissues. The sensor is integrated with conducting SU-8 pillars to study the electrical property of the tissue. Through electro-mechanical characterization studies using this MEMS-based sensor, we were able to measure the accuracy of the fabricated device and ascertain the difference between benign and cancer breast tissue specimens.
Hemming, Laureen; Maher, David
Pain is the major source of anxiety and distress at the end of life, particularly in cases of end-stage cancer. However, pain management is not always effective or effectively implemented. This article identifies several barriers to effective pain relief in terminal cancer--the complexity of pain; difficulties in physical, emotional and spiritual assessment; difficulties in the delivery of medication--that challenge the skills of all professionals involved in palliative care. There are no simple answers, but awareness of the breadth of the issues may help focus nurses' minds on the patient in every encounter.
Gany, Francesca; Ramirez, Julia; Nierodzick, Mary Lynn; McNish, Thelma; Lobach, Iryna; Leng, Jennifer
Purpose: This study investigates the impact of a multilingual, multidisciplinary team targeting social and economic determinants of cancer treatment adherence among at-risk Hispanic immigrants. Methods: Patients were recruited at 10 hospital-based cancer clinics in New York City between December 2008 and November 2009. This is a nested cohort study of Hispanic patients and their sociodemographic characteristics, areas of needed assistance, and reported impact of meeting service needs on keeping appointments. At the core of the intervention is the trained, bilingual Portal Access Facilitator, who assesses needs and synchronizes an individualized set of transdisciplinary services for each patient. Results: A total of 328 Hispanic patients participated in the study. Of these, 89% preferred to speak Spanish in the health care setting, and 17% had no health insurance. The most common cancer diagnosis among participants was breast cancer (35%) followed by GI (17%) and gynecologic (16%) cancers. Patients most commonly requested financial support (59%), food support (37%), transportation assistance (21%), social work services (14%), psychosocial support (6%), help with health insurance issues (5%), and legal services (5%). In a follow-up assessment of high-need patients in urgent need of financial support, 86% reported that portal services helped them attend cancer care and treatment appointments, and 72% reported that portal services decreased worry about their care. Conclusion: Most patients reported that financial, social, and logistical support would help them attend their appointments for cancer care and treatment. Further multidisciplinary interventions should be implemented and evaluated to address social and economic determinants in cancer care for this population. PMID:21532808
Mayer, Deborah K
Nursing research and nurse researchers have been an integral and significant part of the Oncology Nursing Society's (ONS's) history, as evidenced by the development of the Nursing Research Committee within a few years of ONS's establishment. Ruth McCorkle, PhD, RN, FAAN, was the committee's first chairperson in 1979. This was followed by the creation of the Advanced Nursing Research Special Interest Group in 1989 under the leadership of Jean Brown, PhD, RN, FAAN. ONS also began to recognize nurse researchers in 1994 by creating the annual ONS Distinguished Researcher Award to recognize the contributions of a member who has conducted or promoted research that has enhanced the science and practice of oncology nursing. The list of recipients and of their work is impressive and reflects the wide range of our practice areas (see http://bit.ly/1MTC5cp for the recipient list). In addition, the ONS Foundation began funding research in 1981 and has distributed more than $24 million in research grants, research fellowships, and other scholarships, lectures, public education projects, and career development awards (ONS Foundation, 2015). And, in 2006, the Putting Evidence Into Practice resource was unveiled, which provides evidence-based intervention reviews for the 20 most common problems experienced by patients with cancer and their caregivers (www.ons .org/practice-resources/pep) .
Terui, Takeshi; Koike, Kazuhiko; Hirayama, Yasuo; Kusakabe, Toshiro; Ono, Kaoru; Mihara, Hiroyoshi; Kobayashi, Kenji; Takahashi, Yuji; Nakajima, Nobuhisa; Kato, Junji; Ishitani, Kunihiko
More than 30 years have passed since the introduction of the concept of palliative care in cancer care in Japan. However, the majority of the estimated three million cancer patients in Japan do not receive palliative care. Higashi Sapporo Hospital was established in 1983 as a hospital specialized in cancer care. The palliative care unit of our hospital currently consists of 58 beds. Our hospital is one of the largest hospitals in Japan in terms of the number of palliative care beds. On admission to our hospital, all patients are evaluated for palliative care by a multi-disciplinary team and some patients who undergo anticancer therapy receive palliative care when necessary. There are about 65 patients on average (28.3%) who are receiving only palliative care. In 2011, 793 patients died of cancer while admitted at our hospital. This number of cancer deaths accounted for 15% of the 5,324 cancer deaths in Sapporo City in the same year. Our hospital has played an active role according to the philosophy that "palliative cancer care is part of cancer medical care". We here report the current status of the contribution of our hospital to overcoming problems in palliative care and cancer care in Japan.
Aparicio, Thomas; Pamoukdjian, Frederic; Quero, Laurent; Manfredi, Sylvain; Wind, Philippe; Paillaud, Elena
Colorectal cancers are common in elderly patients. However, cancer screening is poorly used after 75. Elderly patients form a heterogeneous population with specific characteristics. Standards of care cannot therefore be transposed from young to elderly patients. Tumour resection is frequently performed but adjuvant chemotherapy is rarely prescribed as there are no clearly established standards of care. In a metastatic setting, recent phase III studies have demonstrated that doublet front-line chemotherapy provided no survival benefit. Moreover, several studies have established the benefit of bevacizumab in association with chemotherapy. There is a lack of evidence for the efficacy of anti-epidermal growth factor antibodies in elderly patients. Geriatric assessments could help to select the adequate treatment strategy for individual patients. Geriatric oncology is now the challenge we have to face, and more specific trials are needed.
Brusint, B; Vich, P; Ávarez-Hernández, C; Cuadrado-Rouco, C; Díaz-García, N; Redondo-Margüello, E
Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family doctors need to thoroughly understand this disease in order to optimize the health care services for these patients, making the best use of available resources. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. The second one deals with population screening and its controversies, screening in high-risk women, and the current recommendations. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors, and helping them to be able to care for their patients for their benefit throughout their illness.
Owusu, Cynthia; Berger, Nathan A
Cancer care at the extremes of life, in the young and the old, is characterized by unique issues associated with pediatrics and geriatric medicine, accentuated by the special vulnerabilities of these groups. In response to these needs, the field of pediatric oncology has been well honed to deal with the special problems associated with juvenile cancer patients. While most adult oncologists consider themselves well prepared to deal with older cancer patients, the current expansion of the geriatric population – their variable levels of fitness, frailty and vulnerability, the fact that cancer is primarily a disease of older adults, the significant expansion of agents and approaches to treat cancer, as well as their resultant toxicities and complications – has led to the development of specialized geriatric oncologists. Moreover, the special characteristics and needs of these patients have led to the evolution of new guidelines for evaluation, management and the conduct of research in older patients with cancer. PMID:25642321
Weldon, Christine B; Friedewald, Sarah M; Kulkarni, Swati A; Simon, Melissa A; Carlos, Ruth C; Strauss, Jonathan B; Bunce, Mikele M; Small, Art; Trosman, Julia R
Radiologists aspire to improve patient experience and engagement, as part of the Triple Aim of health reform. Patient engagement requires active partnerships among health providers and patients, and rigorous teamwork provides a mechanism for this. Patient and care team engagement are crucial at the time of cancer diagnosis and care initiation but are complicated by the necessity to orchestrate many interdependent consultations and care events in a short time. Radiology often serves as the patient entry point into the cancer care system, especially for breast cancer. It is uniquely positioned to play the value-adding role of facilitating patient and team engagement during cancer care initiation. The 4R approach (Right Information and Right Care to the Right Patient at the Right Time), previously proposed for optimizing teamwork and care delivery during cancer treatment, could be applied at the time of diagnosis. The 4R approach considers care for every patient with cancer as a project, using project management to plan and manage care interdependencies, assign clear responsibilities, and designate a quarterback function. The authors propose that radiology assume the quarterback function during breast cancer care initiation, developing the care initiation sequence, as a project care plan for newly diagnosed patients, and engaging patients and their care teams in timely, coordinated activities. After initial consultations and treatment plan development, the quarterback function is transitioned to surgery or medical oncology. This model provides radiologists with opportunities to offer value-added services and solidifies radiology's relevance in the evolving health care environment. To implement 4R at cancer care initiation, it will be necessary to change the radiology practice model to incorporate patient interaction and teamwork, develop 4R content and local adaption approaches, and enrich radiology training with relevant clinical knowledge, patient interaction
Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal use. For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia. Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects. PMID:27022315
Samuel, Cleo A.; Landrum, Mary Beth; McNeil, Barbara J.; Bozeman, Samuel R.; Williams, Christina D.
Objectives. We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. Methods. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12 897), lung (n = 25 608), or prostate (n = 38 202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between- or within-hospital differences. Results. Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10). Conclusions. Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences. PMID:25100422
Sergio Cantoreggi speaks to Henry Ireland, Commissioning Editor: Sergio Cantoreggi, PhD, is the Chief Scientific Officer and Global Head of Research and Development of the Helsinn Group, a mid-sized pharmaceutical company headquartered in Lugano, Switzerland, and focused on providing cancer supportive care solutions to oncology patients worldwide. Dr Cantoreggi has overall responsibility for all R&D activities of the Helsinn Group and has contributed to six major regulatory approvals of cancer supportive care agents in the USA, Europe and Japan. Dr Cantoreggi joined Helsinn Healthcare in 2000 as drug development scientist and was appointed Head of R&D in 2005. In 2010, he was promoted to his current role. From 1994 to 2000 he worked as toxicologist and regulatory scientist for Du Pont, Sandoz and Novartis. Prior to joining industry, Dr Cantoreggi completed a postdoctoral fellowship and earned a Master of Science degree in chemistry and a Doctoral degree in natural sciences with a thesis on the mechanism of chemical carcinogenesis from the Swiss Federal Institute of Technology in Zürich, Switzerland. Sergio Cantoreggi discusses Helsinn's role in cancer supportive care, describing current treatment options for patients, the company's pipeline and Helsinn's work in supporting the field as a whole.
Vich, P; Brusint, B; Alvarez-Hernández, C; Cuadrado-Rouco, C; Diaz-García, N; Redondo-Margüello, E
Breast cancer is a prevalent disease affecting all areas of the patients' lives. Therefore, family physicians should have a thorough knowledge of this disease in order to optimize the health care services for these patients, and making the best use of available resources. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. The first article reviews the epidemiology, risk factors, and protective factors in this disease This summary report aims to provide a current and practical review on breast cancer, providing answers to family doctors and helping them to support the patients for their benefit throughout their illness.
Denton, Eve; Conron, Matthew
Lung cancer is a major worldwide health burden, with high disease-related morbidity and mortality. Unlike other major cancers, there has been little improvement in lung cancer outcomes over the past few decades, and survival remains disturbingly low. Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, despite a relative lack of evidence that this model of care improves outcomes. In this article, the available literature concerning the impact of multidisciplinary care on key measures of lung cancer outcomes is reviewed. This includes the limited observational data supporting improved survival with multidisciplinary care. The impact of multidisciplinary care on other benchmark measures of quality lung cancer treatment is also examined, including staging accuracy, access to diagnostic investigations, improvements in clinical decision making, better utilization of radiotherapy and palliative care services, and improved quality of life for patients. Health service research suggests that multidisciplinary care improves care coordination, leading to a better patient experience, and reduces variation in care, a problem in lung cancer management that has been identified worldwide. Furthermore, evidence suggests that the multidisciplinary model of care overcomes barriers to treatment, promotes standardized treatment through adherence to guidelines, and allows audit of clinical services and for these reasons is more likely to provide quality care for lung cancer patients. While there is strengthening evidence suggesting that the multidisciplinary model of care contributes to improvements in lung cancer outcomes, more quality studies are needed.
Denton, Eve; Conron, Matthew
Lung cancer is a major worldwide health burden, with high disease-related morbidity and mortality. Unlike other major cancers, there has been little improvement in lung cancer outcomes over the past few decades, and survival remains disturbingly low. Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, despite a relative lack of evidence that this model of care improves outcomes. In this article, the available literature concerning the impact of multidisciplinary care on key measures of lung cancer outcomes is reviewed. This includes the limited observational data supporting improved survival with multidisciplinary care. The impact of multidisciplinary care on other benchmark measures of quality lung cancer treatment is also examined, including staging accuracy, access to diagnostic investigations, improvements in clinical decision making, better utilization of radiotherapy and palliative care services, and improved quality of life for patients. Health service research suggests that multidisciplinary care improves care coordination, leading to a better patient experience, and reduces variation in care, a problem in lung cancer management that has been identified worldwide. Furthermore, evidence suggests that the multidisciplinary model of care overcomes barriers to treatment, promotes standardized treatment through adherence to guidelines, and allows audit of clinical services and for these reasons is more likely to provide quality care for lung cancer patients. While there is strengthening evidence suggesting that the multidisciplinary model of care contributes to improvements in lung cancer outcomes, more quality studies are needed. PMID:27099511
Thailand has a universal multi-payer system with two main types of health insurance: National Health Security Office or public health insurance and private insurance. National health insurance is designed for people who are not eligible to be members of any employment-based health insurance program. Although private health insurance is also available, all Thai citizens are required to be enrolled in either national health insurance or employees’ health insurance. There are many differences between the public health insurance and private insurance. Public health insurance, therefore, initiates programs that offer many sets of benefit packages for high-cost care. For cancer care, cover screening, curative treatment such as surgery, chemotherapy, radiation together with supportive and palliative care. PMID:27981139
Rafii, Forugh; Oskouie, Fatemeh; Shoghi, Mahnaz
The life of a mother undergoes a dramatic change after a child is diagnosed with cancer. The present study aimed to determine effects on the everyday life process and health status of mothers with children suffering from leukemia. This qualitative study was based on a grounded theory approach with sixteen mothers. The results indicate that after onset of disease in their children, they marginalized their own health and tied their identities to taking care of the child and keeping the child healthy by ignoring themselves, becoming imprisoned in a taking-care-of-the-child position, and trying very hard for seek balance and stability Enduring physical pressures on the one hand, and constantly attempting to achieve balance and stability in family processes on the other hand, gradually cause exhaustion. It seems that health care providers and nurses should pay much more attention to the health status of this group of mothers.
Results from the first randomized clinical trial of its kind have revealed a surprising and welcome benefit of early palliative care for patients with advanced lung cancer—longer median survival. Although several researchers said that the finding needs to be confirmed in other trials of patients with other cancer types, they were cautiously optimistic that the trial results could influence oncologists’ perceptions and use of palliative care. |
Various surveys show that interest in complementary and alternative medicine (CAM) is high among cancer patients. Patients want to explore all options that may help their treatment. Many CAM modalities offer patients an active role in their self-care, and the resulting sense of empowerment is very appealing. On the other hand, many unscrupulous marketeers promote alternative cancer "cures," targeting cancer patients who are particularly vulnerable. Some alternative therapies can hurt patients by delaying effective treatment or by causing adverse effects or detrimental interactions with other medications. It is not in the best interest of cancer patients if they cannot get appropriate guidance on the use of CAM from the health care professionals who are part of their cancer care team. The Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center in New York was established in 1999 to address patient interest in cam, to incorporate helpful complementary therapies into each patient's overall treatment management, to guide patients in avoiding harmful alternative therapies, and to develop prospective research to evaluate the efficacy of CAM modalities.
Various surveys show that interest in complementary and alternative medicine (cam) is high among cancer patients. Patients want to explore all options that may help their treatment. Many cam modalities offer patients an active role in their self-care, and the resulting sense of empowerment is very appealing. On the other hand, many unscrupulous marketeers promote alternative cancer “cures,” targeting cancer patients who are particularly vulnerable. Some alternative therapies can hurt patients by delaying effective treatment or by causing adverse effects or detrimental interactions with other medications. It is not in the best interest of cancer patients if they cannot get appropriate guidance on the use of cam from the health care professionals who are part of their cancer care team. The Integrative Medicine Service at Memorial Sloan–Kettering Cancer Center in New York was established in 1999 to address patient interest in cam, to incorporate helpful complementary therapies into each patient’s overall treatment management, to guide patients in avoiding harmful alternative therapies, and to develop prospective research to evaluate the efficacy of cam modalities. PMID:18769574
Luta, Gheorghe; Sheppard, Vanessa; Isaacs, Claudine; Cohen, Harvey J.; Muss, Hyman B.; Yung, Rachel; Clapp, Jonathan D.; Winer, Eric; Hudis, Clifford; Tallarico, Michelle; Wang, Julhy; Barry, William T.; Mandelblatt, Jeanne S.
Purpose Survivorship care plans (SCP) are recommended for all cancer patients and could be especially useful to survivors 65 years and over (“older”). This study examined receipt of SCPs among older breast cancer survivors and whether SCPs were associated with improved patient-reported outcomes. Methods Three hundred and twenty-eight older women diagnosed with invasive, nonmetastatic breast cancer between 2007–2011 were recruited from 78 cooperative-group sites. Participants completed telephone interviews at baseline and 1-year posttreatment. Regression analyses examined SCP receipt (yes/no) and functioning (EORTC-QLQ-C30), cancer worry, and experiences of survivorship care (care coordination, knowledge). Results Only 35 % of women received SCPs. For each 1-year increase in age, there was a 5 % lower odds of receiving an SCP (odds ratio (OR)=0.94, 95 % confidence interval (CI) 0.91–0.98, p=0.007). Besides age, no other factor predicted SCPs. SCP receipt was associated with greater knowledge and understanding of requisite follow-up care (p<0.05); however, functioning was not significantly different among those with vs. without SCPs. Conclusions Receipt of care plans was limited. SCPs improved understanding of breast cancer follow-up care among older survivors, but did not impact functioning one year post-treatment. Implications for Cancer Survivors To impact functioning and salient needs of the growing cohort of older survivors, survivorship care plans likely should be tailored to geriatric-specific issues. To improve functioning, SCP content should expand to include exercise, nutrition, polypharmacy, social support and management of symptom burden from cancer, and other comorbid conditions. To improve follow-up care for cancer survivors, SCPs should delineate shared care roles between oncology and primary care in managing recurrence surveillance, screening, and cancer sequelae. PMID:24917307
Saita, Emanuela; Acquati, Chiara; Molgora, Sara
The positive outcomes associated with Patient Engagement (PE) have been strongly supported by the recent literature. However, this concept has been marginally addressed in the context of cancer. Limited attention has also received the role of informal caregivers in promoting physical and psychological well-being of patients, as well as the interdependence of dyads. The Cancer Dyads Group Intervention (CDGI) is a couple-based psychosocial intervention developed to promote engagement in management behaviors, positive health outcomes, and the quality of the relationship between cancer patients and their informal caregivers. The article examines the ability of the CDGI to promote adaptive coping behaviors and the perceived level of closeness by comparing cancer patients participating in the intervention and patients receiving psychosocial care at usual. Results indicate that individuals diagnosed with cancer attending the CDGI present significant increases in Fighting Spirit and Avoidance, while reporting also reduced levels of Fatalism and Anxious Preoccupation. Initial indications suggest that the intervention may contribute to strengthening the relationship with the primary support person. PMID:27826279
Winters, Paul C.; Jean-Pierre, Pascal; Warren-Mears, Victoria; Post, Douglas; Van Duyn, Mary Ann S.; Fiscella, Kevin; Darnell, Julie; Freund, Karen M.
Purpose Despite growing popularity of patient navigation (PN) as a means to improve cancer care quality and reduce cancer-related disparities, there are few well-designed controlled trials assessing the impact of PN on patient outcomes like satisfaction with care. The present controlled study examined effect of PN on satisfaction with cancer-related care. Methods Patients who presented with a symptom or abnormal screening test (n=1788) or definitive diagnosis (n=445) of breast, cervical, colorectal, or prostate cancer from eight Patient Navigator Research Program sites were included in one of two groups: intervention (PN) or comparison (usual care or usual care plus cancer educational materials). Trained patient navigators met with intervention group participants to help them assess and identify resources to address barriers to cancer diagnostic or treatment care. Using a validated instrument, we assessed participants' satisfaction with their cancer diagnostic or treatment care up to 3 months after diagnostic resolution of a cancer-related abnormality or within 3 months of initiation of cancer treatment. Results Overall, patients reported high satisfaction with diagnostic care and cancer treatment. There were no statistically significant differences between PN and control groups in satisfaction with cancer-related care (p>0.05). Hispanic and African American participants were less likely to report high satisfaction with cancer care when compared to White patients. Middle-aged participants with higher education, higher household income, private insurance, owning their own home, working full-time, and those whose primary language is English had higher satisfaction with cancer-related diagnostic care. Conclusions PN had no statistically significant effect on patients' satisfaction with cancer-related care. Further research is needed to define the patient populations who might benefit from PN, content of PN that is most useful, and services that might enhance PN. PMID
Dietmann, Mary E.
As the number of individuals surviving cancer continues to rise, short and long term effects of cancer and its treatment that result in physical, psychosocial, and spiritual needs unique to the care of the cancer survivor has not been addressed in nursing curricula. The Institute of Medicine (IOM, 2005) recommends that all health care providers…
Soneji, Samir; Yang, JaeWon
Despite sharp increases in spending on cancer treatment since 1970 in the United States compared to Western Europe, US cancer mortality rates have decreased only modestly. This has raised questions about the additional value of US cancer care derived from this additional spending. We calculated the number of US cancer deaths averted, compared to the situation in Western Europe, between 1982 and 2010 for twelve cancer types. We also assessed the value of US cancer care, compared to that in Western Europe, by estimating the ratio of additional spending on cancer to the number of quality-adjusted life-years saved. Compared to Western Europe, for three of the four costliest US cancers-breast, colorectal, and prostate-there were approximately 67,000, 265,000, and 60,000 averted US deaths, respectively, and for lung cancer there were roughly 1,120,000 excess deaths in the study period. The ratio of incremental cost to quality-adjusted life-years saved equaled $402,000 for breast cancer, $110,000 for colorectal cancer, and $1,979,000 for prostate cancer-amounts that exceed most accepted thresholds for cost-effective medical care. The United States lost quality-adjusted life-years despite additional spending for lung cancer: -$19,000 per quality-adjusted life-year saved. Our results suggest that cancer care in the United States may provide less value than corresponding cancer care in Western Europe for many leading cancers.
Fluchel, Mark N.; Kirchhoff, Anne C.; Bodson, Julia; Sweeney, Carol; Edwards, Sandra L.; Ding, Qian; Stoddard, Gregory J.; Kinney, Anita Y.
Background Childhood cancers typically require rigorous treatment at specialized centers in urban areas, which can create substantial challenges for families residing in remote communities. We evaluated the impact of residence and travel time on the burden of care for families of childhood cancer patients. Procedure We conducted a cross-sectional, self-administered survey of 354 caregivers of pediatric cancer patients at a children’s hospital serving a seven state area. Measures included the impact of cancer treatment on relocation, employment, schooling and finances. We evaluated these domains by rural/urban residence and travel time (>1 hour and >2 hours) to the hospital in multivariable regression models. Results Of the 29% of caregivers who reported moving residences since their child was diagnosed, 33% reported that the move was due to their child’s cancer. Rural and remote (e.g., >1 hour travel time) caregivers missed more days of work during the first month after diagnosis than did urban and local caregivers, however, these differences did not persist over the first six months of therapy. One-third of caregivers reported quitting or changing jobs as a direct result of their child being diagnosed with cancer. Rural respondents had greater out-of-pocket travel expenses and reported a significantly greater perceived financial burden. Rural patients missed more school days and were at an increased risk of having to repeat a grade. Conclusions Childhood cancer has an appreciable impact on the lives of patients and caregivers. The burden is greater for those living far from a treatment center. PMID:25131518
An audit was undertaken of people with a diagnosis of breast cancer who were referred to a community palliative care specialist nursing team over a 12-month period, to explore the reasons for referral to the service and the duration of involvement with the service. Breast cancer patients accounted for 10% of the total referrals to the specialist service, with symptom management (including pain control) and emotional support being the main reasons for referral. The majority of people referred with breast cancer had metastatic breast cancer (87%); interestingly, 13% had primary breast cancer. The mean duration of intervention was 3 months and 1 week. Referrals seemed to occur late in patients' disease trajectories, and total numbers were lower than might be expected. It may be concluded that there is scope for the specialist palliative care team to be a more integral part of care for patients with metastatic breast cancer.
Walaszek, Anne; Perdue, David G.; Rhodes, Kristine L.; Haverkamp, Donald; Forster, Jean
Introduction The epidemiology of colorectal cancer, including incidence, mortality, age of onset, stage of diagnosis, and screening, varies regionally among American Indians. The objective of the Improving Northern Plains American Indian Colorectal Cancer Screening study was to improve understanding of colorectal cancer screening among health care providers serving Northern Plains American Indians. Methods Data were collected, in person, from a sample of 145 health care providers at 27 health clinics across the Northern Plains from May 2011 through September 2012. Participants completed a 32-question, self-administered assessment designed to assess provider practices, screening perceptions, and knowledge. Results The proportion of providers who ordered or performed at least 1 colorectal cancer screening test for an asymptomatic, average-risk patient in the previous month was 95.9% (139 of 145). Of these 139 providers, 97.1% ordered colonoscopies, 12.9% ordered flexible sigmoidoscopies, 73.4% ordered 3-card, guaiac-based, fecal occult blood tests, and 21.6% ordered fecal immunochemical tests. Nearly two-thirds (64.7%) reported performing in-office guaiac-based fecal occult blood tests using digital rectal examination specimens. Providers who reported receiving a formal update on colorectal cancer screening during the previous 24 months were more likely to screen using digital rectal exam specimens than providers who had received a formal update on colorectal cancer screening more than 24 months prior (73.9% vs 56.9%, respectively, χ2 = 4.29, P = .04). Conclusion Despite recommendations cautioning against the use of digital rectal examination specimens for colorectal cancer screening, the practice is common among providers serving Northern Plains American Indian populations. Accurate up-to-date, ongoing education for patients, the community, and health care providers is needed. PMID:27978410
Brito-Silva, Keila; Bezerra, Adriana Falangola Benjamin; Chaves, Lucieli Dias Pedreschi; Tanaka, Oswaldo Yoshimi
OBJECTIVE To evaluate integrity of access to uterine cervical cancer prevention, diagnosis and treatment services. METHODS The tracer condition was analyzed using a mixed quantitative and qualitative approach. The quantitative approach was based on secondary data from the analysis of cytology and biopsy exams performed between 2008 and 2010 on 25 to 59 year-old women in a municipality with a large population and with the necessary technological resources. Data were obtained from the Health Information System and the Regional Cervical Cancer Information System. Statistical analysis was performed using PASW statistic 17.0 software. The qualitative approach involved semi-structured interviews with service managers, health care professionals and users. NVivo 9.0 software was used for the content analysis of the primary data. RESULTS Pap smear coverage was low, possible due to insufficient screening and the difficulty of making appointments in primary care. The numbers of biopsies conducted are similar to those of abnormal cytologies, reflecting easy access to the specialized services. There was higher coverage among younger women. More serious diagnoses, for both cytologies and biopsies, were more prevalent in older women. CONCLUSIONS Insufficient coverage of cytologies, reported by the interviewees allows us to understand access difficulties in primary care, as well as the fragility of screening strategies. PMID:24897045
Levine, Deena R.; Johnson, Liza-Marie; Snyder, Angela; Wiser, Robert K.; Gibson, Deborah; Kane, Javier R.; Baker, Justin N.
Background The demonstrated benefit of integrating palliative care (PC) into cancer treatment has triggered an increased need for PC services. The trajectory of integrating PC in comprehensive cancer centers, particularly pediatric centers, is unknown. We describe our eight-year experience of initiating and establishing PC with the Quality of Life Service (QoLS) at St. Jude Children’s Research Hospital. Patients and Methods We retrospectively reviewed records of patients seen by the QoLS (n= 615) from March 2007 to December 2014. Variables analyzed for each year, using descriptive statistics, included diagnostic groups, QoLS encounters, goals of care, duration of survival, and location of death. Results Total QoLS patient encounters increased from 58 (2007) to 1297 (2014), new consults increased from 17 (2007) to 115 (2014), and mean encounters per patient increased from 5.06 (2007) to 16.11 (2014). Goal of care at initial consultation shifted from primarily comfort to an increasing goal of cure. The median number of days from initial consult to death increased from 52 days (2008) to 223 days (2014). A trend toward increased outpatient location of death was noted with 42% outpatient deaths in 2007 increasing to a majority in each subsequent year (range 51–74%). Hospital-wide, patients receiving PC services before death increased from approximately 50% to nearly 100%. Conclusions Since its inception, the QoLS experienced a dramatic rise in referrals and encounters per patient, utilization by all clinical services, a trend toward earlier consultation and longer term follow-up, increasing outpatient location of death, and near-universal PC involvement at the end-of-life. The successful integration of PC in a comprehensive cancer center, and resulting potential for improved care provision over time, can serve as a model for other programs on a broad scale. PMID:27283167
Álvarez Hernández, C; Vich Pérez, P; Brusint, B; Cuadrado Rouco, C; Díaz García, N; Robles Díaz, L
Breast cancer is a prevalent disease with implications in all aspects of patientś life, therefore, family doctors must know this pathology in depth, in order to optimize the health care provided to these patients with the best available resources. This series of five articles on breast cancer is based on a review of the scientific literature of the last ten years. This third article will review the clinical context and the staging and prognostic factors of the disease. This summary report aims to provide a global, current and practical review about this problem, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness.
APPLEBAUM, ALLISON J.; BREITBART, WILLIAM
Objective Informal caregivers (ICs) are relatives, friends, and partners who have a significant relationship with and provide assistance (i.e., physical, emotional) to a patient with a life-threatening, incurable illness. The multidimensional burden that results from providing care to a patient with cancer is well documented, and as a result, a growing number of psychosocial interventions have been developed specifically to address this burden. The purpose of the present study was to characterize the state of the science of psychosocial interventions for informal cancer caregivers. Method A comprehensive systematic review of interventions for cancer caregivers was conducted via an electronic literature search of publications between 1980 and January 13, 2011. A final sample of 49 interventions was reviewed in detail. Results The interventions, which varied in terms of modality and patient population, fell into the following eight categories: psychoeducation, problem-solving/skills building interventions, supportive therapy, family/couples therapy, cognitive-behavioral therapy, interpersonal therapy, complementary and alternative medicine interventions, and existential therapy. Benefits and disadvantages of each of the categories are discussed, with special attention given to studies that produced null findings. Significance of results Beyond specific techniques, structured, goal-oriented, and time-limited interventions that are integrative appear to be the most feasible and offer the greatest benefits for ICs of cancer patients. Future studies are needed to examine the specific benefits and challenges of delivering interventions in alternative modalities (Internet, Skype) so that the needs of a greater number of ICs may be addressed. PMID:23046977
Smith, Edith C
Mutations in the PALB2 gene are responsible for a small but significant percentage of cancer risks in familial breast and pancreatic cancer families. PALB2 mutations may be associated with an increase in other cancer risks as well. This article will provide an overview of the PALB2 gene, cancer risks associated with carrying a PALB2 mutation, and implications for patient care.
Bruns, Eric J.; Walker, Janet S.
In human services, clear definition of key concepts and strategies is critical to facilitating training, implementation, and research. This article reflects on methods undertaken to specify the wraparound process for children and families, and considers lessons that may be relevant to defining the system of care concept.
... Diagnosis, and Staging What Should You Ask Your Health Care Team About Thyroid Cancer? As you deal with ... only ones who can give you information. Other health care professionals, such as nurses and social workers, may ...
... Diagnosis, and Staging What Should You Ask Your Health Care Team About Pancreatic Cancer? It’s important to have ... only ones who can give you information. Other health care professionals, such as nurses and social workers, can ...
Kaye, Erica C; Friebert, Sarah; Baker, Justin N
Despite increasing data to support pediatric palliative care (PPC) as an integral component of high-quality care for children with life-threatening conditions and their families, timely integration of PPC is offered inconsistently to children with high-risk cancer. In this review, we summarize the growing body of literature in support of early integration of PPC for children with high-risk cancer and their families, advocating that PPC principles and resources are imperative to holistic cancer-directed care and rooted in evidence-based medicine. Finally, we offer possible strategies for optimizing integration of PPC into holistic cancer care for children and families.
Wilbur, Kerry; Al-Okka, Maha; Jumaat, Ebaa; Eissa, Nesma; Elbashir, Merwa; Al-Yafei, Sumaya M Al Saadi
Purpose Cancer treatments are frequently associated with adverse effects, but there may be a cultural reluctance by care providers to be forthcoming with patients regarding these risks for fear of promoting nonadherence. Conversely, research in a number of countries indicates high levels of patient desire for this information. We sought to explore cancer patient experiences, satisfaction, and preferences for medication risk communication in a Middle East care setting. Methods We developed and administered a ten-item questionnaire (Arabic and English) to a convenience sample of consenting adult patients receiving treatment at the National Center for Cancer Care and Research in Qatar. Results One hundred and forty-three patients were interviewed. Most (88%) stated that the level of side effect information they received was sufficient, with physicians (86%) followed by pharmacists (39%) as the preferred sources. The majority (97%) agreed that knowing about possible side effects would help them recognize and manage the reaction, and 92% agreed that it would help them understand how to minimize or prevent the risks. Eighteen percent indicated that this information would make them not want to take treatment. Two-thirds (65%) had previously experienced intolerance to their cancer treatment regimen. Conclusion Most patients surveyed expressed preference for the details of possible side effects they may encounter in their treatment. However, one in five considered such information a factor for nonadherence, indicating the need for patient-specific approaches when communicating medication risks. PMID:27175061
Amir, Z; Scully, J; Borrill, C
Since the 1970s breast cancer services have witnessed considerable changes in the management of patients. One significant change was the introduction of specialist core personnel, including the breast care nurse (BCN). The role of the BCN has been gaining credence rapidly in the British NHS and this service is perhaps the paradigm of care for other services. With the lack of specific evidence of the role of specialist nurses in the breast care team, the current study aims to explore this area by in-depth interviews with core team members, and observations of 16 multi-disciplinary teams in England. The study explores the following themes: Nurses' unique informal management leadership role in ensuring the co-ordination, communication and planning of the team work; nurses' innovatory role in making the bureaucracy respond to patients and their relatives needs; nurses supportive role in the provision of expert advice and guidance to other members of the team; nurses confidence and humour in well-performing teams; and the limitations of the professional role of the breast cancer nurse. This study indicates that there is evidence that the BCN is practicing at an advanced level of practice. However, there is a severe lack of evidence-based description of that advanced practice. Cancer nurses including the BCNs should develop and participate in programmes of research in line with cancer legislation in order to build an evidence base that ultimately supports their unique role.
De Paoli, Paolo; Ciliberto, Gennaro; Ferrarini, Manlio; Pelicci, PierGiuseppe; Dellabona, Paolo; De Lorenzo, Francesco; Mantovani, Alberto; Musto, Pellegrino; Opocher, Giuseppe; Picci, Piero; Ricciardi, Walter; De Maria, Ruggero
Alliance Against Cancer (ACC) was established in Rome in 2002 as a consortium of six Italian comprehensive cancer centers (Founders). The aims of ACC were to promote a network among Italian oncologic institutions in order to develop specific, advanced projects in clinical and translational research. During the following years, many additional full and associate members joined ACC, that presently includes the National Institute of Health, 17 research-oriented hospitals, scientific and patient organizations. Furthermore, in the last three years ACC underwent a reorganization process that redesigned the structure, governance and major activities. The present goal of ACC is to achieve high standards of care across Italy, to implement and harmonize principles of modern personalized and precision medicine, by developing cost effective processes and to provide tailored information to cancer patients. We herein summarize some of the major initiatives that ACC is currently developing to reach its goal, including tumor genetic screening programs, establishment of clinical trial programs for cancer patients treated in Italian cancer centers, facilitate their access to innovative drugs under development, improve quality through an European accreditation process (European Organization of Cancer Institutes), and develop international partnerships. In conclusion, ACC is a growing organization, trying to respond to the need of networking in Italy and may contribute significantly to improve the way we face cancer in Europe.
Sesen, M. Berkan; Peake, Michael D.; Banares-Alcantara, Rene; Tse, Donald; Kadir, Timor; Stanley, Roz; Gleeson, Fergus; Brady, Michael
Multidisciplinary team (MDT) meetings are becoming the model of care for cancer patients worldwide. While MDTs have improved the quality of cancer care, the meetings impose substantial time pressure on the members, who generally attend several such MDTs. We describe Lung Cancer Assistant (LCA), a clinical decision support (CDS) prototype designed to assist the experts in the treatment selection decisions in the lung cancer MDTs. A novel feature of LCA is its ability to provide rule-based and probabilistic decision support within a single platform. The guideline-based CDS is based on clinical guideline rules, while the probabilistic CDS is based on a Bayesian network trained on the English Lung Cancer Audit Database (LUCADA). We assess rule-based and probabilistic recommendations based on their concordances with the treatments recorded in LUCADA. Our results reveal that the guideline rule-based recommendations perform well in simulating the recorded treatments with exact and partial concordance rates of 0.57 and 0.79, respectively. On the other hand, the exact and partial concordance rates achieved with probabilistic results are relatively poorer with 0.27 and 0.76. However, probabilistic decision support fulfils a complementary role in providing accurate survival estimations. Compared to recorded treatments, both CDS approaches promote higher resection rates and multimodality treatments. PMID:24990290
Uemura, Marc; Morgan, Robert; Mendelsohn, Mary; Kagan, Jean; Saavedra, Crystal; Leong, Lucille
Changing healthcare policy will undoubtedly affect the healthcare environment in which providers function. The current Fee for Service reimbursement model will be replaced by Value-Based Purchasing, where higher quality and more efficient care will be emphasized. Because of this, large healthcare organizations and individual providers must adapt to incorporate performance outcomes into patient care. Here, we present a Continuing Medical Education (CME)-based initiative at the City of Hope National Cancer Center that we believe can serve as a model for using CME as a value added component to achieving such a goal. PMID:23608956
Uemura, Marc; Morgan, Robert; Mendelsohn, Mary; Kagan, Jean; Saavedra, Crystal; Leong, Lucille
Changing healthcare policy will undoubtedly affect the healthcare environment in which providers function. The current Fee for Service reimbursement model will be replaced by Value-Based Purchasing, where higher quality and more efficient care will be emphasized. Because of this, large healthcare organizations and individual providers must adapt to incorporate performance outcomes into patient care. Here, we present a Continuing Medical Education (CME)-based initiative at the City of Hope National Cancer Center that we believe can serve as a model for using CME as a value added component to achieving such a goal.
Lopez-Class, Maria; Perret-Gentil, Monique; Kreling, Barbara; Caicedo, Larisa; Mandelblatt, Jeanne; Graves, Kristi D.
Objectives Breast cancer is the most common cancer among Latinas. This study examined social, cultural, and health care system factors that impact quality of life and survivorship experiences of Latina immigrant breast cancer survivors. Design We interviewed Latina breast cancer survivors (n=19) and, based on the interview findings, conducted two focus groups (n=9). Research staff translated transcripts from Spanish into English. Two trained raters reviewed the content and identified themes. Thematic content analysis was used to categorize and organize data. Results Participants were largely mono-lingual in Spanish, predominantly from Central and South America and most (68%) had lived in the U.S. for 10 or more years. All women were diagnosed and treated in the U.S. and were an average of 3.1 years from diagnosis. Women’s survivorship experiences appeared to be shaped by cultural beliefs and experiences as immigrants such as secrecy/shame about a breast cancer diagnosis, feelings of isolation, importance of family support (familism), challenges with developing social relationships in the U.S. (less personalismo), and, for some, their partner’s difficulty with showing emotional support (machismo). Navigating the U.S. medical system and language barriers were additional challenges in participants’ health care interactions. Conclusion Latina breast cancer survivors adhere to certain cultural values and face unique issues as immigrants, potentially influencing overall quality of life and doctor-patient communication. Efforts to improve Latina immigrant breast cancer survivors’ quality of life could include increased assessment of psychosocial functioning and referral to social support services, culturally-sensitive navigation programs and consistent use of appropriately trained interpreters. PMID:21706194
Lopez-Class, Maria; Perret-Gentil, Monique; Kreling, Barbara; Caicedo, Larisa; Mandelblatt, Jeanne; Graves, Kristi D
Breast cancer is the most common cancer among Latinas. This study examined social, cultural, and health care system factors that impact the quality of life and survivorship experiences of Latina immigrant breast cancer survivors. We interviewed Latina breast cancer survivors (n = 19) and, based on the interview findings, conducted two focus groups (n = 9). Research staff translated transcripts from Spanish into English. Two trained raters reviewed the content and identified themes. Thematic content analysis was used to categorize and organize data. Participants were largely monolingual in Spanish, predominantly from Central and South America and most (68%) had lived in the U.S. for ten or more years. All women were diagnosed and treated in the U.S. and were an average of 3.1 years from diagnosis. Women's survivorship experiences appeared to be shaped by cultural beliefs and experiences as immigrants such as secrecy/shame about a breast cancer diagnosis, feelings of isolation, importance of family support (familism), challenges with developing social relationships in the U.S. (less personalismo), and, for some, their partner's difficulty with showing emotional support (machismo). Navigating the U.S. medical system and language barriers were additional challenges in the participants' health care interactions. Latina breast cancer survivors adhere to certain cultural values and face unique issues as immigrants, potentially influencing overall quality of life and doctor-patient communication. Efforts to improve Latina immigrant breast cancer survivors' quality of life could include increased assessment of psychosocial functioning and referral to social support services, culturally sensitive navigation programs, and consistent use of appropriately trained interpreters.
The sparse cells that are shed from tumors into peripheral circulation are an increasingly promising resource for noninvasive monitoring of cancer progression, early diagnosis of disease, and serve as a tool for improving our understanding of cancer metastasis. However, the extremely sparse concentration of circulating tumor cells (CTCs) in blood (~1–100 CTC in 7.5 mL of blood) as well as their heterogeneous biomarker expression has limited their detection using conventional laboratory techniques. To overcome these challenges, we have developed a microfluidic chip-based micro-Hall detector (μHD), which can directly measure single, immunomagnetically tagged cells in whole blood. The μHD can detect individual cells even in the presence of vast numbers of blood cells and unbound reactants, and does not require any washing or purification steps. Furthermore, this cost-effective, single-cell analytical technique is well suited for miniaturization into a mobile platform for low-cost point-of-care use. In this chapter, we describe the methodology used to design, fabricate, and apply these chips to cancer diagnostics. PMID:25626536
Jabbarzadeh Tabrizi, Faranak; Rahmani, Azad; Asghari Jafarabadi, Mohammad; Jasemi, Madineh; Allahbakhshian, Atefeh
Introduction: Investigation of supportive care needs of cancer patients is important to implement any supportive care programs. There is no relevant studies investigated supportive care needs of Iranian cancer patients and factors affecting such needs. So, the aims of present study were to determine the unmet supportive care needs of Iranian cancer patients and its predictive factors. Methods: In this descriptive- correlational study 274 cancer patients in one referral medical center in North West of Iran participated. For data collection, demographic and cancer related information checklist and Supportive Care Needs Survey (SCNS) was used. Logistic regression was used for data analysis of un-adjusted and adjusted Odds Ratios (ORs) for patients needs and analysis of variables of study based on Backward LR procedure SPSS Ver.13. Results: More than fifty percent of participants reported unmet needs in 18 items of SCNS. Most frequent unmet needs were related to health system and information domains and most meet needs were related to sexuality and psychological domains. The result of logistic regression identified predictors of each domain of supportive care needs. The variable such as sex, age and living situation were most important predictors of unmet needs. Conclusion: The results showed that Iranian cancer patients have many supportive care needs in different domains. In general female cancer patients are at risk of more unmet supportive care needs. So, health care professionals should be more sensitive to fulfillment of supportive care needs of female. PMID:28032075
Spinks, Tracy; Ganz, Patricia A.; Sledge, George W.; Levit, Laura; Hayman, James A.; Eberlein, Timothy J.; Feeley, Thomas W.
In 1999, the Institute of Medicine (IOM) published Ensuring Quality Cancer Care, an influential report that described an ideal cancer care system and issued ten recommendations to address pervasive gaps in the understanding and delivery of quality cancer care. Despite generating much fervor, the report’s recommendations—including two recommendations related to quality measurement—remain largely unfulfilled. Amidst continuing concerns regarding increasing costs and questionable quality of care, the IOM charged a new committee with revisiting the 1999 report and with reassessing national cancer care, with a focus on the aging US population. The committee identified high-quality patient-clinician relationships and interactions as central drivers of quality and attributed existing quality gaps, in part, to the nation’s inability to measure and improve cancer care delivery in a systematic way. In 2013, the committee published its findings in Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which included two recommendations that emphasize coordinated, patient-centered quality measurement and information technology enhancements: Develop a national quality reporting program for cancer care as part of a learning health care system; and,Develop an ethically sound learning health care information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings. These recommendations underscore the need for independent national oversight, public-private collaboration, and substantial funding to create robust, patient-centered quality measurement and learning enterprises to improve the quality, accessibility, and affordability of cancer care in America. PMID:24839592
Spinks, Tracy; Ganz, Patricia A; Sledge, George W; Levit, Laura; Hayman, James A; Eberlein, Timothy J; Feeley, Thomas W
In 1999, the Institute of Medicine (IOM) published Ensuring Quality Cancer Care, an influential report that described an ideal cancer care system and issued ten recommendations to address pervasive gaps in the understanding and delivery of quality cancer care. Despite generating much fervor, the report's recommendations-including two recommendations related to quality measurement-remain largely unfulfilled. Amidst continuing concerns regarding increasing costs and questionable quality of care, the IOM charged a new committee with revisiting the 1999 report and with reassessing national cancer care, with a focus on the aging US population. The committee identified high-quality patient-clinician relationships and interactions as central drivers of quality and attributed existing quality gaps, in part, to the nation's inability to measure and improve cancer care delivery in a systematic way. In 2013, the committee published its findings in Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which included two recommendations that emphasize coordinated, patient-centered quality measurement and information technology enhancements: Develop a national quality reporting program for cancer care as part of a learning health care system; and,Develop an ethically sound learning health care information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings. These recommendations underscore the need for independent national oversight, public-private collaboration, and substantial funding to create robust, patient-centered quality measurement and learning enterprises to improve the quality, accessibility, and affordability of cancer care in America.
Redaniel, Maria Theresa; Ridd, Matthew; Martin, Richard M; Coxon, Fareeda; Jeffreys, Mona; Wade, Julia
Objectives To ascertain the challenges associated with implementation of the 2-week wait referral criteria and waiting time targets for colorectal cancer and to identify recommendations for improvements to the pathway. Design Qualitative research using semistructured interviews and applying thematic analysis using the method of constant comparison. Setting 10 primary care surgeries and 6 secondary care centres from 3 geographical areas in the England. Participants Purposive sample of 24 clinicians (10 general practitioners (GPs), 7 oncologists and 7 colorectal surgeons). Results GPs and specialists highlighted delays in patient help-seeking, difficulties applying the colorectal cancer referral criteria due to their low predictive value, and concerns about the stringent application of targets because of potential impact on individual care and associated penalties for breaching. Promoting patient awareness and early presentation, clarifying predictive symptoms, allowing flexibility, optimising resources and maximising care coordination were suggested as improvements. Conclusions Challenges during diagnosis and treatment persist, with guidelines and waiting time targets producing the perception of unintended harms at individual and organisational levels. This has led to variations in how guidelines are implemented. These require urgent evaluation, so that effective practices can be adopted more widely. PMID:26493457
Meropol, Neal J; Schrag, Deborah; Smith, Thomas J; Mulvey, Therese M; Langdon, Robert M; Blum, Diane; Ubel, Peter A; Schnipper, Lowell E
Advances in early detection, prevention, and treatment have resulted in consistently falling cancer death rates in the United States. In parallel with these advances have come significant increases in the cost of cancer care. It is well established that the cost of health care (including cancer care) in the United States is growing more rapidly than the overall economy. In part, this is a result of the prices and rapid uptake of new agents and other technologies, including advances in imaging and therapeutic radiology. Conventional understanding suggests that high prices may reflect the costs and risks associated with the development, production, and marketing of new drugs and technologies, many of which are valued highly by physicians, patients, and payers. The increasing cost of cancer care impacts many stakeholders who play a role in a complex health care system. Our patients are the most vulnerable because they often experience uneven insurance coverage, leading to financial strain or even ruin. Other key groups include pharmaceutical manufacturers that pass along research, development, and marketing costs to the consumer; providers of cancer care who dispense increasingly expensive drugs and technologies; and the insurance industry, which ultimately passes costs to consumers. Increasingly, the economic burden of health care in general, and high-quality cancer care in particular, will be less and less affordable for an increasing number of Americans unless steps are taken to curb current trends. The American Society of Clinical Oncology (ASCO) is committed to improving cancer prevention, diagnosis, and treatment and eliminating disparities in cancer care through support of evidence-based and cost-effective practices. To address this goal, ASCO established a Cost of Care Task Force, which has developed this Guidance Statement on the Cost of Cancer Care. This Guidance Statement provides a concise overview of the economic issues facing stakeholders in the cancer
Johansson, Ann-Caroline; Axelsson, Malin; Berndtsson, Ina; Brink, Eva
Illness is constituted by subjective experiences of symptoms and their psychosocial consequences. Illness perceptions concern people's lay beliefs about understandings and interpretation of a disease and expectations as to disease outcome. Our knowledge about illness perceptions and coping in relation to the cancer care context among persons with colorectal cancer (CRC) and their partners is incomplete. The aim of the present study was to explore illness perceptions in relation to contemporary cancer care settings among CRC survivors and partners. The present research focused on illness rather than disease, implying that personal experiences are central to the methodology. The grounded theory method used is that presented by Kathy Charmaz. The present results explore illness perceptions in the early recovery phase after being diagnosed and treated for cancer in a contemporary cancer care setting. The core category outlook on the cancer diagnosis when quickly informed, treated, and discharged illustrates the illness perceptions of survivors and partners as well as the environment in which they were found. The cancer care environment is presented in the conceptual category experiencing contemporary cancer care settings. Receiving treatment quickly and without waiting was a positive experience for both partners and survivors; however partners experienced the information as massive and as causing concern. The period after discharge was being marked by uncertainty and loneliness, and partners tended to experience non-continuity in care as more problematic than the survivor did. The results showed different illness perceptions and a mismatch between illness perceptions among survivors and partners, presented in the conceptual category outlook on the cancer diagnosis. One illness perception, here presented among partners, focused on seeing the cancer diagnosis as a permanent life-changing event. The other illness perception, here presented among survivors, concentrated on
The Cancer Trends Progress Report, first issued in 2001, summarizes our nation's advances against cancer in relation to Healthy People targets set forth by the Department of Health and Human Services.
Singh, Hardeep; Arora, Neeraj K.; Mazor, Kathleen M.; Street, Richard L.
The Veterans Health Administration (VHA) is charged with providing high-quality health care, not only in terms of technical competence but also with regard to patient-centered care experiences. Patient-centered coordination of care and communication are especially important in cancer care, as deficiencies in these areas have been implicated in many cases of delayed cancer diagnosis and treatment. Additionally, because cancer care facilities are concentrated within the VHA system, geographical and system-level barriers may present prominent obstacles to quality care. Systematic assessment of patient-centered communication (PCC) may help identify both individual veterans who are at risk of suboptimal care and opportunities for quality improvement initiatives at the service, facility, or system-wide level. In this manuscript, we describe our vision to implement an assessment of PCC through patient self-report to improve the quality of cancer care and other health services in the VHA. We outline a possible strategy to assess PCC that leverages the VHA’s existing initiative to promote use of an online personal health record for veterans (MyHealtheVet). Questionnaires administered periodically or following specific episodes of care can be targeted to assess PCC in cancer care. Assessment of PCC can also be tied to clinical and administrative data for more robust analysis of patient outcomes. Ultimately, the goal of any assessment of PCC is to gather valid, actionable data that can assist VHA clinicians and staff with providing the best possible care for veterans with cancer.
Ginsburg, Ophira; Badwe, Rajan; Boyle, Peter; Derricks, Gemma; Dare, Anna; Evans, Tim; Eniu, Alexandru; Jimenez, Jorge; Kutluk, Tezer; Lopes, Gilberto; Mohammed, Sulma I; Qiao, You-Lin; Rashid, Sabina Faiz; Summers, Diane; Sarfati, Diana; Temmerman, Marleen; Trimble, Edward L; Padela, Aasim I; Aggarwal, Ajay; Sullivan, Richard
Breast and cervical cancer are major threats to the health of women globally, particularly in low-income and middle-income countries. Radical progress to close the global cancer divide for women requires not only evidence-based policy making, but also broad multisectoral collaboration that capitalises on recent progress in the associated domains of women's health and innovative public health approaches to cancer care and control. Such multisectoral collaboration can serve to build health systems for cancer, and more broadly for primary care, surgery, and pathology. This Series paper explores the global health and public policy landscapes that intersect with women's health and global cancer control, with new approaches to bringing policy to action. Cancer is a major global social and political priority, and women's cancers are not only a tractable socioeconomic policy target in themselves, but also an important Trojan horse to drive improved cancer control and care.
Andersen, Rikke Sand; Vedsted, Peter; Olesen, Frede; Bro, Flemming; Søndergaard, Jens
Objective The absence of a more significant improvement in cancer survival in countries such as the UK and Denmark may be partly rooted in delayed care-seeking among cancer patients. Past research on patient delay has mainly focused on patient characteristics (e.g. sociodemographic and psychological factors and symptom recognition) as causes of delayed care-seeking, while few studies have examined how the organizational structure of health care systems may influence patients’ reflections on seeking care. The aim of this study was to explore this relationship. Design The analysis presented is based on semi-structured interviews with 30 cancer patients and their families. Results The article raises two hypotheses on the relationship between structural elements of a health care system and people's reflections on seeking health care: (1) Gatekeeping introduces an asymmetrical relationship between the patient and the GP which potentially results in self-restricting care-seeking, (2) Continuity in the doctor–patient relationship may negatively influence patient reflections on access to health care, as the focus shifts from the medical issues of the consultation to reflections on how to properly interact with the GP and the system in which she/he is situated. Conclusion It is concluded that these hypotheses form a sound basis for further primary care research on how the organizational structure of health care systems influences patient reflections on access to medical care. PMID:21861597
Dunn, Emily F.; Kozak, Kevin R.; Moody, John S.
Purpose: Despite its common and well characterized use in other gastrointestinal malignancies, little is known about radiotherapy (RT) use in nonmetastatic colon cancer in the United States. To address the paucity of data regarding RT use in colon cancer management, we examined the RT patterns of care in this patient population. Methods and Materials: Patients with nonmetastatic colon cancer, diagnosed between 1988 and 2005, were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate methods were used to identify factors associated with RT use. Results: On univariate analysis, tumor location, age, sex, race, T stage, N stage, and geographic location were each associated with differences in RT use (all p < 0.01). In general, younger patients, male patients, and patients with more advanced disease were more likely to receive RT. On multivariate analysis, tumor location, age, gender, T and N stage, time of diagnosis and geographic location were significantly associated with RT use (all p < 0.001). Race, however, was not associated with RT use. On multivariate analysis, patients diagnosed in 1988 were 2.5 times more likely to receive RT than those diagnosed in 2005 (p = 0.001). Temporal changes in RT use reflect a responsiveness to evolving evidence related to the therapeutic benefits of adjuvant RT. Conclusions: External beam RT is infrequently used for colon cancer, and its use varies according to patient and tumor characteristics. RT use has declined markedly since the late 1980s; however, it continues to be used for nonmetastatic disease in a highly individualized manner.
Cárdenas-García, Maura; González-Pérez, Pedro P.; Montagna, Sara; Cortés, Oscar Sánchez; Caballero, Elena Hernández
Intercellular communication is very important for cell development and allows a group of cells to survive as a population. Cancer cells have a similar behavior, presenting the same mechanisms and characteristics of tissue formation. In this article, we model and simulate the formation of different communication channels that allow an interaction between two cells. This is a first step in order to simulate in the future processes that occur in healthy tissue when normal cells surround a cancer cell and to interrupt the communication, thus preventing the spread of malignancy into these cells. The purpose of this study is to propose key molecules, which can be targeted to allow us to break the communication between cancer cells and surrounding normal cells. The simulation is carried out using a flexible bioinformatics platform that we developed, which is itself based on the metaphor chemistry-based model. PMID:26997867
Cárdenas-García, Maura; González-Pérez, Pedro P; Montagna, Sara; Cortés, Oscar Sánchez; Caballero, Elena Hernández
Intercellular communication is very important for cell development and allows a group of cells to survive as a population. Cancer cells have a similar behavior, presenting the same mechanisms and characteristics of tissue formation. In this article, we model and simulate the formation of different communication channels that allow an interaction between two cells. This is a first step in order to simulate in the future processes that occur in healthy tissue when normal cells surround a cancer cell and to interrupt the communication, thus preventing the spread of malignancy into these cells. The purpose of this study is to propose key molecules, which can be targeted to allow us to break the communication between cancer cells and surrounding normal cells. The simulation is carried out using a flexible bioinformatics platform that we developed, which is itself based on the metaphor chemistry-based model.
Higashi, Takahiro; Nakamura, Fumiaki; Shibata, Akiko; Emori, Yoshiko; Nishimoto, Hiroshi
Monitoring the current status of cancer care is essential for effective cancer control and high-quality cancer care. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancer care hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancer care hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancer care hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancer care. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice.
Park, H J
True nursing care means total nursing care which includes physical, emotional and spiritual care. The modern nursing care has tendency to focus toward physical care and needs attention toward emotional and spiritual care. The total nursing care is mandatory for patients with terminal cancer and for this purpose, hospice care became emerged. Hospice care originated from the place or shelter for the travellers to Jerusalem in medieval stage. However, the meaning of modern hospice care became changed to total nursing care for dying patients. Modern hospice care has been developed in England, and spreaded to U.S.A. and Canada for the patients with terminal cancer. Nowadays, it became a part of nursing care and the concept of hospice care extended to the palliative care of the cancer patients. Recently, it was introduced to Korea and received attention as model of total nursing care. This study was attempted to assess the efficacy of hospice care. The purpose of this study was to prove a difference in terms of physical, emotional and spiritual aspect between the group who received hospice care and who didn't receive hospice care. The subject for this study were 113 patients with advanced cancer who were hospitalized in the 8 different hospitals. 67 patients received hospice care in 4 different hospitals, and 46 patients didn't receive hospice care in another 4 different hospitals. The method of this study was the questionnaire which was made through the descriptive study. The descriptive study was made by individual contact with 102 patients of advanced cancer for 9 months period. The measurement tool for questionaire was made by author through the descriptive study, and included the personal religious orientation obtained from chung (originated R. Fleck) and 5 emotional stages before dying from Kübler Ross. The content of questionnaire consisted in 67 items which included 11 for general characteristics, 10 for related condition with cancer, 13 for wishes for physical
Yoshino, Kazuho; Nishiumi, Noboru; Kushino, Nobuhisa; Tsukada, Michiko; Douzono, Sachiko; Saito, Yuki; Yagame, Mitsunori; Tokuda, Yutaka
The palliative care team's roles are to provide a symptom relief to cancer patients, help them accept their medical conditions, and offer advice regarding the selection of appropriate medical treatments to suit their needs. Seeking the comfort of their homes, patients prefer a home care of superior medical care provided at hospitals. In 2008, 25 of the end-stage cancer patients at hospitals were expressed their desires to have a home medical care, and 10 of them were allowed to do so. We considered the following contributing factors that a patient should have for a smooth transition from hospital care to home medical care: (1) life expectancy of more than 2 months, (2) no progressive breathing difficulties experienced daily, (3) good awareness of medical condition among patients and families, (4) living with someone who has a good understanding of the condition, (5) availability of an appropriate hospital in case of a sudden change in medical requirements, and (6) good collaboration between emergency care hospitals, home physicians, and visiting nurses. To treat the end-stage cancer patients at home, there is a need for information sharing and a joint training of physicians specialized in cancer therapy, palliative care teams, home physicians, and visiting nurses. This would ensure a sustainable "face-to-face collaboration" in community health care.
Walter, Fiona M; Usher-Smith, Juliet A; Yadlapalli, Suresh; Watson, Eila
Background Increasing numbers of people are living with, and beyond, cancer. They are at risk of long-term morbidity and premature mortality due to the consequences of their disease and its treatment. Primary care can contribute to providing ongoing care. Aim To determine the current practice and views of GPs in England regarding cancer survivorship care. Design and setting Online survey of a sample of 500 GPs, stratified by NHS region in England. Method The survey included questions adapted from prior surveys assessing physician knowledge and attitudes regarding care of patients with cancer. Results In total, 500 GPs responded; approximately half reported often providing care to people living beyond cancer for treatment-related side effects (51%), psychological symptoms (65%), and lifestyle advice (55%). Only 29% felt very confident managing treatment-related side effects compared with 46% and 65% for psychological symptoms and lifestyle advice respectively. Half reported usually receiving cancer treatment summaries and survivorship care plans but most of the sample felt these would improve their ability to provide care (76%). Only 53% were convinced of the usefulness of cancer care reviews. Although most felt that primary and specialist care should share responsibility for managing bone (81%) and cardiovascular (77%) health consequences, fewer than half reported often taking previous history of cancer or cancer treatment into consideration when assessing bone health; only one-fifth did this in relation to cardiovascular health. Most responders were interested in receiving education to improve their knowledge and expertise. Conclusion GPs have a potentially important role to play in caring for people following cancer treatment. This study has highlighted areas where further support and education are needed to enable GPs to optimise their role in cancer survivorship care. PMID:26500324
Onega, Tracy; Duell, Eric J.; Shi, Xun; Demidenko, Eugene; Goodman, David
Context: Disparities in cancer care for rural residents and for African Americans have been documented, but the interaction of these factors is not well understood. Purpose: The authors examined the simultaneous influence of race and place of residence on access to and utilization of specialized cancer care in the United States. Methods: Access to…
Nikseresht, F; Rassouli, M; Torabi, F; Farzinfard, F; Mansouri, S; Ilkhani, M
This study measured the effect of spiritual care on mental health in mothers of children with cancer. The present quasi-experimental study was with one group pretest posttest design. The findings show that implementation of spiritual care in mothers of children with cancer can improve their mental health.
Slenker, Suzanne E.; And Others
The effect of the use of guidelines on the care of patients with breast, colon, and non-small-cell lung cancers is reported. Audits of patient records revealed an increase over time in the percentage of recommended cancer care procedures that were complied with. (Author/MLW)
Wade, Julia; Holding, Peter N; Bonnington, Susan; Rooshenas, Leila; Lane, J Athene; Salter, C Elizabeth; Tilling, Kate; Speakman, Mark J; Brewster, Simon F; Evans, Simon; Neal, David E; Hamdy, Freddie C; Donovan, Jenny L
Objectives To develop a nurse-led, urologist-supported model of care for men managed by active surveillance or active monitoring (AS/AM) for localised prostate cancer and provide a formative evaluation of its acceptability to patients, clinicians and nurses. Nurse-led care, comprising an explicit nurse-led protocol with support from urologists, was developed as part of the AM arm of the Prostate testing for cancer and Treatment (ProtecT) trial. Design Interviews and questionnaire surveys of clinicians, nurses and patients assessed acceptability. Setting Nurse-led clinics were established in 9 centres in the ProtecT trial and compared with 3 non-ProtecT urology centres elsewhere in UK. Participants Within ProtecT, 22 men receiving AM nurse-led care were interviewed about experiences of care; 11 urologists and 23 research nurses delivering ProtecT trial care completed a questionnaire about its acceptability; 20 men managed in urology clinics elsewhere in the UK were interviewed about models of AS/AM care; 12 urologists and three specialist nurses working in these clinics were also interviewed about management of AS/AM. Results Nurse-led care was commended by ProtecT trial participants, who valued the flexibility, accessibility and continuity of the service and felt confident about the quality of care. ProtecT consultant urologists and nurses also rated it highly, identifying continuity of care and resource savings as key attributes. Clinicians and patients outside the ProtecT trial believed that nurse-led care could relieve pressure on urology clinics without compromising patient care. Conclusions The ProtecT AM nurse-led model of care was acceptable to men with localised prostate cancer and clinical specialists in urology. The protocol is available for implementation; we aim to evaluate its impact on routine clinical practice. Trial registration numbers NCT02044172; ISRCTN20141297. PMID:26384727
Hweissa, N Ab; Lim, J N W; Su, T T
In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health-care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health-care provider's perception around cervical cancer screening. In-depth, face-to-face interviews were conducted with 16 health-care providers, from both public and private sectors in Az-Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health-care providers did not provide sufficient information regarding cervical cancer screening for women who attend health-care facilities. The results highlight the role played by health-care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health-care providers to offer a precious advice regarding the screening. On the other hand, health-care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health-care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women.
Ogihara, Miyoko; Yamaoka, Keita; Fujimaki, Yoko; Watanabe, Mutsuko; Hirohara, Masayoshi; Kushida, Kazuki
Although many patients wish to remain in their familiar home environment while undergoing cancer treatment, many obstacles prevent a patient from receiving cancer care at home. With early-stage cancer, the patients may better accept the diagnosis and have a greater will to fight the illness. However as time proceeds, progression or recurrence of cancer may occur, and eventually, proactive treatments will not be available. This progression results in great physical and mental strain on the patients and their family. At all stages of such progression, opportunities exist for a care provider to assist with overcoming potential obstacles by openly communicating with the patients, talking through the patients' experiences, and understanding their feelings. However, on diagnosis, cancer patients must often face the reality that they have very little time left to live. When transiting medical care from their long-trusted hospital to a home care base, a new physician must be selected and other decisions related to their care must be quickly made. Transferring responsibility to a good home care provider can greatly influence a patient's emotional state. This paper reports one such case in which the patients died in their homes with the best comfort and possible outcome.
Initial Experience of Head and Neck Cancer Patients Treated in an Oncologist Led Palliative Cancer Care Clinic at a Tertiary Cancer Care Center in Uttar Pradesh: Is the Initiative of a Full-fledged Palliative Care for Cancer Patients Justified
Lal, Punita; Verma, Mranalini; Kumar, Gaurav; Shrivastava, Resham; Kumar, Shaleen
Introduction: Poor socioeconomic status and illiteracy attribute to the advanced presentation of head and neck cancer (HNC) patients in India and are candidates for palliation in our setup. We set up a palliative cancer care clinic (PCCC), and an audit of initial 153 HNC patients is presented. Aims and Objectives: To assess the impact of palliative cancer care services. Methodology: Data of advanced HNC patients suited for palliation were collected to document demography, symptomatology, cancer treatment, and supportive care. Results: One hundred and fifty-three patients were seen during January 2013 to March 2015 in the PCCC. Seventy-two (47%) referral cases were due to disease progression and 81 (53%) due to de novo advanced cases. Median follow-up for this group was 5.3 months. Ninety (59%) cases needed some degree of assistance for their normal activities. Sixty-seven (44%) patients belonged to poor socioeconomic status and 65 (43%) were educated up to equivalent of high school. One hundred and thirty-five (88%) patients had an adequate family support. Pain was the most common presenting symptom in 134 (87%) cases with adequate relief in 112 (84%) patients with another 13 (09%) could not be assessed. Overall median duration of symptoms was 6 months. Cancer-directed therapy was used in 143 (93%) patients. Near the end of life in 47 (73%) out of 63 documented cases, caregivers were psychologically prepared for the inevitable. Conclusion: The role of palliative care team in alleviating physical, psychosocial, and emotional issues of patient and family members was significant. PCCC seems to be a feasible working model in our setup. PMID:27803571
Kvale, Elizabeth A.; Rocque, Gabrielle B.; Demark-Wahnefried, Wendy; Martin, Michelle Y.; Jackson, Bradford E.; Meneses, Karen; Partridge, Edward E.; Pisu, Maria
Background. Treatment summaries and follow-up care plan information should be provided to cancer survivors. This study examines the association of receiving summaries and care plans with cancer survivor self-efficacy for chronic illness management, and whether self-efficacy was associated with health care utilization. Methods. Four hundred forty-one cancer survivors (≥2 years from diagnosis and had completed treatment) ≥65 years old from 12 cancer centers across 5 states completed telephone surveys. Survivors responded to three questions about receiving a written treatment summary, written follow-up plan, and an explanation of follow-up care plans. Respondents completed the Stanford Chronic Illness Management Self-Efficacy Scale and reported emergency room visits and hospitalizations in the past year. Three multiple linear regression models estimated the association of written treatment summary, written follow-up care plan, and verbal explanation of follow-up plan with total self-efficacy score. Log-binomial models estimated the association of self-efficacy scores with emergency room visits and hospitalizations (yes/no). Results. Among survivors, 40% and 35% received a written treatment summary and follow-up care plan, respectively. Seventy-nine percent received an explanation of follow-up care plans. Receiving a verbal explanation of follow-up care instructions was significantly associated with higher self-efficacy scores (β = 0.72, p = .009). Higher self-efficacy scores were significantly associated with lower prevalence ratios of emergency room visits (prevalence ratio, 0.92; 95% confidence interval, 0.88–0.97) and hospitalizations (prevalence ratio, 0.94; 95% confidence interval, 0.89–0.99). Conclusion. Explanation of the follow-up care plan, beyond the written component, enhances survivor self-efficacy for managing cancer as a chronic condition—an important mediator for improving health care utilization outcomes. Implications for Practice: Older
Sanders, Jason L.
In recent years, the decline in youth smoking rates has stopped as the tobacco industry strives to successfully reclaim market areas where it has lost favor. The plateau in lung cancer incidence and stagnation in progress toward smoking abstinence illustrates the necessity for renewed efforts to fight tobacco use. Barriers to fighting tobacco use exist in both the clinical arena and within the general population, but can be overcome. Primary care physicians (PCPs) are uniquely poised to successfully treat nicotine dependence with strategic targeting of these barriers, improved training in smoking cessation techniques, and focused political efforts in tobacco control. Herein, this article describes the landscape of tobacco use in America and provides background, methodology, and resources for PCPs to help achieve the goals of Healthy People 2010 in reducing the illness, disability, and death that occur as a result of tobacco use and exposure to secondhand smoke. PMID:18172737
Brown, Jeremy; Grudzen, Corita; Kyriacou, Demetrios N; Obermeyer, Ziad; Quest, Tammie; Rivera, Donna; Stone, Susan; Wright, Jason; Shelburne, Nonniekaye
To identify research priorities and appropriate resources and to establish the infrastructure required to address the emergency care of patients with cancer, the National Institutes of Health's National Cancer Institute and the Office of Emergency Care Research sponsored a one-day workshop, "Cancer and Emergency Medicine: Setting the Research Agenda," in March 2015 in Bethesda, MD. Participants included leading researchers and clinicians in the fields of oncology, emergency medicine, and palliative care, and representatives from the National Institutes of Health. Attendees were charged with identifying research opportunities and priorities to advance the understanding of the emergency care of cancer patients. Recommendations were made in 4 areas: the collection of epidemiologic data, care of the patient with febrile neutropenia, acute events such as dyspnea, and palliative care in the emergency department setting.
Gesell, Sabina B; Gregory, Nancy
In parallel to developing new cancer therapies, the healthcare community has the responsibility of creating positive treatment experiences for patients. Data from 5907 cancer outpatients treated at 23 hospitals across the United States were analyzed to identify the top priorities for service improvement in outpatient cancer treatment facilities. They included meeting patients' emotional needs, providing information to patients and family members, reducing waiting times, and providing convenience and coordinated care among physicians and other care providers.
Randall, Thomas C.; Ghebre, Rahel
Virtually all cases of invasive cervical cancer are associated with infection by high-risk strains of human papilloma virus. Effective primary and secondary prevention programs, as well as effective treatment for early-stage invasive cancer have dramatically reduced the burden of cervical cancer in high-income countries; 85% of the mortality from cervical cancer now occurs in low- and middle-income countries. This article provides an overview of challenges to cervical cancer care in sub-Saharan Africa (SSA) and identifies areas for programmatic development to meet the global development goal to reduce cancer-related mortality. Advanced stage at presentation and gaps in prevention, screening, diagnostic, and treatment capacities contribute to reduced cervical cancer survival. Cost-effective cervical cancer screening strategies implemented in low resource settings can reduce cervical cancer mortality. Patient- and system-based barriers need to be addressed as part of any cervical cancer control program. Limited human capacity and infrastructure in SSA are major barriers to comprehensive cervical cancer care. Management of early-stage, locally advanced or metastatic cervical cancer involves multispecialty care, including gynecology oncology, medical oncology, radiology, pathology, radiation oncology, and palliative care. Investment in cervical cancer care programs in low- and middle-income countries will need to include effective recruitment programs to engage women in the community to access cancer screening and diagnosis services. Though cervical cancer is a preventable and treatable cancer, the challenges to cervical control in SSA are great and will require a broadly integrated and sustained effort by multiple stakeholders before meaningful progress can be achieved. PMID:27446806
Randall, Thomas C; Ghebre, Rahel
Virtually all cases of invasive cervical cancer are associated with infection by high-risk strains of human papilloma virus. Effective primary and secondary prevention programs, as well as effective treatment for early-stage invasive cancer have dramatically reduced the burden of cervical cancer in high-income countries; 85% of the mortality from cervical cancer now occurs in low- and middle-income countries. This article provides an overview of challenges to cervical cancer care in sub-Saharan Africa (SSA) and identifies areas for programmatic development to meet the global development goal to reduce cancer-related mortality. Advanced stage at presentation and gaps in prevention, screening, diagnostic, and treatment capacities contribute to reduced cervical cancer survival. Cost-effective cervical cancer screening strategies implemented in low resource settings can reduce cervical cancer mortality. Patient- and system-based barriers need to be addressed as part of any cervical cancer control program. Limited human capacity and infrastructure in SSA are major barriers to comprehensive cervical cancer care. Management of early-stage, locally advanced or metastatic cervical cancer involves multispecialty care, including gynecology oncology, medical oncology, radiology, pathology, radiation oncology, and palliative care. Investment in cervical cancer care programs in low- and middle-income countries will need to include effective recruitment programs to engage women in the community to access cancer screening and diagnosis services. Though cervical cancer is a preventable and treatable cancer, the challenges to cervical control in SSA are great and will require a broadly integrated and sustained effort by multiple stakeholders before meaningful progress can be achieved.
A pioneering residential child care project in inner city Dublin began operations in July 1981. The project was designed to function as a resource for seriously deprived or at-risk children and their families. The community served is one characterized by exceptionally high unemployment, a 10 percent rate of heroin addiction among local 15- to…
Bultz, Barry D; Travado, Luzia; Jacobsen, Paul B; Turner, Jane; Borras, Josep M; Ullrich, Andreas W H
The International Psycho-oncology Society (IPOS) has just celebrated its 30th anniversary. The growth of psychosocial oncology has been exponential, and this relatively new field is becoming a core service that focuses on prevention, reducing the burden of cancer, and enhancing the quality of life from time of diagnosis, through treatment, survivorship, and palliative care. Looking back over the past 30 years, we see that cancer care globally has evolved to a new and higher standard. Today, 'cancer care for the whole patient' is being accomplished with an evidence-based model that addresses psychosocial needs and integrates psycho-oncology into the treatment and care of patients. The President's Plenary Session in Lisbon, Portugal, highlighted the IPOS Mission of promoting global excellence in psychosocial care of people affected by cancer through our research, public policy, advocacy, and education. The internationally endorsed IPOS Standard of Quality Cancer Care, for example, clearly states the necessity of integrating the psychosocial domain into routine care, and that distress should be measured as the sixth vital sign after temperature, blood pressure, pulse, respiratory rate, and pain. The plenary paper also discussed the global progress being made in Europe, North America, and Australia in providing quality cancer care for the whole patient. Collaborative partnerships between IPOS and organizations such as the European Partnership Action Against Cancer and the World Health Organization are essential in building capacity for the delivery of high-quality psycho-oncology services in the future.
Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim
The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.
Hayes, Daniel F
Physicians have provided personalized care with as much precision as possible for several centuries. However, increasingly sophisticated understanding of the human genome and of cancer biology has permitted identification of genetic and phenotypic distinctions that might permit development of new tumor biomarker tests for risk categorization, screening, differential diagnosis, prognosis, prediction, and monitoring. Both commercial and academic laboratories are offering tests for single analytes, panels of tests of single analytes, multiparameter assays coalesced into a signature, and total genomic, transcriptomic, or proteomic analyses. However, the absence of a consistent regulatory environment has led to marketing of assays without proven analytic validity or clinical utility. U.S. Food and Drug Administration (FDA) approval or clearance does not necessarily imply that use of the test will improve patient outcomes, and FDA discretion to permit laboratory-developed tests results in unknown benefit, or harm, of others. In this regard, a "bad tumor marker is as bad as a bad drug." Caveat emptor is not a satisfactory approach to delivering high-quality care. Rather, adoption of tumor biomarker tests should be based on high levels of evidence generated in scientifically rigorous studies that demonstrate both analytical validity and clinical utility. Doing so will ensure that clinicians and patients are confident that a tumor biomarker test is likely to improve their outcomes.
Aubin, Michèle; Vézina, Lucie; Verreault, René; Fillion, Lise; Hudon, Éveline; Lehmann, François; Leduc, Yvan; Bergeron, Rénald; Reinharz, Daniel; Morin, Diane
PURPOSE There has been little research describing the involvement of family physicians in the follow-up of patients with cancer, especially during the primary treatment phase. We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician’s involvement in their follow-up at the different phases of cancer. METHODS In 5 hospitals in the province of Quebec, Canada, patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months, whether they had metastasis or not, for a maximum of 18 months, to assess aspects of their family physician’s involvement in cancer care. RESULTS Of the 395 participating patients, 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer. A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey, except at the advanced phase, where a majority attributed this role to their family physician. At baseline, only 16% of patients perceived a shared care pattern between their family physician and oncologists, but this proportion increased with cancer progression. Most patients would have liked their family physician to be more involved in all aspects of cancer care. CONCLUSIONS Although patients perceive that the oncology team is the main party responsible for the follow-up of their lung cancer, they also wish their family physicians to be involved. Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow-up. PMID:21060123
Hui, David; Elsayem, Ahmed; Li, Zhijun; De La Cruz, Maxine; Palmer, J Lynn; Bruera, Eduardo
BACKGROUND Cancer patients admitted to a palliative care unit generally have a poor prognosis. The role of antineoplastic therapy (ANT) in these patients is controversial. We examined the frequency and predictors associated with ANT use in hospitalized patients who required an acute palliative care unit (APCU) stay. METHODS We included all 2604 patients admitted over a five-year period to a 12-bed APCU located within a National Cancer Institute comprehensive cancer center, where patients can access both palliative care and ANT. We retrospectively retrieved from institutional databases patient demographics, cancer diagnosis, ANT use, length of hospital stay, and survival from time of admission. RESULTS The median hospital stay was 11 days and the median survival was 22 days. During hospitalization, 435 patients (17%) received ANT, including chemotherapy (N=297, 11%), hormonal agents (N=54, 2%) and targeted therapy (N=155, 6%). No significant change in frequency of ANT use was detected over the 5 year period. Multivariate logistic regression analysis revealed that younger age, specific cancer diagnoses and longer admissions were independently associated with ANT use. CONCLUSION The use of ANT during hospitalization that included an APCU stay was limited to a small percentage of patients, and did not increase over time. ANT use was associated with younger age, specific cancer diagnoses and longer admissions. The APCU facilitates simultaneous care where patients access palliative care while on ANT. PMID:20162701
Thomson, Maria D.; Siminoff, Laura A.
Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer…
Baudendistel, I; Winkler, E C; Kamradt, M; Brophy, S; Längst, G; Eckrich, F; Heinze, O; Bergh, B; Szecsenyi, J; Ose, D
Cross-sectoral cancer care is complex and involves collaboration from health care professionals (HCPs) across multiple sectors. However, when health information exchange (HIE) is not adequate, it results in impeded coordination and continuity of care. A web-based personal electronic health record (PEPA) under patients' control, providing access to personal health data across sectors, is being developed. Aim of this study was to explore perceived benefits and concerns. Using a qualitative approach, 10 focus groups were performed collecting views of three prospective user groups: patients with colorectal cancer (n = 12), physicians (n = 17) and other HCPs (n = 16). Representatives from different health sectors across the Rhine-Neckar region (Germany) participated. Data were audio- and videotaped, transcribed verbatim and thematically analysed. Our study shows that patients and HCPs expected a PEPA to enhance cross-sectoral availability of information, cross-sectoral cooperation and facilitate data management. Quality of cancer care was expected to be improved. Concerns were expressed in terms of data protection and data security. Concepts like a PEPA offer the chance to support HIE and avoid gaps of information in cross-sectoral cancer care. This may lead to improvements in coordination and continuity of care. Issues concerning data security and protection have to be addressed.
Chen, Ronald C.; Dusetzina, Stacie B.; Wheeler, Stephanie B.; Jackson, George L.; Nielsen, Matthew E.; Carpenter, William R.; Weinberger, Morris
Purpose: The Centers for Medicare and Medicaid Services recently initiated small reimbursement adjustments to improve the value of care delivered under fee-for-service. To estimate the degree to which reimbursement influences physician decision making, we examined utilization of gonadotropin-releasing hormone (GnRH) agonists among urologists as Part B drug reimbursement varied in a fee-for-service environment. Methods: We analyzed treatment patterns of urologists treating 15,128 men included in SEER-linked Medicare claims who were diagnosed with localized prostate cancer between January 1, 2000, and December 31, 2003. We calculated a reimbursement generosity index to measure differences in GnRH agonist reimbursement among regional Medicare carriers and over time. We used multilevel analysis to control for patient and provider characteristics. Results: Among urologists treating early-stage and lower grade prostate cancer, variation in reimbursement was not associated with overuse of GnRH agonists from 2000 to 2003, a period of guideline stability (odds ratio, 1.00; 95% CI, 0.99 to 1.00). Conclusion: Small differences in androgen-deprivation therapy reimbursement generosity were not associated with differential use. Fee-for-service reimbursement changes currently being implemented to improve quality in fee-for-service Medicare may not affect patterns of cancer care. PMID:26957641
Lee, Stephen; Aranyosi, A J; Wong, Michelle D; Hong, Ji Hyung; Lowe, Jared; Chan, Carol; Garlock, David; Shaw, Scott; Beattie, Patrick D; Kratochvil, Zachary; Kubasti, Nick; Seagers, Kirsten; Ghaffari, Roozbeh; Swanson, Christina D
In developing countries, the deployment of medical diagnostic technologies remains a challenge because of infrastructural limitations (e.g. refrigeration, electricity), and paucity of health professionals, distribution centers and transportation systems. Here we demonstrate the technical development and clinical testing of a novel electronics enabled microfluidic paper-based analytical device (EE-μPAD) for quantitative measurement of micronutrient concentrations in decentralized, resource-limited settings. The system performs immune-detection using paper-based microfluidics, instrumented with flexible electronics and optoelectronic sensors in a mechanically robust, ultrathin format comparable in size to a credit card. Autonomous self-calibration, plasma separation, flow monitoring, timing and data storage enable multiple devices to be run simultaneously. Measurements are wirelessly transferred to a mobile phone application that geo-tags the data and transmits it to a remote server for real time tracking of micronutrient deficiencies. Clinical tests of micronutrient levels from whole blood samples (n=95) show comparable sensitivity and specificity to ELISA-based tests. These results demonstrate instantaneous acquisition and global aggregation of diagnostics data using a fully integrated point of care system that will enable rapid and distributed surveillance of disease prevalence and geographical progression.
Niu, Lizhi; Zhou, Liang; Xu, Kecheng; Mu, Feng
Cryosurgery as one of the ablation methods is performed intraoperatively, laparoscopically or percutaneously, is especially adapted for ablation of prostate cancer, liver cancer, lung cancer, kidney cancer, breast cancer, benign fibroadenomas of breast, uterine tumors and neoplasms of soft tissue. Compared with other ablation methods (such as radiofrequency and microwave ablation), cryoablation has several advantages on therapeutic efficacy, imaging guidance and modality.
Adenocarcinoma of the Lung; Mucinous Adenocarcinoma of the Colon; Mucinous Adenocarcinoma of the Rectum; Signet Ring Adenocarcinoma of the Colon; Signet Ring Adenocarcinoma of the Rectum; Squamous Cell Lung Cancer; Stage I Colon Cancer; Stage I Rectal Cancer; Stage IA Non-small Cell Lung Cancer; Stage IB Non-small Cell Lung Cancer; Stage IIA Colon Cancer; Stage IIA Non-small Cell Lung Cancer; Stage IIA Rectal Cancer; Stage IIB Colon Cancer; Stage IIB Non-small Cell Lung Cancer; Stage IIB Rectal Cancer; Stage IIC Colon Cancer; Stage IIC Rectal Cancer; Stage IIIA Colon Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIA Rectal Cancer; Stage IIIB Colon Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IIIB Rectal Cancer; Stage IIIC Colon Cancer; Stage IIIC Rectal Cancer
Ussher, Jane M; Sandoval, Mirjana; Perz, Janette; Wong, W K Tim; Butow, Phyllis
Women cancer carers have consistently been found to report higher levels of distress than men carers. However, there is little understanding of the mechanisms underlying these gender differences in distress, and a neglect of rewarding aspects of care. We conducted in-depth semistructured interviews with 53 informal cancer carers, 34 women and 19 men, to examine difficult and rewarding aspects of cancer care. Thematic analysis was used to analyze the transcripts. Women were more likely to report negative changes in the relationship with the person with cancer; neglect of self, social isolation, and physical health consequences; anxiety; personal strength and growth; and to position caring as a privilege. Men were more likely to report increased relational closeness with the person with cancer, and the burden of additional responsibilities within the home as a difficult aspect of caring. We interpret these findings in relation to a social constructionist analysis of gender roles.
Colorectal cancer is the second most common cancer in women and the third most common in men worldwide. In this study, we used MEDLINE to conduct a systematic review of existing literature published in English between 2000 and 2010 on patterns of colorectal cancer care. Specifically, this review examined 66 studies conducted in Europe, Australia, and New Zealand to assess patterns of initial care, post-diagnostic surveillance, and end-of-life care for colorectal cancer. The majority of studies in this review reported rates of initial care, and limited research examined either post-diagnostic surveillance or end-of-life care for colorectal cancer. Older colorectal cancer patients and individuals with comorbidities generally received less surgery, chemotherapy, or radiotherapy. Patients with lower socioeconomic status were less likely to receive treatment, and variations in patterns of care were observed by patient demographic and clinical characteristics, geographical location, and hospital setting. However, there was wide variability in data collection and measures, health-care systems, patient populations, and population representativeness, making direct comparisons challenging. Future research and policy efforts should emphasize increased comparability of data systems, promote data standardization, and encourage collaboration between and within European cancer registries and administrative databases. PMID:23962509
Patients with cancer commonly use complementary and integrative medicine, including homeopathy. Homeopathy has grown in popularity with the public but is viewed with skepticism by medical academia and is still excluded from conventionally prescribed treatments. In recent years, homeopathy has been used in cancer care in Europe and other countries worldwide. This use raised the question if there is any benefit in utilizing this type of care with cancer patients. The purpose of this manuscript is to explore the evidence related to the benefit of homeopathy in cancer care. Limited research has suggested that homeopathic remedies appear to cause cellular changes in some cancer cells. In animal models, several homeopathic remedies have had an inhibitory effect on certain tumor development. Some clinical studies of homeopathic remedies combined with conventional care have shown that homeopathic remedies improve quality of life, reduce symptom burden, and possibly improve survival in patients with cancer. The findings from several lab and clinical studies suggest that homeopathy might have some beneficial effect in cancer care; however, further large, comprehensive clinical studies are needed to determine these beneficial effects. Although additional studies are needed to confirm these findings, given the low cost, minimal risks, and the potential magnitude of homeopathy's effects, this use might be considered in certain situations as an additional tool to integrate into cancer care.
... of doctors at a top cancer hospital in India, researchers say. In cases involving more complex cancers, ... of the Manipal Comprehensive Cancer Center in Bengaluru, India. The program then lists possible treatments in three ...
In this editorial, the authors comment on a recently published review paper by Molassiotis et al. on the developments made over the past 40 years in supportive care for patients with lung cancer. During this period, a paradigm shift promoting patient-centered care (PCC) has led to an important change in the approach of supportive cancer care, from a purely disease-centered approach, measuring survival-related outcomes, to recognizing the importance of quality of life outcomes as well. This change of understanding in supportive and palliative care for patients with lung cancer can be further advanced through the understanding that there is a need to address bio-psycho-spiritual concerns and health belief models, within the context of the family socio-cultural environment, for both patients and their caregivers. There is also a need to address the psycho-spiritual effects of cancer on those health care professionals treating patients with lung cancer, in order to reduce compassion fatigue and increase resilience. Future directions for supportive care for patients with lung cancer may include the development of a patient-tailored treatment approach, assisted by the integration of a multidisciplinary team of health care providers and evidence-based complementary medicine practices, within conventional supportive care practice. PMID:26629435
McAlearney, Ann Scheck; Murray, Kelsey; Sieck, Cynthia; Lin, Jenny J.; Bellacera, Bonnie; Bickell, Nina A.
Background Minority breast cancer patients tend to have higher rates of adjuvant treatment underuse. We implemented a web-based intervention that closes referral loops between surgeons and oncologists at inner-city safety net hospitals serving high volumes of minority breast cancer patients to assist these hospitals to improve care coordination. Research Design Following intervention implementation, we conducted interviews with key personnel to improve our understanding of the implementation process and to identify barriers, facilitators, and opportunities for improvement. We used the constant comparative method of analysis to code interview transcripts and identify common themes regarding intervention implementation. Subjects We interviewed 64 administrative and clinical key informants from 10 inner-city safety net hospitals with high volumes of minority breast cancer patients. Results We found substantial barriers to implementing an intervention designed to support care coordination efforts, despite initial feedback that the intervention itself was both easy to use and in line with organizational goals. We also characterized facilitators and challenges of breast cancer care coordination in the safety net environment, as well as opportunities to improve intervention design to support increased quality of breast cancer care. Conclusions Coordination of care for women with breast cancer is extremely important, but safety net hospitals face considerable resource constraints from lack of time, support, and information systems. As safety net hospital networks grow across numerous care sites, the challenge of care coordination will likely increase, highlighting the importance of interventions that can be successfully implemented and used to promote better care. PMID:26565530
Ensuring that surgical cancer patients obtain optimal rehabilitation care (defined here as all care provided post-operatively following cancer surgery) can be challenging because of the fragmented nature of the U.S. healthcare delivery and payment systems. In the managed care environment, surgical cancer patients' access to rehabilitation care is likely to vary by type of health insurance plan, by setting, by type of provider, and by whether care is provided in-network or out-of-network. The author of this article, who negotiates managed care contracts for the Roswell Park Cancer Institute (RPCI), gives examples of strategies used with some success by RPCI to collaborate with local payers to ensure that surgical cancer patients get optimal rehabilitation care, especially as they make the transition from hospital to outpatient care. She suggests that further collaborations of healthcare providers, payers, consumers, and policymakers are needed to help ensure optimal rehabilitation care for surgical cancer patients.
Marshall, Ernie; Krzyzanowska, Monika; Robinson, Bridget; Brown, Sean; Collinson, Fiona; Seligmann, Jennifer; Abbas, Afroze; Rees, Adrian; Swinson, Daniel; Neville-Webbe, Helen; Selby, Peter
Remarkable progress has been made over the past decade in cancer medicine. Personalized medicine, driven by biomarker predictive factors, novel biotherapy, novel imaging, and molecular targeted therapeutics, has improved outcomes. Cancer is becoming a chronic disease rather than a fatal disease for many patients. However, despite this progress, there is much work to do if patients are to receive continuous high-quality care in the appropriate place, at the appropriate time, and with the right specialized expert oversight. Unfortunately, the rapid expansion of therapeutic options has also generated an ever-increasing burden of emergency care and encroaches into end-of-life palliative care. Emergency presentation is a common consequence of cancer and of cancer treatment complications. It represents an important proportion of new presentations of previously undiagnosed malignancy. In the U.K. alone, 20%–25% of new cancer diagnoses are made following an initial presentation to the hospital emergency department, with a greater proportion in patients older than 70 years. This late presentation accounts for poor survival outcomes and is often associated with poor patient experience and poorly coordinated care. The recent development of acute oncology services in the U.K. aims to improve patient safety, quality of care, and the coordination of care for all patients with cancer who require emergency access to care, irrespective of the place of care and admission route. Furthermore, prompt management coordinated by expert teams and access to protocol-driven pathways have the potential to improve patient experience and drive efficiency when services are fully established. The challenge to leaders of acute oncology services is to develop bespoke models of care, appropriate to local services, but with an opportunity for acute oncology teams to engage cancer care strategies and influence cancer care and delivery in the future. This will aid the integration of highly
Clinical trials form the evidence base for medical decision making and may provide patients with life-threatening conditions their best chance to find an effective treatment. A growing number of states and the federal government are mandating coverage of the routine costs of cancer clinical trials, although the extent of coverage varies. Individual health plans are following suit on behalf of their beneficiaries. Trials conducted at the National Cancer Institute (NCI) are an attractive resource for payers, because NCI provides medical services at no charge, enables patient access to promising care, emphasizes continuity with patients' regular physicians, and makes the referral and enrollment process easy and efficient through its Clinical Studies Support Center's toll-free information line 1-888-NCI-1937.
Kim, Chloe S; Vanture, Sarah; Cho, Margaret; Klapperich, Catherine M; Wang, Catharine; Huang, Franklin W
Well-developed point-of-care (POC) cancer screening tools have the potential to provide better cancer care to patients in both developed and developing countries. However, new medical technology will not be adopted by medical providers unless it addresses a population's existing needs and end-users' preferences. The goals of our study were to assess primary care providers' level of awareness, interest, and preferences in using POC cancer screening technology in their practice and to provide guidelines to biomedical engineers for future POC technology development. A total of 350 primary care providers completed a one-time self-administered online survey, which took approximately 10 minutes to complete. A $50 Amazon gift card was given as an honorarium for the first 100 respondents to encourage participation. The description of POC cancer screening technology was provided in the beginning of the survey to ensure all participants had a basic understanding of what constitutes POC technology. More than half of the participants (57%) stated that they heard of the term "POC technology" for the first time when they took the survey. However, almost all of the participants (97%) stated they were either "very interested" (68%) or "somewhat interested" (29%) in using POC cancer screening technology in their practice. Demographic characteristics such as the length of being in the practice of medicine, the percentage of patients on Medicaid, and the average number of patients per day were not shown to be associated with the level of interest in using POC. These data show that there is a great interest in POC cancer screening technology utilization among this population of primary care providers and vast room for future investigations to further understand the interest and preferences in using POC cancer technology in practice. Ensuring that the benefits of new technology outweigh the costs will maximize the likelihood it will be used by medical providers and patients.
Redmond, Jennifer; Vanderpool, Robin; McClung, Rebecca
Background: Patients are more likely to be screened for colorectal cancer if it is recommended by a health care provider. Therefore, it is imperative that providers have access to the latest screening guidelines. Purpose: This practice-based project sought to identify Kentucky primary care providers' preferred sources and methods of receiving…
Lodrigues, William; Dumas, Judy; Rao, Madhu; Lilley, Lisa; Rao, Roshni
To provide evaluations of cancer care quality, the Commission on Cancer and the National Quality Forum (NQF) established three breast cancer treatment quality measures. Programs that submit data to the National Cancer Data Base (NCDB) can receive feedback on their compliance with these quality measures, and perform comparisons with other member institutions. Data received by a county hospital from the NCDB revealed poor compliance. The purpose of this study was to evaluate the accuracy of submitted data, identify contributing factors and initiate processes to improve. Reported 2004 NCDB quality measure compliance was 26% for radiation, 61.4% for chemotherapy, and 21.3% for hormonal therapy. Retrospective treatment review was performed. Data collected included: patient demographics, pathology, final surgical intervention, adjuvant treatment, and quality measure compliance. Sources included two electronic records, an electronic results depository, two paper charts, a pharmacy data base, and a "shadow chart." Applicability of and compliance with these quality measures was noted. Of 540 records reviewed, 132 met final study criteria. Actual compliance differed significantly from NCDB rates and were found to be 97% for radiation, 98% for chemotherapy, and 88% for hormonal therapy. Process analysis revealed the need for tumor registry staff to evaluate all sources of data. A significant problem was neo-adjuvant chemotherapy and the requirement to submit NCDB data within 6 months of initial diagnosis. Processes and education initiated for tumor registry staff, medical records personnel, physicians, and other care providers resulted in significantly improved 2007 compliance of data submitted to the NCDB. Prior to public reporting, institutions should perform NQF quality measure compliance assessments, confirm accuracy, and initiate educational processes/imperatives.
Afiyanti, Yati; Rachmawati, Imami Nur; Milanti, Ariesta
Objective: This study aims to describe the factors affecting successful nursing care intervention on sexuality. Methods: A one-group pre- and post-test design was used. Fifty-three cervical cancer survivors and their spouses were administered with nursing care intervention on sexuality in three sessions and evaluated after 6 weeks. Results: Sexual intervention reduced dyspareunia symptoms, improved vaginal lubrication, improved sexual satisfaction, and enhanced sexual arousal, sexual desire, and orgasm among cancer survivors and their spouses. The other influencing factors also simultaneously contributed to the success of nursing care intervention. Conclusions: Nursing care intervention on sexuality could be a part of supportive nursing care and an important aspect in standard nursing care for cancer patients in Indonesia. PMID:27981170
Babin, Emmanuel; Heutte, Natacha; Grandazzi, Guillaume; Prévost, Virginie; Robard, Laetitia
The quality of life of patients treated for head and neck cancers and their carers is part of the current concerns of health care teams. Assessment tools were created and helped to highlight the severe physical effects (pain, mucositis…) and chronic (mutilation, post-radiation complications…) related to the disease or to different treatments but also to consider the psychosocial impact of this disease. Improving the quality of life through a thoughtful and comprehensive support that must be associated with somatic care, mental health care, rehabilitation and inclusion of social difficulties and suffering relatives. Supportive care shall ensure a good quality of life for patients treated and their families but also reduce the physical effects associated with the disease and treatment. They rely on coordination of care including the cancer networks established in the cancer plan to ensure comprehensive and continuous care for these patients.
Tinmouth, Jill; Ritvo, Paul; McGregor, S. Elizabeth; Patel, Jigisha; Guglietti, Crissa; Levitt, Cheryl A.; Paszat, Lawrence F.; Rabeneck, Linda
Abstract Objective To describe the perceptions of those who received invitations to the ColonCancerCheck Primary Care Invitation Pilot (the Pilot) about the mailed invitation, colorectal cancer (CRC) screening in general, and their specific screening experiences. Design Qualitative study with 6 focus group sessions, each 1.5 hours in length. Setting Hamilton, Ont; Ottawa, Ont; and Thunder Bay, Ont. Participants Screening-eligible adults, aged 50 years and older, who received a Pilot invitation for CRC screening. Methods The focus groups were conducted by a trained moderator and were audiorecorded and transcribed verbatim. The transcripts were analyzed using grounded-theory techniques facilitated by the use of electronic software. Main findings Key themes related to the invitation letter, the role of the family physician, direct mailing of the fecal occult blood testing (FOBT) kit, and alternate CRC screening promotion strategies were identified. Specifically, participants suggested the letter content should use stronger, more powerful language to capture the reader’s attention. The importance of the family physician was endorsed, although participants favoured clarification of the physician and program roles in the actual mailed invitation. Participants expressed support for directly mailing FOBT kits to individuals, particularly those with successful previous test completion, and for communication of both negative and positive screening results. Conclusion This study yielded a number of important findings including strategies to optimize letter content, support for directly mailed FOBT kits, and strategies to report results that might be highly relevant to other health programs where population-based CRC screening is being considered. PMID:24336559
Varner, Ashley; Ellis, Erin; Ebner, Stephen; Moxley, John; Siegrist, Erika; Weng, David
Background and Purpose. The cost of illness in cancer care and the subsequent distress has attracted scrutiny. Guidelines recommend enhanced discussion of costs, assuming this will reduce both stress and costs. Little is known about patient attitudes about cost considerations influencing treatment decisions. Methods. A convenience-sample survey of patients currently receiving radiation and/or intravenous chemotherapy at an outpatient cancer center was performed. Assessments included prevalence and extent of financial burden, level of financial distress, attitudes about using costs to influence treatment decisions, and frequency or desirability of cost discussions with oncologists. Results. A total of 132 participants (94%) responded. Overall, 47% reported high financial stress, 30.8% felt well informed about costs prior to treatment, and 71% rarely spoke to their oncologists about cost. More than 71% of patients did not want either society’s or personal costs to influence treatment, and this result did not change based on degree of financial stress. Even when asked to assume that lower cost regimens were equally effective, only 28% would definitely want the lower cost regimen. Patients did not believe it was the oncologist’s duty to perform cost discussions. Conclusion. Even insured patients have a high degree of financial distress. Most, including those with the highest levels of distress, did not speak often with oncologists about costs and were strongly adverse to having cost considerations influence choice of regimen. The findings suggest that patients are not cost sensitive with regard to treatment decisions. Oncologists will require improved tools to have meaningful cost discussion, as recommended by the American Society of Clinical Oncology. Implications for Practice: This study raises important questions regarding optimal communication with patients about costs. If patients are not cost sensitive regarding treatment decisions, they will not be full
Richards, Thomas B.; White, Mary C.; Caraballo, Ralph S.
This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary care providers. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary care providers should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients. PMID:24830610
Bakitas, Marie; Lyons, Kathleen Doyle; Hegel, Mark T.; Ahles, Tim
Purpose To understand oncology clinicians’ perspectives about the care of advanced cancer patients following the completion of the ENABLE II (Educate, Nurture, Advise, Before Life Ends) randomized clinical trial (RCT) of a concurrent oncology palliative care model. Methods Qualitative interview study of 35 oncology clinicians about their approach to patients with advanced cancer and the effect of the ENABLE II RCT. Results Oncologists believed that integrating palliative care at the time of an advanced cancer diagnosis enhanced patient care and complemented their practice. Self-assessment of their practice with advanced cancer patients comprised four themes: 1) treating the whole patient, 2) focusing on quality versus quantity of life, 3) “some patients just want to fight”, and 4) helping with transitions; timing is everything. Five themes comprised oncologists’ views on the complementary role of palliative care: 1) “refer early and often”, 2) referral challenges: “Palliative” equals hospice; “Heme patients are different”, 3) palliative care as consultants or co-managers, 4) palliative care “shares the load”, and 5) ENABLE II facilitated palliative care integration. Conclusions Oncologists described the RCT as holistic and complementary, and as a significant factor in adopting concurrent care as a standard of care. PMID:23040412
Milam, Joel; Meeske, Kathleen; Slaughter, Rhona; Sherman-Bien, Sandra; Ritt-Olson, Anamara; Kuperberg, Aura; Freyer, David R.; Hamilton, Ann S.
Background Follow-up care is critical for childhood cancer survivors (CCS) who are at high risk for co-morbidities and late effects of cancer treatments. Understanding factors associated with maintaining follow-up care is needed, especially for Hispanic CCS who are underrepresented in previous studies. Methods Risk and protective factors for receiving cancer-related follow-up care were examined among 193 Los Angeles County CCS diagnosed between 2000–2007 (54% Hispanic; mean age=19.9, SD=2.8; mean age at diagnosis=12.1, SD=3.0; mean years since diagnosis=7.8, SD=2.0). Self-report surveys assessed follow-up care, insurance status, demographics, clinical factors, and psychosocial risk (e.g., depression) and protective [e.g., self-efficacy (SE)] factors. Multivariable logistic regression was used to determine factors associated with previous (in prior 2 years) and intent for future cancer-related follow-up care. Results Seventy-three percent of CCS reported a cancer follow-up visit in the prior 2 years, which was positively associated (p’s<.05) with having health insurance, White ethnicity (vs. Hispanic), younger age and greater treatment intensity. Sixty-nine percent reported intent for follow-up care in the next two years, which was positively associated (p’s<.05) with having health insurance and greater SE. Conclusions Hispanics and older CCS are more likely to lack previous follow-up care. Because health insurance was strongly associated with both previous follow-up care and intent to seek care, recent changes in health coverage may improve follow-up among CCS. Interventions targeting improved SE may help increase intent to receive follow-up care for this population. PMID:25345867
Obre, Emilie; Rossignol, Rodrigue
The field of energy metabolism dramatically progressed in the last decade, owing to a large number of cancer studies, as well as fundamental investigations on related transcriptional networks and cellular interactions with the microenvironment. The concept of metabolic flexibility was clarified in studies showing the ability of cancer cells to remodel the biochemical pathways of energy transduction and linked anabolism in response to glucose, glutamine or oxygen deprivation. A clearer understanding of the large-scale bioenergetic impact of C-MYC, MYCN, KRAS and P53 was obtained, along with its modification during the course of tumor development. The metabolic dialog between different types of cancer cells, but also with the stroma, also complexified the understanding of bioenergetics and raised the concepts of metabolic symbiosis and reverse Warburg effect. Signaling studies revealed the role of respiratory chain-derived reactive oxygen species for metabolic remodeling and metastasis development. The discovery of oxidative tumors in human and mice models related to chemoresistance also changed the prevalent view of dysfunctional mitochondria in cancer cells. Likewise, the influence of energy metabolism-derived oncometabolites emerged as a new means of tumor genetic regulation. The knowledge obtained on the multi-site regulation of energy metabolism in tumors was translated to cancer preclinical studies, supported by genetic proof of concept studies targeting LDHA, HK2, PGAM1, or ACLY. Here, we review those different facets of metabolic remodeling in cancer, from its diversity in physiology and pathology, to the search of the genetic determinants, the microenvironmental regulators and pharmacological modulators.
Bakkum-Gamez, Jamie N.; Laughlin, Shannon K.; Jensen, Jani R.; Akogyeram, Clement O.; Pruthi, Sandhya
Premenopausal women with a new diagnosis of breast cancer are faced with many challenges. Providing health care for issues such as gynecologic comorbidities, reproductive health concerns, and vasomotor symptom control can be complicated because of the risks of hormone treatments and the adverse effects of adjuvant therapies. It is paramount that health care professionals understand and be knowledgeable about hormonal and nonhormonal treatments and their pharmacological parameters so they can offer appropriate care to women who have breast cancer, with the goal of improving quality of life. Articles for this review were identified by searching the PubMed database with no date limitations. The following search terms were used: abnormal uterine bleeding, physiologic sex steroids, endometrial ablation, hysteroscopic sterilization, fertility preservation in endometrial cancer, tranexamic acid and breast cancer, menorrhagia treatment and breast cancer, abnormal uterine bleeding and premenopausal breast cancer, levonorgestrel IUD and breast cancer, tamoxifen and gynecologic abnormalities, tamoxifen metabolism, hormones and breast cancer risk, contraception and breast cancer, pregnancy and breast cancer, and breast cancer and infertility treatment. PMID:21307388
Roxin, Áron; Zheng, Gang
Peptides can serve as versatile cancer-targeting ligands and have been used for clinically relevant applications such as cancer imaging and therapy. A current and long-standing focus within peptide research is the creation of structurally constrained peptides generated through cyclization. Cyclization is envisioned to enhance the selective binding, uptake, potency and stability of linear precursors. This review compares closely related linear and cyclic peptides in these respects. Peptide cyclization generally improves the selective binding and stability of linear precursors; however, not all cyclization strategies and constrained geometries enhance these properties to the same extent. In some instances, linear analogues actually have better cancer-targeting properties compared with their cyclic counterparts. Although cyclization does not necessarily improve the cancer-targeting properties of linear analogues, cyclic peptides may obtain properties that allow them to be used for additional applications. This review aims to convey the advantages and limitations of cyclic cancer-targeting peptides.
Casey, Petra M; Faubion, Stephanie S; MacLaughlin, Kathy L; Long, Margaret E; Pruthi, Sandhya
The breast cancer care continuum entails detection, diagnosis, treatment, and survivorship. During this time, focus on the whole woman and medical concerns beyond the breast cancer diagnosis itself is essential. In this comprehensive review, we critically review and evaluate recent evidence regarding several topics pertinent to and specific for the woman living with a prior history of breast cancer. More specifically, we discuss the most recent recommendations for contraceptive options including long-acting reversible contraception and emergency contraception, fertility and pregnancy considerations during and after breast cancer treatment, management of menopausal vasomotors symptoms and vulvovaginal atrophy which often occurs even in young women during treatment for breast cancer. The need to directly query the patient about these concerns is emphasized. Our focus is on non-systemic hormones and non-hormonal options. Our holistic approach to the care of the breast cancer survivor includes such preventive health issues as sexual and bone health,which are important in optimizing quality of life. We also discuss strategies for breast cancer recurrence surveillance in the setting of a prior breast cancer diagnosis. This review is intended for primary care practitioners as well as specialists caring for female breast cancer survivors and includes key points for evidence-based best practice recommendations. PMID:25302171
Gianti, Eleonora; Zauhar, Randy J
Prostate Cancer (PCa), a leading cause of cancer death worldwide (www.cancer.gov), is a complex malignancy where a spectrum of targets leads to a diversity of PCa forms. A widely pursued therapeutic target is the Androgen Receptor (AR). As a Steroid Hormone Receptor, AR serves as activator of transcription upon binding to androgens and plays a central role in the development of PCa. AR is a structurally flexible protein, and conformational plasticity of residues in the binding-pocket is a key to its ability to accommodate ligands from various chemical classes. Besides direct modulation of AR activity by antagonists, inhibition of cytochrome CYP17 (17α-hydroxylase/17,20-lyase), essential in androgen biosynthesis, has widely been considered an effective strategy against PCa. Interestingly, Handratta et al. (2005) discovered new, potent inhibitors of CYP17 (C-17 steroid derivatives) with pure AR antagonistic properties. Although the antiandrogenic activity of their lead compound (VN/124-1) has been experimentally proven both in vitro and in vivo, no structural data are currently available to elucidate the molecular determinants responsible for these desirable dual inhibitory properties. We implemented a Structure-based Drug Design (SBDD) approach to generate a valuable hypothesis as to the binding modes of steroidal CYP17 inhibitors/antiandrogens against the AR. To deal with the plasticity of residues buried in the Ligand Binding Domain (LBD), we developed a flexible-receptor Docking protocol based on Induced-Fit (IFD) methodology (www.schrodinger.com/). Our results constitute an ideal starting point for the rational design of next-generation analogues of CYP17 inhibitors/antiandrogens as well as an attractive tool to suggest novel chemical classes of AR antagonists.
Dudevich, Alexey; Chen, Allie; Gula, Cheryl; Fagbemi, Josh
Cancer is the leading cause of death in Canada, and the number of new cases is expected to increase as the population ages and grows. This study examined the use of hospital services in the last month of life by adult cancer patients who died in Canadian acute care hospitals in fiscal year 2012-2013. Almost 25,000 Canadian cancer patients - excluding those in Quebec - died in acute care hospitals, representing approximately 45% of the estimated cancer deaths in 2012-2013. The proportion of in-hospital deaths varied across jurisdictions. Twenty-three percent of these patients were admitted to acute care multiple times in their last 28 days of life, with a higher percentage for rural (29%) compared to urban (21%) patients. Relatively few patients used intensive care units or received inpatient chemotherapy in their last 14 days of life.
Yamakawa, Jun-ichi; Motoo, Yoshiharu; Moriya, Junji; Ogawa, Masao; Uenishi, Hiroaki; Akazawa, Sumiyo; Sasagawa, Toshiyuki; Nishio, Matomo; Kobayashi, Junji
The current standard treatment for cancer is a multidisciplinary therapy whereby various types of treatment are properly combined. Chemotherapy with multiple anticancer drugs is now common, and traditional, complementary, and alternative therapies are adopted as supportive measures. Medical care in Japan is distinguished by the ability for patients to access both Western and Kampo medical cares at the same time. There is a high degree of trust in the safety of Kampo therapies because they are practiced by medical doctors who are educated with fundamental diagnosis of Western medicine. Highly reliable clinical studies are being published, demonstrating that palliative or supportive care for cancer patients using Kampo preparations alleviates adverse effects of chemotherapy or radiotherapy. This paper reports the circumstances around cancer care in Japan where traditional therapeutic Kampo formulas are used for patients undergoing cancer treatment with cutting-edge chemotherapy, specifically to alleviate adverse effects of anticancer drugs. PMID:23861712
Anxiety; Fatigue; Nausea and Vomiting; Neurotoxicity Syndrome; Recurrent Fallopian Tube Carcinoma; Recurrent Ovarian Carcinoma; Recurrent Primary Peritoneal Carcinoma; Stage I Ovarian Cancer; Stage IA Fallopian Tube Cancer; Stage IB Fallopian Tube Cancer; Stage IC Fallopian Tube Cancer; Stage II Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIB Fallopian Tube Cancer; Stage IIC Fallopian Tube Cancer; Stage III Ovarian Cancer; Stage III Primary Peritoneal Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIC Fallopian Tube Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer; Stage IV Primary Peritoneal Cancer
Wognum, S.; Chai, X.; Hulshof, M. C. C. M.; Bel, A.; Bondar, L.; Zolnay, A. G.; Hoogeman, M. S.
Purpose: Future developments in image guided adaptive radiotherapy (IGART) for bladder cancer require accurate deformable image registration techniques for the precise assessment of tumor and bladder motion and deformation that occur as a result of large bladder volume changes during the course of radiotherapy treatment. The aim was to employ an extended version of a point-based deformable registration algorithm that allows control over tissue-specific flexibility in combination with the authors' unique patient dataset, in order to overcome two major challenges of bladder cancer registration, i.e., the difficulty in accounting for the difference in flexibility between the bladder wall and tumor and the lack of visible anatomical landmarks for validation. Methods: The registration algorithm used in the current study is an extension of the symmetric-thin plate splines-robust point matching (S-TPS-RPM) algorithm, a symmetric feature-based registration method. The S-TPS-RPM algorithm has been previously extended to allow control over the degree of flexibility of different structures via a weight parameter. The extended weighted S-TPS-RPM algorithm was tested and validated on CT data (planning- and four to five repeat-CTs) of five urinary bladder cancer patients who received lipiodol injections before radiotherapy. The performance of the weighted S-TPS-RPM method, applied to bladder and tumor structures simultaneously, was compared with a previous version of the S-TPS-RPM algorithm applied to bladder wall structure alone and with a simultaneous nonweighted S-TPS-RPM registration of the bladder and tumor structures. Performance was assessed in terms of anatomical and geometric accuracy. The anatomical accuracy was calculated as the residual distance error (RDE) of the lipiodol markers and the geometric accuracy was determined by the surface distance, surface coverage, and inverse consistency errors. Optimal parameter values for the flexibility and bladder weight
Ross, Louie E.; Stroud, Leonardo A.; Rose, Shyanika W.; Jorgensen, Cynthia M.
African-American men have a greater burden from prostate cancer than do white men and men of other races/ethnicities in the United States. To date, there have been no studies of how African-American primary care physicians screen their patients for prostate cancer. The purpose of this study was to examine the use of telephone focus groups as a methodology and to learn about this practice among a group of African-American primary care physicians. A total of 41 physicians participated in eight telephone focus groups. Results from the study are found in a separate article. Regarding telephone focus group methodology, we found that a majority of the physicians in this study preferred telephone focus groups over the conventional face-to-face focus groups. We also discuss some of the advantages (e.g., no travel, high acceptance rates, more flexibility than in-person groups, and general cost efficiency) as well as disadvantages (e.g., nonverbal communication limits and reduction of group interaction) of this methodology. This methodology may prove useful in studies involving African-American physicians, physicians in general and other difficult-to-reach healthcare professionals. PMID:16916127
Tin Tin, Sandar; Elwood, J. Mark; Lawrenson, Ross; Campbell, Ian; Harvey, Vernon; Seneviratne, Sanjeewa
Background Patients who received private health care appear to have better survival from breast cancer compared to those who received public care. This study investigated if this applied to New Zealand women and identified factors that could explain such disparities. Methods This study involved all women who were diagnosed with primary breast cancer in two health regions in New Zealand, covering about 40% of the national population, between June 2000 and May 2013. Patients who received public care for primary treatment, mostly surgical treatment, were compared with those who received private care in terms of demographics, mode of presentation, disease factors, comorbidity index and treatment factors. Cox regression modelling was performed with stepwise adjustments, and hazards of breast cancer specific mortality associated with the type of health care received was assessed. Results Of the 14,468 patients, 8,916 (61.6%) received public care. Compared to patients treated in private care facilities, they were older, more likely to be Māori, Pacifika or Asian and to reside in deprived neighbourhoods and rural areas, and less likely to be diagnosed with early staged cancer and to receive timely cancer treatments. They had a higher risk of mortality from breast cancer (hazard ratio: 1.95; 95% CI: 1.75, 2.17), of which 80% (95% CI: 63%, 100%) was explained by baseline differences, particularly related to ethnicity, stage at diagnosis and type of loco-regional therapy. After controlling for these demographic, disease and treatment factors, the risk of mortality was still 14% higher in the public sector patients. Conclusions Ethnicity, stage at diagnosis and type of loco-regional therapy were the three key contributors to survival disparities between patients treated in public and private health care facilities in New Zealand. The findings underscore the need for more efforts to improve the quality, timeliness and equitability of public cancer care services. PMID:27054698
Kang, Ravinder; Goodney, Philip P.; Wong, Sandra L.
The cost of cancer care in the U.S. has increased by fivefold over the last three decades. Rising cancer prevalence, costly pharmaceuticals, physician and facility fees have all contributed to the expenditure. As our healthcare system shifts from volume to value, greater scrutiny of interventions with clinical equipoise is required. Traditionally, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) have served as surrogate markers for value. However, these calculations fail to incorporate population or patient preferences. The diagnosis and treatment of prostate cancer, breast cancer and thyroid cancer are used as a framework to discuss value and cost-effectiveness. PMID:27334052
Maddison, André R; Asada, Yukiko; Urquhart, Robin
Despite the policy and research attention on ensuring equitable access--equal access for equal need--to health care, research continues to identify inequities in access to cancer services. We conducted a literature review to identify the current state of knowledge about inequity in access to cancer health services in Canada in terms of the continuum of care, disease sites, and dimensions of inequity (e.g., income). We searched MEDLINE, CINAHL, and Embase for studies published between 1990 and 2009. We retrieved 51 studies, which examine inequity in access to cancer services from screening to end-of-life care, for multiple cancer types, and a variety of socioeconomic, geographic, and demographic factors that may cause concern for inequity in Canada. This review demonstrates that income has the most consistent influence on inequity in access to screening, while age and geography are most influential for treatment services and end-of-life care, even after adjusting for patient need. Our review also reports on methods used in the literature and new techniques to explore. Equitable access to cancer care is vitally important in all health systems. Obtaining information on the current status of inequities in access to cancer care is a critical first step toward action.
Malloy, Pam; Boit, Juli; Tarus, Allison; Marete, Joyce; Ferrell, Betty; Ali, Zipporah
Cancer is the third highest cause of death in Kenya, preceded by infectious and cardiovascular diseases, and in most cases, diagnosed in later stages. Nurses are the primary caregivers, assessing and managing these patients in the clinic, in inpatient settings, and in rural and remote communities. While cancer rates remain high, the burden to the patient, the caregiver, and society as a whole continues to rise. Kenya's poverty complicates cancer even further. Many Kenyans are unaware of cancer's signs and symptoms, and limited diagnostic and treatment centers are available. Despite these barriers, there is still hope and help for those in Kenya, who suffer from cancer. The World Health Organization has stated that palliative care is a basic human right and nurses providing this care in Kenya are making efforts to support cancer patients’ ongoing needs, in order to promote compassionate palliative care and prevent suffering. The purpose of this paper is to address the palliative care needs of patients with cancer in Kenya by providing education to nurses and influencing health-care policy and education at micro and macro levels. A case study weaved throughout will highlight these issues. PMID:28217729
Jiang, Shantong; Li, Pingping
Lung cancer is the leading cause of death among all cancers in China. It also has the highest incidence when compared to other cancers. Almost half of all lung cancers occur over 70-year-old. Approximately 85% of all lung cancers are non-small cell lung cancer (NSCLC). The majority of patients are advanced lung cancer. Due to the unique alterations in physiology, elderly patients are at a greater risk of toxicity from chemotherapy. Palliative care as a special medical care is an important treatment for elderly patients with advanced NSCLC. Low-dose palliative radiotherapy can improve respiratory symptoms in elderly patients with NSCLC, with the tolerated side effects. Elderly patients with epidermal growth factor receptor (EGFR) mutation can benefit from gefitinib and have a good tolerate of erlotiib. Cryocare Surgical System has an increasing trend of application in the treatment of elderly patients with NSCLC. Chinese medicine has effects in improving clinical symptoms and reducing side effects of chemotherapy, it can also improve the quality of life in these patients. Psychosocial support therapy can alleviate the burden of patients with NSCLC to some extent, but needs to improve its systematicness. Assessment and the time of palliative care are two important factors which determine the outcome of patients. We introduce the progress in palliative care benefit of elderly NSCLC, in order to provide the basis for palliative care of elderly NSCLC.
Griffiths, Jane; Ewing, Gail; Rogers, Margaret; Barclay, Stephen; Martin, Anna; McCabe, Janet; Todd, Chris
The aim of this study was to examine UK district nurses' perceptions of their role in supporting palliative care cancer patients. Patients with cancer are living longer with the disease. District nurses are the largest UK workforce caring for people with cancer at home, the preferred place of care. Meeting patients' supportive and palliative care needs is complex. Little is known about district nurses' supportive role in the early phase of palliative care. Semistructured interviews were conducted with 34 district nurses. Data were analyzed thematically, with assistance from Atlas/ti. A dominant theme emerging from the interviews was ambiguity in the district nurses' supportive role in early palliative care. District nurses discussed the importance of making contact early on to support cancer patients and their families but had difficulty articulating this "support." Ambiguity, lack of confidence, and perceived skill deficits presented district nurses with dilemmas that were difficult to resolve. District nurses have great potential for meeting cancer patients' supportive and palliative care needs, a potential not currently realized. Education alone is unlikely to improve practice without an understanding of the tensions faced by district nurses in their work. Recognizing and addressing dilemmas in the everyday work of district nurses is central to moving practice forward.
Kilsdonk, Melvin J; Siesling, Sabine; Otter, Rene; van Harten, Wim H
External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews were held with clinicians, oncology nurses, and managers from fifteen general hospitals that participated in three rounds of peer review over a period of 16 years. Interviewees reflected on the goals and expectations, experiences, perceived impact, and future role of external peer review. Transcriptions of the interviews were coded to discover recurrent themes. Improving clinical care and organization were the main motives for participation. Positive impact was perceived on multiple aspects of care such as shared responsibilities, internal prioritization of cancer care, improved communication, and a clear structure and position of cancer care within general hospitals. Establishing a direct relationship between the external peer review and organizational or clinical impact proved to be difficult. Criticism was raised on the content of the program being too theoretical and organization-focussed after three rounds. According to most stakeholders, external peer review can improve multidisciplinary team work in cancer care; however, the acceptance is threatened by a perceived disbalance between effort and visible clinical impact. Leaner and more clinically focused programs are needed to keep repeated peer reviews challenging and worthwhile.
Cook, Neil; Thomson, Gillian; Dey, Paola
Objectives In the UK, there have been a number of national initiatives to promote earlier detection and prompt referral of patients presenting to primary care with signs and symptoms of cancer. The aim of the study was to explore the experiences of a range of primary care staff in promoting earlier presentation, detection and referral of patients with symptoms suggestive of cancer. Setting Six primary care practices in northwest England. Participants: 39 primary care staff from a variety of disciplines took part in five group and four individual interviews. Results The global theme to emerge from the interviews was ‘managing risk’, which had three underpinning organising themes: ‘complexity’, relating to uncertainty of cancer diagnoses, service fragmentation and plethora of guidelines; ‘continuity’, relating to relationships between practice staff and their patients and between primary and secondary care; ‘conflict’ relating to policy drivers and staff role boundaries. A key concern of staff was that policymakers and those implementing cancer initiatives did not fully understand how risk was managed within primary care. Conclusions Primary care staff expressed a range of views and opinions on the benefits of cancer initiatives. National initiatives did not appear to wholly resolve issues in managing risk for all practitioners. Staff were concerned about the number of guidelines and priorities they were expected to implement. These issues need to be considered by policymakers when developing and implementing new initiatives. PMID:24928585
Matsuyama, Robin K.; Grange, Christina; Lyckholm, Laurie J.; Utsey, Shawn O.; Smith, Thomas J.
PURPOSE: This exploratory study examined perceptions and beliefs of African Americans and Caucasians related to cancer care. Understanding belief systems and cultures optimizes cancer treatment and care delivery to ethnic minority individuals. PATIENTS AND METHODS: Focus groups were conducted with 39 African-American and Caucasian cancer patients. Data analysis included whole group analysis with a team of five researchers. RESULTS: Regardless of ethnicity, cancer patients share many of the same emotions and experiences, and want complete information and quality care. Differences were also apparent. African-American participants were more likely to report increased religious behaviors, believe that healthcare providers demonstrate care with simple actions and provision of practical assistance, and use church and community information sources. Caucasian participants were more likely to report spiritual but not overtly religious changes, and depend on healthcare providers for information. CONCLUSION: Understanding how culture colors perceptions, communication and information requirements is critical to providing effective care to ethnically diverse cancer patients. Findings have implications for professionals understanding ways patients seek information, the role of spirituality and religion in care, and ways healthcare providers demonstrate care. PMID:17987914
Berg, Carla; Stratton, Erin; Esiashvili, Natia; Mertens, Ann; Vanderpool, Robin C
We examined healthcare providers' perceptions of the goals of survivorship care and survivor programs, systems-level barriers and individual patient-level barriers to engaging patients in survivorship care, and potential resources for increasing engagement. In 2012, we recruited 21 healthcare providers of young adult survivors of childhood cancers from a children's hospital and a cancer center in the Southeastern USA to complete telephone-based semi-structured interviews. The sample was 45.95 years old (SD = 7.57) on average, 52.4 % female, and 81.0 % MDs. The major goals of survivorship programs identified were medical care management (e.g., addressing late and long-term effects, providing survivorship care plans (SCPs), assisting in transition of care) and holistic care including addressing psychosocial issues and promoting healthy lifestyles. Systems-level barriers to engagement in survivorship care included limited resources (e.g., time), role confusion (e.g., within cancer centers, from treatment team to survivorship care, role of primary care providers), communication challenges within the medical system (e.g., limited tracking of patients, lack of understanding of the role of survivorship clinic), communication challenges with patients (e.g., setting expectations regarding transition to survivorship care), and lack of insurance coverage. Perceived patient-level factors included psychological barriers (e.g., fear, avoidance), resistance to survivorship care, and physical barriers (e.g., distance from survivorship clinics). Resources to address these barriers included increased access to information, technology-based resources, and ensuring valuable services. There are several systems-level and patient-level barriers to survivorship care, thus requiring multilevel interventions to promote engagement in care among young adult survivors of childhood cancer.
Expert-reviewed information summary about communicating with the cancer patient and his or her family, including unique aspects of communication with cancer patients, factors affecting communication, and training in communication skills.
Expert-reviewed information summary about communicating with the cancer patient and his or her family, including unique aspects of communication with cancer patients, factors affecting communication, and training in communication skills.
Zdenkowski, Nicholas; Tesson, Stephanie; Lombard, Janine; Lovell, Melanie; Hayes, Sandra; Francis, Prudence A; Dhillon, Haryana M; Boyle, Frances M
Patients diagnosed with breast cancer may have supportive care needs for many years after diagnosis. High quality multidisciplinary care can help address these needs and reduce the physical and psychological effects of breast cancer and its treatment. Ovarian suppression and extended endocrine therapy benefits are associated with vasomotor, musculoskeletal, sexual and bone density-related side effects. Aromatase inhibitor musculoskeletal syndrome is a common reason for treatment discontinuation. Treatment strategies include education, exercise, simple analgesia and a change to tamoxifen or another aromatase inhibitor. Chemotherapy-induced alopecia may be a constant reminder of breast cancer to the patient, family, friends, acquaintances and even strangers. Alopecia can be prevented in some patients using scalp-cooling technology applied at the time of chemotherapy infusion. The adverse impact of breast cancer diagnosis and treatment on sexual wellbeing is under-reported. Identification of physical and psychological impacts is needed for implementation of treatment strategies. Fear of cancer recurrence reduces quality of life and increases distress, with subsequent impact on role functioning. Identification and multidisciplinary management are key, with referral to psychosocial services recommended where indicated. The benefits of exercise include reduced fatigue, better mental health and reduced musculoskeletal symptoms, and may also include reduced incidence of breast cancer recurrence. Identification and management of unmet supportive care needs are key aspects of breast cancer care, to maximise quality of life and minimise breast cancer recurrence.
Coleman, C. Norman; Formenti, Silvia C.; Williams, Tim R.; Petereit, Daniel G.; Soo, Khee C.; Wong, John; Chao, Nelson; Shulman, Lawrence N.; Grover, Surbhi; Magrath, Ian; Hahn, Stephen; Liu, Fei-Fei; DeWeese, Theodore; Khleif, Samir N.; Steinberg, Michael; Roth, Lawrence; Pistenmaa, David A.; Love, Richard R.; Mohiuddin, Majid; Vikram, Bhadrasain
The growing burden of non-communicable diseases including cancer in low- and lower-middle income countries (LMICs) and in geographic-access limited settings within resource-rich countries requires effective and sustainable solutions. The International Cancer Expert Corps (ICEC) is pioneering a novel global mentorship–partnership model to address workforce capability and capacity within cancer disparities regions built on the requirement for local investment in personnel and infrastructure. Radiation oncology will be a key component given its efficacy for cure even for the advanced stages of disease often encountered and for palliation. The goal for an ICEC Center within these health disparities settings is to develop and retain a high-quality sustainable workforce who can provide the best possible cancer care, conduct research, and become a regional center of excellence. The ICEC Center can also serve as a focal point for economic, social, and healthcare system improvement. ICEC is establishing teams of Experts with expertise to mentor in the broad range of subjects required to establish and sustain cancer care programs. The Hubs are cancer centers or other groups and professional societies in resource-rich settings that will comprise the global infrastructure coordinated by ICEC Central. A transformational tenet of ICEC is that altruistic, human-service activity should be an integral part of a healthcare career. To achieve a critical mass of mentors ICEC is working with three groups: academia, private practice, and senior mentors/retirees. While in-kind support will be important, ICEC seeks support for the career time dedicated to this activity through grants, government support, industry, and philanthropy. Providing care for people with cancer in LMICs has been a recalcitrant problem. The alarming increase in the global burden of cancer in LMICs underscores the urgency and makes this an opportune time fornovel and sustainable solutions to transform cancer care
Wulff, Christian; Søndergaard, Jens; Olesen, Frede; Vedsted, Peter
Care coordination is a superordinate term for terms related to the optimization of care for people suffering from chronic diseases and cancer. In this article, we present Danish terms for "disease management programme" and "case management" among others, and effects are summarized. The central Danish terms explored are "forløbskoordinering", "forløbsprogram", "forløbskoordinator", and "tovholder".
Kahana, Eva; Kahana, Boaz; Wykle, May; Kulle, Diana
This article offers a stress theory-based conceptual framework for understanding proactive options for care-getting for patients living with cancer that is also relevant to patients living with other chronic or life-threatening illnesses. Barriers and facilitators to active efforts for obtaining responsive care from both informal and formal…
Thulesius, Hans; Håkansson, Anders; Petersson, Kerstin
In this grounded theory study, the authors interviewed caregivers and patients in end-of-life cancer care and found Balancing to be a fundamental process explaining the problem-solving strategies of most participants and offering a comprehensive perspective on both health care in general and end-of-life cancer care in particular. Balancing stages were Weighing--sensing needs and wishes signaled by patients, gauging them against caregiver resources in diagnosing and care planning; Shifting--breaking bad news, changing care places, and treatments; and Compensating--controlling symptoms, educating and team-working, prioritizing and "stretching" time, innovating care methods, improvising, and maintaining the homeostasis of hope. The Balancing outcome is characterized by Compromising, or "Walking a fine line," at best an optimized situation, at worst a deceit.
Asada, Yukiko; Burge, Fred; Johnston, Grace W.; Urquhart, Robin
Access to high-quality end-of-life (EOL) care is critical for all those with incurable cancer. The objective of this study was to examine inequalities in access to, and quality of, EOL care by assessing registration in a palliative care program, emergency room visits in the last 30 days of life, and location of death among individuals who died of colorectal cancer in Nova Scotia, Canada, between 2001 and 2008. We used population-based linked administrative data and performed multivariate logistic regression models to assess the association between socio-economic, geographic, and demographic factors and outcomes related to access to, and quality of, EOL care (n=1,201). This study demonstrates that although access to, and quality of, EOL care appears to have improved, there remain significant inequalities throughout the population. Of primary concern is the variation in access to, and quality of, EOL care based on geographic location of residence and patient age. PMID:22860381
Stratton, Erin; Esiashvili, Natia; Mertens, Ann
We examined correlates of low engagement in the healthcare system, experiences with survivorship care, barriers to follow-up care, and potential resources for promoting follow-up care among young adult survivors of childhood cancers. We conducted a mixed-method study involving surveys of 106 survivors of childhood cancer aged 18–34 recruited from a university-affiliated children’s hospital and an NCI-designated cancer center in the Southeastern USA. Phone-based semistructured interviews were then conducted in a subset of 26. Assessments included health factors, psychosocial factors, healthcare system interaction, and interest in resources to promote engagement in healthcare. Survey participants were on average 22.14(SD=3.16) years old, 50.0 % female, and 77.4 % White. Overall, 46.0 % had attended survivorship clinic, 47.2 % reported receiving a treatment summary, 68.9 % had a primary care provider, and 17.0 % reported no interaction with healthcare in the past 2 years. Correlates of less than annual healthcare provider visits included being older (p=0.003), being male (p<0.001), lack of insurance (p=0.002), and having had chemotherapy (p=0.05). Participants reported varied experiences in terms of how health and treatment information was presented, from none or too little to overwhelming or anxiety-provoking amounts. Barriers to engaging in survivorship care included no/limited insurance, time, or transportation; major life changes; anxiety; and difficulty transitioning from pediatrics to adult care. Participants highlighted the need for educational and psychosocial resources, particularly technology-based resources. Multilevel interventions are needed to increase engagement in survivor-ship care among young adult cancer survivors. Technology-based resources addressing social support and mental well-being are intervention possibilities. PMID:25948413
Lamont, Elizabeth B.; He, Yulei; Subramanian, S.V.; Zaslavsky, Alan M.
Purpose Area social deprivation is associated with unfavorable health outcomes of residents across the full clinical course of cancer from the stage at diagnosis through survival. We sought to determine whether area social factors are associated with the area health care supply. Patients and Methods We studied the area supply of health services required for the provision of guideline-recommended care for patients with breast cancer and colorectal cancer (CRC) in each of the following three distinct clinical domains: screening, treatment, and post-treatment surveillance. We characterized area social factors in 3,096 urban zip code tabulation areas by using Census Bureau data and the health care supply in the corresponding 465 hospital service areas by using American Hospital Association, American Medical Association, and US Food and Drug Administration data. In two-level hierarchical models, we assessed associations between social factors and the supply of health services across areas. Results We found no clear associations between area social factors and the supply of health services essential to the provision of guideline recommended breast cancer and CRC care in urban areas. The measures of health service included the supply of physicians who facilitate screening, treatment, and post-treatment care and the supply of facilities required for the same services. Conclusion Because we found that the supply of types of health care required for the provision of guideline-recommended cancer care for patients with breast cancer and CRC did not vary with markers of area socioeconomic disadvantage, it is possible that previously reported unfavorable breast cancer and CRC outcomes among individuals living in impoverished areas may have occurred despite an apparent adequate area health care supply. PMID:22869877
Kumar, Senthil P
Objective: A common disorder requiring symptom palliation in palliative and end-of-life care is cancer. Cancer pain is recognized as a global health burden. This paper sought to systematically examine the extent to which there is an adequate scientific research base on cancer pain and its reporting characteristics in the palliative care journal literature. Materials and Methods: Search conducted in MEDLINE and CINAHL sought to locate all studies published in 19 palliative/ hospice/ supportive/ end-of-life care journals from 2009 to 2010. The journals included were: American Journal of Hospice and Palliative Care, BMC Palliative Care, Current Opinion in Supportive and Palliative Care, End of Life Care Journal, European Journal of Palliative Care, Hospice Management Advisor, Indian Journal of Palliative Care, International Journal of Palliative Nursing, Internet Journal of Pain Symptom Control and Palliative Care, Journal of Pain and Palliative Care Pharmacotherapy, Journal of Palliative Care, Journal of Palliative Medicine, Journal of Social Work in End-of-life and Palliative Care, Journal of Supportive Oncology, Palliative Medicine, Palliative and Supportive Care, and Supportive Care in Cancer. Journal contents were searched to identify studies that included cancer pain in abstract. Results: During the years 2009 and 2010, of the selected 1,569 articles published in the journals reviewed, only 5.86% (92 articles) were on cancer pain. Conclusion: While researchers in the field of palliative care have studied cancer pain, the total percentage for studies is still a low 5.86%. To move the field of palliative care forward so that appropriate guidelines for cancer pain management can be developed, it is critical that more research be reported upon which to base cancer pain therapy in an evidence-based palliative care model. PMID:21633623
Cadet, Tamara; Davis, Cindy; Elks, Jacinta; Wilson, Patricia
Background: Globally, the burden of cancer continues to increase and it is well-documented that while not a homogeneous population, cancer patients and cancer survivors face many physical, psychological, social, spiritual, and financial issues. Cancer care is shifting from a disease-focused to a patient-centered approach resulting in an increased need to address these concerns. Methods: Utilizing a quality improvement approach, this paper describes an integrated cancer care model at Bloomhill Cancer Center (BCC) in Queensland, Australia that demonstrates the ability to meet the holistic needs of patients living with and beyond cancer and to identify opportunities for better practice and service provision. Results: Survey results indicate that 67% and 77% of respondents were very satisfied and 27% and 17% were satisfied with their first contact and very satisfied with their first meeting with a nurse at BCC. Clients also reported being very satisfied (46%) or satisfied (30%) with the emotional support they received at BCC and over 90% were very satisfied or satisfied with the touch therapies that the received. Conclusion: Due to the early success of the interventions provided by BCC, the model potentially offers other states and countries a framework for supportive cancer care provision for people living with and beyond cancer. PMID:27869728
Baggett, Travis P.; Chang, Yuchiao; Porneala, Bianca C.; Bharel, Monica; Singer, Daniel E.; Rigotti, Nancy A.
Introduction Homeless people have a high burden of cancer risk factors and suboptimal rates of cancer screening, but the epidemiology of cancer has not been well described in this population. We assessed cancer incidence, stage, and mortality in homeless adults relative to general population standards. Methods We cross-linked a cohort of 28,033 adults seen at Boston Health Care for the Homeless Program in 2003–2008 to Massachusetts cancer registry and vital registry records. We calculated age-standardized cancer incidence and mortality ratios (SIRs and SMRs). We examined tobacco use among incident cases and estimated smoking-attributable fractions. Trend tests were used to compare cancer stage distributions with those in Massachusetts adults. Analyses were conducted in 2012–2015. Results During 90,450 person-years of observation, there were 361 incident cancers (SIR=1.13, 95% CI=1.02, 1.25) and 168 cancer deaths (SMR=1.88, 95% CI=1.61, 2.19) among men, and 98 incident cancers (SIR=0.93, 95% CI=0.76, 1.14) and 38 cancer deaths (SMR=1.61, 95% CI=1.14, 2.20) among women. For both sexes, bronchus and lung cancer was the leading type of incident cancer and cancer death, exceeding Massachusetts estimates more than twofold. Oropharyngeal and liver cancer cases and deaths occurred in excess among men, whereas cervical cancer cases and deaths occurred in excess among women. About one third of incident cancers were smoking-attributable. Colorectal, female breast, and oropharyngeal cancers were diagnosed at more-advanced stages than in Massachusetts adults. Conclusions Efforts to reduce cancer disparities in homeless people should include addressing tobacco use and enhancing participation in evidence-based screening. PMID:26143955
New treatments and technological advances mean the vasty majority of cancer patients are receiving their care on an outpatient basis. Increasingly, for-profit cancer centers are providing that care. Although some hospitals have embraced the centers as partners, others see them as interlopers, drawing off lucrative business and threatening patients' continuity of care.
Jamjoom, Roaa S; Etoom, Yousef; Solano, Tanya; Desjardins, Marie-Pier; Fischer, Jason W
The use of point-of-care ultrasound in the pediatric emergency department is evolving beyond conventional applications as users become more expert with the technology. In this case series, we describe the potential utility of recognizing abnormal anatomy to impact care in the context of possible cancer in pediatric patients. We describe 4 patients with Langerhans histiocytosis, neuroblastoma, Wilms tumor, and rhabdomyosarcoma, in which point-of-care ultrasound was used to facilitate the diagnoses.
Pradella, Davide; Naro, Chiara; Sette, Claudio; Ghigna, Claudia
Epithelial-to-mesenchymal transition (EMT) is associated with metastasis formation as well as with generation and maintenance of cancer stem cells. In this way, EMT contributes to tumor invasion, heterogeneity and chemoresistance. Morphological and functional changes involved in these processes require robust reprogramming of gene expression, which is only partially accomplished at the transcriptional level. Alternative splicing is another essential layer of gene expression regulation that expands the cell proteome. This step in post-transcriptional regulation of gene expression tightly controls cell identity between epithelial and mesenchymal states and during stem cell differentiation. Importantly, dysregulation of splicing factor function and cancer-specific splicing isoform expression frequently occurs in human tumors, suggesting the importance of alternative splicing regulation for cancer biology.In this review, we briefly discuss the role of EMT programs in development, stem cell differentiation and cancer progression. Next, we focus on selected examples of key factors involved in EMT and stem cell differentiation that are regulated post-transcriptionally through alternative splicing mechanisms. Lastly, we describe relevant oncogenic splice-variants that directly orchestrate cancer stem cell biology and tumor EMT, which may be envisioned as novel targets for therapeutic intervention.
So, Winnie K. W.
The cancer burden is a global problem, and oncology nurses should be accountable for delivering safe and effective cancer care and providing the best possible experience for patients. The development and application of evidence-based practice in cancer care is an effective strategy in achieving this goal; however, the journey in which such practice involves may encounter various challenges. In this article, the author discusses her own experience, successful and unsuccessful of such a journey. Both challenges and opportunities are identified, and suggestions put forward for making collaborative efforts. PMID:27981134
Black, Pat; Hyde, Christine
Longevity in people with learning disabilities has increased substantially over recent years and as life expectancy increases for this population so does the risk of colorectal cancer. Today, with the transition from institution to the community for people with learning disabilities, conscientious and competent medical and nursing care is a necessity. This article examines autonomy, consent, treatment, palliative care and death relating to people with profound learning disabilities and challenging behaviour, who also have colorectal cancer and stomas. Lack of written information, knowledge, and organizational planning need to be addressed to bring cancer services for the patient with learning disabilities to the level that it is for the general population.
Henry, Elizabeth; Silva, Abigail; Tarlov, Elizabeth; Czerlanis, Cheryl; Bernard, Margie; Chauhan, Cynthia; Schalk, Denise; Stewart, Greg
Cancer care delivery is highly complex. Treatment involves coordination within oncology health-care teams and across other teams of referring primary and specialty providers (a team of teams). Each team interfaces with patients and caregivers to offer component parts of comprehensive care. Because patients frequently obtain specialty care from divergent health-care systems resulting in cross-system health-care use, oncology teams need mechanisms to coordinate and collaborate within and across health-care systems to optimize clinical outcomes for all cancer patients. Transactive memory is one potential strategy that can help improve comprehensive patient care delivery. Transactive memory is a process by which two or more team professionals develop a shared system for encoding, storing, and retrieving information. Each professional is responsible for retaining only part of the total information. Applying this concept to a team of teams results in system benefits wherein all teams share an understanding of specialized knowledge held by each component team. The patient's role as the unifying member of the team of teams is central to successful treatment delivery. This clinical case presents a patient who is receiving oral treatment for advanced prostate cancer within two health systems. The case emphasizes the potential for error when multiple teams function without a point team (the team coordinating efforts of all other primary and specialty teams) and when the specialty knowledge of providers and patients is not well integrated into all phases of the care delivery process.
Sun, Virginia; Grant, Marcia; Koczywas, Marianna; Freeman, Bonnie; Zachariah, Finly; Fujinami, Rebecca; Del Ferraro, Catherine; Uman, Gwen; Ferrell, Betty
Background Family caregivers (FCGs) experience significant deteriorations in quality of life while caring for lung cancer patients. This study tested the effectiveness of an interdisciplinary palliative care intervention for FCGs of patients diagnosed with stage I–IV non-small cell lung cancer (NSCLC). Methods FCGs who were identified by patients as the primary caregiver were enrolled in a prospective, quasi-experimental study whereby the usual care group was accrued first followed by the intervention group. FCGs in the intervention group were presented at interdisciplinary care meetings, and they also received four educational sessions organized in the physical, psychological, social, and spiritual domains. The sessions included self-care plans to support the FCG’s own needs. Caregiver burden, caregiving skills preparedness, psychological distress, and FCG QOL were assessed at baseline and 12 weeks using validated measures. Results A total of 366 FCGs were included in the primary analysis. FCGs who received the interdisciplinary palliative care intervention had significantly better scores for social well-being (5.84 vs. 6.86; p<.001) and lower psychological distress (4.61 vs. 4.20; p=.010) at 12 weeks compared to FCGs in the usual care group. FCGs in the intervention group had significantly less caregiver burden compared to FCGs in the usual care group (p=.008). Conclusions An interdisciplinary approach to palliative care in lung cancer resulted in statistically significant improvements in the FCG’s social well-being, psychological distress, and less caregiver burden. PMID:26150131
Pascal, J; Johnson, N; Dickson-Swift, V; McGrath, P; Dangerfield, F
The concept of receptivity is a new way of understanding the personal and social factors that affect a person living with and beyond cancer, and how these factors influence access to formal supportive care service provision and planning. This article contributes to new knowledge through applying the concept of receptivity to informal supportive cancer care in regional Australia. Literature indicates that a cancer diagnosis is a life-changing experience, particularly in regional communities, where survival rates are lower and there are significant barriers to accessing services. Heideggerian phenomenology informed the design of the study and allowed for a rich and nuanced understanding of participants lived experiences of informal supportive cancer care. These experiences were captured using in-depth interviews, which were subsequently thematically analysed. Nineteen participants were recruited from across regional Victoria, Australia. Participants self-reported a range of stages and types of cancer. Significantly, findings revealed that most participants were not referred to, and did not seek, formal supportive care. Instead, they were receptive to informal supportive care. Understanding receptivity and the role of anxiety and fear of death has implications for partners, family, community members, as well as professionals working with people with living with and beyond cancer.
Weaver, M S; Yao, A J J; Renner, L A; Harif, M; Lam, C G
Background: Given the burden of childhood cancer and palliative care need in Africa, this paper investigated the paediatric and palliative care elements in cancer control plans. Methods: We conducted a comparative content analysis of accessible national cancer control plans in Africa, using a health systems perspective attentive to context, development, scope, and monitoring/evaluation. Burden estimates were derived from World Bank, World Health Organisation, and Worldwide Palliative Care Alliance. Results: Eighteen national plans and one Africa-wide plan (10 English, 9 French) were accessible, representing 9 low-, 4 lower-middle-, and 5 upper-middle-income settings. Ten plans discussed cancer control in the context of noncommunicable diseases. Paediatric cancer was mentioned in 7 national plans, representing 5127 children, or 13% of the estimated continental burden for children aged 0–14 years. Palliative care needs were recognised in 11 national plans, representing 157 490 children, or 24% of the estimated Africa-wide burden for children aged 0–14 years; four plans specified paediatric palliative needs. Palliative care was itemised in four budgets. Sample indicators and equity measures were identified, including those highlighting contextual needs for treatment access and completion. Conclusions: Recognising explicit strategies and funding for paediatric and palliative services may guide prioritised cancer control efforts in resource-limited settings. PMID:26042935
Mohan, S; Wilkes, L M; Ogunsiji, O; Walker, A
This study aims to describe the experiences of nurses caring for cancer patients in non-specialist wards. The study was conducted in a large (420 beds) and small (32 beds) hospital in an area health service with urban and rural populations in the west of Sydney. A qualitative descriptive approach was utilized to collect data from the nurses. Data were collected using a survey and in-depth interviews of nurses working in non-specialist cancer wards. Transcribed data were managed with Nudist Vivo software and analysed for common themes using process of constant comparison and contrast. Twenty-five surveys were returned and five nurses volunteered to be interviewed. The six major themes that emerged from analysis of data were: emotional nature of care, lack of time, lack of knowledge of cancer treatment, family support, environment not conducive to proper care and dealing with patient's non-acceptance of cancer diagnosis. The nurses in this study wished to provide quality supportive care for cancer patients and their families but the inconducive environment and inadequate relevant training hindered the nurses' efforts. This then presents further need of relevant training for nurses in cancer care and time management, to meet up with these challenges.
Olson, Kristofor A.; Schell, John C.; Rutter, Jared
Dysregulated metabolism is an emerging hallmark of cancer and there is abundant interest in developing therapies to selectively target these aberrant metabolic phenotypes. Sitting at the decision point between mitochondrial carbohydrate oxidation and aerobic glycolysis (i.e., the “Warburg Effect”), the synthesis and consumption of pyruvate is tightly controlled and is often differentially regulated in cancer cells. This review examines recent efforts toward understanding and targeting mitochondrial pyruvate metabolism, and addresses some of the successes, pitfalls and significant challenges of metabolic therapy to date. PMID:26873641
Aktas, Demet; Terzioglu, Fusun
The purpose of the research was to determine the effect of home care service on the quality of life in patients with gynecological cancer. This randomized case control study was carried out in a womans hospital between September 2011 and February 2012. Women undergoing gynecological cancer treatment were separated into intervention and control groups, of 35 patients each. The intervention group was provided with nursing care service through hospital and home visits (1st, 12th weeks) within the framework of a specifically developed nursing care plan. The control group was monitored without any intervention through the hospital routine protocols (1st, 12th weeks). Data were collected using An Interview Form, Home Visit Monitoring Form and Quality of Life Scale/Cancer Survivors. Effects of home care service on the quality of life in gynecological cancer patients were investigated using chi-square tests, McNemar's test, independent t-test and ANOVA. This study found that the intervention group receiving home care service had a moderately high quality of life (average mean: 6.01±0.64), while the control group had comparatively lower quality (average mean: 4.35±0.79) within the 12 week post- discharge period (p<0.05). This study found home care services to be efficient in improving the quality of life in patients with gynecological cancer.
Mayer, Deborah K
This provocative question was addressed in a report from the Institute of Medicine ([IOM], 2013), Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. An interdisciplinary committee synthesized many of the changes that are occurring in our society and health care that will challenge our existing cancer care system. These changes are familiar to many of us: an aging population along with the resulting increase in the number of cancer survivors, an inadequate number of and increased demand for trained healthcare providers, and rising healthcare costs. The IOM report recommended a framework of six interconnected components for improving the quality of cancer care (see Figures 1 and 2). Each of these components is worthy of an editorial and more. I would like to focus, however, on one of them: an adequately staffed, trained, and coordinated workforce. And, for good reason, as I want to retire someday and know that others will be taking my place in caring for cancer survivors across the care continuum. So let's explore this one component in more detail.
Jain, Anshu K; Fennell, Mary L; Chagpar, Anees B; Connolly, Hannah K; Nembhard, Ingrid M
Effective communication is a requirement in the teamwork necessary for improved coordination to deliver patient-centered, value-based cancer care. Communication is particularly important when care providers are geographically distributed or work across organizations. We review organizational and teams research on communication to highlight psychological safety as a key determinant of high-quality communication within teams. We first present the concept of psychological safety, findings about its communication effects for teamwork, and factors that affect it. We focus on five factors applicable to cancer care delivery: familiarity, clinical hierarchy-related status differences, geographic dispersion, boundary spanning, and leader behavior. To illustrate how these factors facilitate or hinder psychologically safe communication and teamwork in cancer care, we review the case of a patient as she experiences the treatment-planning process for early-stage breast cancer in a community setting. Our analysis is summarized in a key principle: Teamwork in cancer care requires high-quality communication, which depends on psychological safety for all team members, clinicians and patients alike. We conclude with a discussion of the implications of psychological safety in clinical care and suggestions for future research.
Zimmermann, Camilla; Swami, Nadia; Krzyzanowska, Monika; Leighl, Natasha; Rydall, Anne; Rodin, Gary; Tannock, Ian; Hannon, Breffni
Background: Early palliative care is increasingly recommended but seldom practised. We sought to examine perceptions of palliative care among patients with advanced cancer and their caregivers. Methods: After conducting a cluster randomized controlled trial of early palliative care versus standard care for patients with advanced cancer, we approached patients and their caregivers to participate in semistructured interviews seeking to assess, qualitatively, their attitudes and perceptions about palliative care. We used the grounded theory method for data collection and analysis. Results: A total of 48 patients (26 intervention, 22 control) and 23 caregivers (14 intervention, 9 control) completed interviews. Participants’ initial perceptions of palliative care in both trial arms were of death, hopelessness, dependency and end-of-life comfort care for inpatients. These perceptions provoked fear and avoidance, and often originated from interactions with health care professionals. During the trial, those in the intervention arm developed a broader concept of palliative care as “ongoing care” that improved their “quality of living” but still felt that the term itself carried a stigma. Participants in the intervention group emphasized the need for palliative care to be reframed and better explained by health care professionals. Participants in the control group generally considered it pointless to rename palliative care, but many in the intervention group stated emphatically that a different name was necessary in the early outpatient setting. Interpretation: There is a strong stigma attached to palliative care, which may persist even after positive experiences with an early palliative care intervention. Education of the public, patients and health care providers is paramount if early integration of palliative care is to be successful. PMID:27091801
Feeley, Thomas W; Sledge, George W; Levit, Laura; Ganz, Patricia A
A recent report from the Institute of Medicine titled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, identifies improvement in information technology (IT) as essential to improving the quality of cancer care in America. The report calls for implementation of a learning healthcare IT system: a system that supports patient-clinician interactions by providing patients and clinicians with the information and tools necessary to make well informed medical decisions and to support quality measurement and improvement. While some elements needed for a learning healthcare system are already in place for cancer, they are incompletely implemented, have functional deficiencies, and are not integrated in a way that creates a true learning healthcare system. To achieve the goal of a learning cancer care delivery system, clinicians, professional organizations, government, and the IT industry will have to partner, develop, and incentivize participation.
New cancer therapies offer the hope of improved diagnosis to patients with life-threatening disease. Over the past 5-10 years, a number of specialty drugs have entered clinical practice to provide better systemic therapy for advanced cancers that respond to few therapeutic alternatives. To date, however, such advances have been only modestly effective in extending life and come with a high price tag, raising questions about their value for money, patient access and implications for health care costs. This article explores some of the key issues present in valuing end-of-life care in the United States in the case of advanced cancer drugs, from the difficult trade-offs between their limited health benefits and high costs to the technical, political and social challenges in assessing their value and applying such evidence to inform policy and practice. A number of initial steps are discussed that could be pursued to improve the value of advanced cancer care.
Jayadevappa, Ravishankar; Chhatre, Sumedha; Gallo, Joseph J; Wittink, Marsha; Morales, Knashawn H; Bruce Malkowicz, S; Lee, David; Guzzo, Thomas; Caruso, Adele; Van Arsdalen, Keith; Wein, Alan J; Sanford Schwartz, J
Prostate cancer is a slow progressing cancer that affects millions of men in the US. Due to uncertainties in outcomes and treatment complications, it is important that patients engage in informed decision making to choose the "optimal treatment". Patient centered care that encompasses informed decision-making can improve treatment choice and quality of care. Thus, assessing patient treatment preferences is critical for developing an effective decision support system. The objective of this patient-centered randomized clinical trial was to study the comparative effectiveness of a conjoint analysis intervention compared to usual care in improving subjective and objective outcomes in prostate cancer patients. We identified preferred attributes of alternative prostate cancer treatments that will aid in evaluating attributes of treatment options. In this two-phase study, in Phase 1 we used mixed methods to develop an adaptive conjoint task instrument. The conjoint task required the patients to trade-off attributes associated with treatments by assessing their relative importance. Phase 2 consisted of a randomized controlled trial of men with localized prostate cancer. We analyzed the effect of conjoint task intervention on the association between preferences, treatment and objective and subjective outcomes. Our conjoint task instrument can lead to a values-based patient-centered decision aid tool and help tailor treatment decision making to the values of prostate cancer patients. This will ultimately improve clinical decision making, clinical policy process, enhance patient centered care and improve prostate cancer outcomes.
Sarkar, Anindya; Shahi, UP
Background and purpose: This prospective study aimed to assess the profiles of elderly cancer patient to optimize cancer care in Indian setup. The profiles have been compared with that of younger patients in terms of epidemiological, clinical data, co-morbidity, treatment, toxicity, clinical outcome, and survival pattern. Materials and Methods: The study comprised cancer patients attending radiotherapy outdoor (November 2005 to June 2006). There were 104 patients of age ≥60 years (elderly group) and 121 patients of 45-59 years (younger group). Results: Elderly group had median age 65 years (60-88 years) with M:F = 1:1. The younger group had median age 50 years (45-59 years) with M:F = 1:2. Elderly had higher proportion of gastrointestinal and genito-urinary tract malignancies. Younger group had higher proportion of breast, lymphoma, and brain tumor. 13% had co-morbidity, 50% received treatment, 27% were treated with radiotherapy with or without surgery, and two-third of these cases belong to elderly group. Majority tolerated treatment well. 10% had significant grade of toxicity. 57% of elderly patients did not accept and one-fourth of all cases did not complete the prescribed treatment. 88% cases were responders of which 70% showed complete response. There were no differences between two groups. At 12 months 35% of treated patients came for follow-up. At first 12 months, 60-70% were alive without disease. Conclusion: There were differences between two groups in terms of performance status, treatment acceptance, and treatment modality prescribed. Elderly patients deserve same opportunity as younger patients for treatment and survival options from the oncologist. PMID:24455630
Mohammadzadeh, Niloofar; Safdari, Reza; Rahimi, Azin
Physicians, in order to study the causes of cancer, detect cancer earlier, prevent or determine the effectiveness of treatment, and specify the reasons for the treatment ineffectiveness, need to access accurate, comprehensive, and timely cancer data. The cancer care environment has become more complex because of the need for coordination and communication among health care professionals with different skills in a variety of roles and the existence of large amounts of data with various formats. The goals of health care systems in such a complex environment are correct health data management, providing appropriate information needs of users to enhance the integrity and quality of health care, timely access to accurate information and reducing medical errors. These roles in new systems with use of agents efficiently perform well. Because of the potential capability of agent systems to solve complex and dynamic health problems, health care system, in order to gain full advantage of E- health, steps must be taken to make use of this technology. Multi-agent systems have effective roles in health service quality improvement especially in telemedicine, emergency situations and management of chronic diseases such as cancer. In the design and implementation of agent based systems, planning items such as information confidentiality and privacy, architecture, communication standards, ethical and legal aspects, identification opportunities and barriers should be considered. It should be noted that usage of agent systems only with a technical view is associated with many problems such as lack of user acceptance. The aim of this commentary is to survey applications, opportunities and barriers of this new artificial intelligence tool for cancer care information as an approach to improve cancer care management.
Sinfield, Paul; Baker, Richard; Camosso‐Stefinovic, Janette; Colman, Andrew M.; Tarrant, Carolyn; Mellon, John K.; Steward, William; Kockelbergh, Roger; Agarwal, Shona
Abstract Objective To review studies of patients’ and carers’ experience of prostate cancer care. Design Narrative literature review. Methods Search strategies were developed for the following databases: MEDLINE (1966–2006), EMBASE (1980–2006), CINAHL (1982–2006) and PsycINFO (1987–2006). A search of SIGLE (System for Information on Grey Literature in Europe) was also undertaken. Experience was defined as patients’ and carers’ reports of how care was organized and delivered to meet their needs. A narrative summary of the included papers was undertaken. Results A total of 90 relevant studies were identified. Most studies reported on experiences of screening, diagnosis, the treatment decision, treatment and post‐initial treatment. Few studies reported on experiences of the stages of referral, testing, and further treatment and palliative care, and no studies reported on monitoring or terminal care. Conclusions Although some phases of care have not been investigated in detail, there is evidence that: (i) many patients have a low level of knowledge of prostate cancer; (ii) patients with prostate cancer and their carers need information throughout the care pathway to enable them to understand the diagnosis, treatment options, self‐care and support available; and (iii) increasing patient knowledge and understanding of prostate cancer (e.g. through interventions) are often associated with a more active role in decision making (e.g. screening, treatment decision). PMID:19754693
Hastie, Eric; Grdzelishvili, Valery Z
Oncolytic virus (OV) therapy is an emerging anti-cancer approach that utilizes viruses to preferentially infect and kill cancer cells, while not harming healthy cells. Vesicular stomatitis virus (VSV) is a prototypic non-segmented, negative-strand RNA virus with inherent OV qualities. Antiviral responses induced by type I interferon pathways are believed to be impaired in most cancer cells, making them more susceptible to VSV than normal cells. Several other factors make VSV a promising OV candidate for clinical use, including its well-studied biology, a small, easily manipulated genome, relative independence of a receptor or cell cycle, cytoplasmic replication without risk of host-cell transformation, and lack of pre-existing immunity in humans. Moreover, various VSV-based recombinant viruses have been engineered via reverse genetics to improve oncoselectivity, safety, oncotoxicity and stimulation of tumour-specific immunity. Alternative delivery methods are also being studied to minimize premature immune clearance of VSV. OV treatment as a monotherapy is being explored, although many studies have employed VSV in combination with radiotherapy, chemotherapy or other OVs. Preclinical studies with various cancers have demonstrated that VSV is a promising OV; as a result, a human clinical trial using VSV is currently in progress.
Silver, Julie K; Raj, Vishwa S; Fu, Jack B; Wisotzky, Eric M; Smith, Sean Robinson; Kirch, Rebecca A
Palliative care and rehabilitation practitioners are important collaborative referral sources for each other who can work together to improve the lives of cancer patients, survivors, and caregivers by improving both quality of care and quality of life. Cancer rehabilitation and palliative care involve the delivery of important but underutilized medical services to oncology patients by interdisciplinary teams. These subspecialties are similar in many respects, including their focus on improving cancer-related symptoms or cancer treatment-related side effects, improving health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision-making. They also aim to improve healthcare efficiencies and minimize costs by means such as reducing hospital lengths of stay and unanticipated readmissions. Although their goals are often aligned, different specialized skills and approaches are used in the delivery of care. For example, while each specialty prioritizes goal-concordant care through identification of patient and family preferences and values, palliative care teams typically focus extensively on using patient and family communication to determine their goals of care, while also tending to comfort issues such as symptom management and spiritual concerns. Rehabilitation clinicians may tend to focus more specifically on functional issues such as identifying and treating deficits in physical, psychological, or cognitive impairments and any resulting disability and negative impact on quality of life. Additionally, although palliative care and rehabilitation practitioners are trained to diagnose and treat medically complex patients, rehabilitation clinicians also treat many patients with a single impairment and a low symptom burden. In these cases, the goal is often cure of the underlying neurologic or musculoskeletal condition. This report defines and describes cancer rehabilitation and palliative care, delineates their
Rayman, Kathleen M.; Edwards, Joellen
Context: Rural women in the United States experience disparity in breast cancer diagnosis and treatment when compared to their urban counterparts. Given the 11% chance of lifetime occurrence of breast cancer for women overall, the continuum of breast cancer screening, diagnosis, treatment, and recovery are of legitimate concern to rural women and…
Faguet, Guy B
This review assesses the current status of end-of-life care based on large-scale, multiyear nationwide surveys of treatment modality, setting, and cost of care during terminal patients' last months of life. It shows that end-of-life care goals often remain suboptimal. Contributing factors include prioritized life preservation, uneven commitment to palliative care, few palliative care specialists, and perverse financial incentives that encourage costly interventions. Although not determinant per se, these factors coupled to doubts about what constitutes end-of-life can lead to overextended disease treatment and a late implementation of palliative care. In order to bridge the existing gap between care received and care expected and achieve quality end-of-life and promote death with dignity, we propose both to view the person rather than the disease as the unit of care and a pragmatic definition of end-of-life. Such a strategy should facilitate selecting an optimal time to transition from disease-targeted treatment to palliative care.
Harris, Lorna H; Parrish, Theodore; Obano, Nosa; Downing, Beverly; Mcallister, Nancy
One in every two men and one in every three women in North Carolina will be diagnosed with cancer during their lifetime. Cancer is a leading cause of death for ethnic minority populations in North Carolina. The impact on cancer patients, on their families, and on their communities is immeasurable. The burden of cancer in ethnic minority communities can be better addressed if proven advances in prevention, early detection, and care are made available. Historically black colleges and universities (HBCLUs) can play a major role in assisting state governments understand the health needs and health-care delivery preferences of underserved populations. This paper describes these major roles as collaborations between four HBCUs and the state of North Carolina. Recommendations that address improving access to cancer services in the African-American, Hispanic, and American Indian communities are presented.
Zaza, C; Sellick, S M; Willan, A; Reyno, L; Browman, G P
Many studies have confirmed unnecessary suffering among cancer patients, due to the inadequate use of analgesic medication and other effective interventions. While pharmacological treatments are appropriately the central component of cancer pain management, the under-utilization of effective nonpharmacological strategies (NPS) may contribute to the problem of pain and suffering among cancer patients. The purpose of this study was to determine health care professionals' familiarity with, and perceptions regarding, NPS for managing cancer pain, and to assess their interest in learning more about NPS as adjuncts to pharmacological analgesics. Two-hundred and fourteen health care professionals were surveyed at two cancer treatment centres in Ontario, Canada. The self-report questionnaire included questions regarding 11 psychological strategies (e.g. imagery) and eight other NPS (e.g. acupuncture). The response rate was 67% (141/214). Subjects were found to be the least familiar with autogenic training, operant conditioning, and cognitive therapy. Other than radiation and surgery, subjects most commonly reported recommending support groups (67%), imagery (54%), music or art therapy (49%) and meditation (43%) for managing cancer pain. Participants were most interested in learning more about acupuncture, massage therapy, therapeutic touch, hypnosis, and biofeedback. Participants were somewhat familiar with most of the 19 NPS presented; however, they use or recommend few NPS for managing cancer pain. Health professionals' interest in NPS has important implications for the supportive care of cancer patients.
Koo, Douglas J.; Tonorezos, Emily S.; Kumar, Chhavi B.; Goring, Tabitha N.; Salvit, Cori; Egan, Barbara C.
Every year, nearly five million adults with cancer are hospitalized. Limited evidence suggests that hospitalization of the cancer patient is associated with adverse morbidity and mortality. Hospitalization of the patient with advanced cancer allows for an intense examination of health status in the face of terminal illness and an opportunity for defining goals of care. This experience-based guide reports what is currently known about the topic and outlines a systematic approach to maximizing opportunities, improving quality, and enhancing the well-being of the hospitalized patient with advanced cancer. PMID:26588430
Del Fabbro, Egidio
Many important advances have occurred in the field of cancer cachexia over the past decade, including progress in understanding the mechanisms of the cancer anorexia-cachexia syndrome (CACS) and the development of promising pharmacologic and supportive care interventions. However, no approved agents for cancer cachexia currently exist, emphasizing the unmet need for an effective pharmacologic therapy. This article reviews the key elements of CACS assessment in daily practice, the contribution of nutritional impact symptoms (NIS), the evidence for current pharmacologic options, and promising anticachexia agents in perclinical and clinical trials. It also proposes a model for multimodality therapy and highlights issues pertinent to CACS in patients with pancreatic, gastric, and esophageal cancer.
Wakiuchi, Julia; Marcon, Sonia Silva; Sales, Catarina Aparecida
Objective understand the experiences of cancer patients regarding the care received and the relationship with Family Health Strategy professionals. Method qualitative research based on Heidegger's phenomenology held with ten cancer patients living in the coverage area of three healthcare centers in a city in northwestern Paraná. Data were collected at the patients' homes from November 2012 to February 2013 through open interviews. Results some patients were faced with the impersonality of professionals and lack of empathy, interaction, and singling in care whereas others had their expectations met since they experienced a comprehensive care permeated with concern, sharing of feelings, and respect. Conclusions the understanding of these experiences raises a reflection on the support that is provided in this instance of care and the importance of overcoming impersonal and inauthentic attitudes in order to transcend to a new level of relationship and care.
da Costa, Thailly Faria; Ceolim, Maria Filomena
Pediatric palliative care is a challenge for nursing because it requires emotional balance and knowledge about its specific features. This study is an integrative literature review that aims to identify nursing actions in palliative care for children and adolescents with cancer, considering peculiarities of the disease and dying process. The review was performed by searching for articles indexed in Biblioteca Virtual da Adolescência (Adolec), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and PubMed databases from January 2004 till May 2009. From 29 references found, six met inclusion criteria. Results show teamwork, home care, pain management, dialogue, family support and particularities of childhood cancer fundamental tools for nursing in palliative care. The complexity of care in this situation requires solidarity, compassion, support and relieving suffering.
Lindley, Lisa C; Edwards, Sheri L
The geographic interface between the need for and the supply of pediatric hospice may be critical in whether children with cancer access care. This study sought to describe the geographic distribution of pediatric hospice need and supply and identify areas lacking pediatric hospice care in Tennessee over a 3-year time period. Using ArcGIS, a series of maps were created. There was a consistent need for care among children with cancer across the state. Most urban areas were supplied by pediatric hospices, except the Knoxville area. Areas within the state were identified where the supply of pediatric hospice care declined, while the need for hospice care was unchanging. This study has important regulatory implications for clinicians practicing in certificate of need states such as Tennessee.
Weingart, Saul N; Hsieh, Candace; Lane, Sharon; Cleary, Angela M
To understand the vulnerability of patients with cancer to central line-associated bloodstream infections related to tunneled central venous catheters (CVCs), patients were asked to describe their line care at home and in clinic and to characterize their knowledge and experience managing CVCs. Forty-five adult patients with cancer were recruited to participate. Patients were interviewed about the type of line, duration of use, and observations of variations in line care. They also were asked about differences between line care at home and in the clinic, precautions taken when bathing, and their education regarding line care. Demographic information and primary cancer diagnosis were taken from the patients' medical records. Patients with hematologic and gastrointestinal malignancies were heavily represented. The majority had tunneled catheters with subcutaneous implanted ports. Participants identified variations in practice among nurses who cared for them. Although many participants expressed confidence in their knowledge of line care, some were uncertain about what to do if the dressing became loose or wet, or how to recognize an infection. Patients seemed to be astute observers of their own care and offered insights into practice variation. Their observations show that CVC care practices should be standardized, and educational interventions should be created to address patients' knowledge deficits.
The program supports research in three areas: prevention or treatment of acute or chronic symptoms and morbidities related to cancer, its treatment and caregiving (symptom management research); effects on quality of life from cancer, its treatment and caregiving (quality of life research); and end-of-life psychosocial issues, caregiving and treatment strategies (end-of-life research). |
Alananzeh, Ibrahim; Levesque, Janelle; Kwok, Cannas; Everett, Bronwyn
This review aimed to identify the unmet supportive care needs to conduct an integrative review of the literature, to identify the unmet supportive care needs of Arab people affected by cancer (patients and caregivers), and the impact of these needs on quality of life and psychosocial well-being. In July 2015 databases, search engines and electronic list servers were searched, with no limit on the year of publication. Reference lists of included articles and published reviews were also hand searched. Six studies met the inclusion criteria. Most studies examined the supportive care/unmet needs of Arab cancer patients and their family caregivers. Language, communication, information, and the need to get relief from dependency were the most frequently reported unmet needs among Arab cancer patients. For immigrant Arab patients, physical unmet needs were higher than other migrant groups and native Anglo-Australians. Arab caregivers’ unmet needs included concerns about providing suitable care for their family member, sharing their experience with other caregivers, obtaining information, and, in the case of pediatric cancers, dealing with siblings’ emotional reactions. The existing literature exploring the unmet supportive care needs of Arab people affected by cancer is limited suggesting that comprehensive studies are needed to enhance our understanding of these needs and to inform service planning. PMID:27981153
Maree, Johanna Elizabeth; Mulonda, Jennipher Kombe
Objective: The objective of this study was to describe the experiences of Zambian nurses caring for women with advanced breast cancer. Methods: We used a qualitative descriptive design and purposive sampling. Seventeen in-depth interviews were conducted with registered nurses practicing in the Cancer Diseases Hospital and the University Teaching Hospital, Lusaka, Zambia, and analyzed using thematic analyses. Results: Two themes emerged from the data - caring for women with advanced breast cancer is challenging and the good outweighs the bad. The majority of the participants agreed that caring for women with advanced breast cancer and witnessing their suffering were challenging. Not having formal education and training in oncology nursing was disempowering, and one of the various frustrations participants experienced. The work environment, learning opportunities, positive patient outcomes, and the opportunity to establish good nurse–patient experiences were positive experiences. Conclusions: Although negative experiences seemed to be overwhelming, participants reported some meaningful experiences while caring for women with advanced breast cancer. The lack of formal oncology nursing education and training was a major factor contributing to their negative experiences and perceived as the key to rendering the quality of care patients deserved. Ways to fulfill the educational needs of nurses should be explored and instituted, and nurses should be remunerated according to their levels of practice. PMID:28217726
Engler, J; Güthlin, C; Dahlhaus, A; Kojima, E; Müller-Nordhorn, J; Weißbach, L; Holmberg, C
The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany. We compared their perspectives on cooperation relationships in cancer care. Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone. Further research should focus on ways to foster GPs' integration in cancer care and evaluate if this can be reached by incorporating GPs in formal cooperation structures such as tumour boards.
Up to 10% of cancers occur through the inherited mutation of a group of genes called cancer predisposition genes. Individuals who carry a mutant allele of these genes have an increased susceptibility to cancer. A growing number of cancer susceptibility genes are being identified, and the physiopathology of germline mutation-based cancer development is also being elucidated with accumulating clinical and molecular data. More importantly, the identification of familial mutations has become routine practice, which is a perfect example of bench-to-bed translational medicine. Recently, other clinical applications of predisposition genes have been exploited, especially as efficient biomarkers predicting prognosis or response to treatment. Thus, it appears interesting to give an overview of the advances and impacts of predisposition genes in personalized cancer care by taking representative and common cancer syndromes as examples: Lynch syndrome for the first example, which is related to cancer susceptibility, and breast and ovary cancer syndrome for the second example, which involves BRCA deficiency-related targeted therapy.
Schellongowski, Peter; Sperr, Wolfgang R; Wohlfarth, Philipp; Knoebl, Paul; Rabitsch, Werner; Watzke, Herbert H; Staudinger, Thomas
This narrative review deals with the challenge of defining adequate therapy goals and intensive care unit (ICU) admission criteria for critically ill patients with cancer. Several specific complications of critically ill patients with cancer require close collaborations of intensive care and cancer specialists. Intensivists require a basic understanding of the pathophysiology, diagnosis and therapy of common cancer-specific problems. Cancer specialists must be knowledgeable in preventing, detecting and treating imminent or manifest organ failures. In case of one or more organ dysfunctions, ICU admissions must be evaluated early. In order to properly define the therapy goals for critically ill patients with cancer, decision-makers must be aware of the short-term intensive care prognosis as well as the long-term oncological options and perspectives. Multidisciplinary teamwork is key when it comes down to decisions on ICU admission, planning of therapeutic aims, patient management in the ICU and tailored therapy limiting with smooth transition into a palliative care (PC) setting, whenever appropriate. PMID:27843637
Tillery, Rachel; Long, Alanna; Phipps, Sean
The primary aims of this study were to: (a) examine child perceptions of overprotection; and (b) explore how these perceptions relate to child health and adjustment. Children with a prior diagnosis of cancer (n = 205) and children without a history of serious illness (n = 76) reported on parental overprotective and caring behaviors. Children with cancer were recruited from one of four strata based on the elapsed time since their cancer diagnosis (1-6 months; 6-24 months; 2-5 years; >5 years) Children also reported on symptoms of depression, anxiety, and posttraumatic stress. Children with cancer did not differ from healthy children in their perceptions of parental care or overprotection. Child distress was more strongly related to perceptions of care and overprotection than child's health status. Children with cancer do not report their parents approach to care and protection differently than children without a cancer history. These findings mirror prior research examining parental perceptions of overprotection and suggest that, despite the challenges of parenting a child with serious illness, parental protection is not significantly altered.
Weinberger, Mark I.; Bruce, Martha L.; Roth, Andrew J.; Breitbart, William; Nelson, Christian J.
Objective To review the literature on depression in cancer patients with a particular focus on depression assessment and barriers to mental health treatment in older cancer patients. Design We conducted a review of the literature on depression and barriers to mental health treatment in older cancer patients. Results Depression is prevalent in cancer patients. However, little is known about prevalence rates of depression in older adults with cancer, assessing depression in older cancer patients and barriers that impede proper mental health treatment in this sample. Conclusion Improved diagnostic clarity and a better understanding of barriers to mental health treatment can help clarify and facilitate mental health referrals and ultimately improve access to care among older cancer patients in need. Continuing to consider the complexities associated with diagnosing depression in older cancer patients is necessary. Further work may be needed to develop new diagnostic measures for such detection, determine the prevalence of depression among older cancer and ways in which to overcome barriers to mental health care. PMID:21157847
Shahsavari, Hooman; Matory, Pegah; Zare, Zahra; Taleghani, Fariba; Kaji, Mohammad Akbari
Context: Breast cancer is the most common cancer among Iranian women. Although survival rate of breast cancer patients has been increased some distresses affect the patients’ quality of life negatively. the effectiveness of self-care education, particularly in the sociocultural context of Iran, has not been adequately investigated. Aims: This study aims at evaluating the effectiveness of nurse-led self-care education program on quality of life in this patients. Settings and Design: A controlled trial as pretest and posttest design was conducted in Sayyed-Al-Shohada Hospital in Isfahan in 2012. Materials and Methods: Sixty patients with breast cancer were assigned to either the nurse-led self-care education program (n = 30), or to routine care (n = 30). Quality of life was measured at the time of recruitment and also 3 months after the intervention by the instrument of the National Medical Center and Beckman Research Institute. Statistical Analysis Used: Data were analyzed by SPSS (version 16) software using T-independent, T-paired and χ2, and Fisher's exact tests. Results: The intervention group had significantly greater improvements in quality of life status (P < 0.05). Furthermore, self-care education caused a significant increase in the quality of life score related to physical (P = 0.00), psychological (P = 0.00), social (P = 0.00), and emotional (P = 0.00) dimensions. Conclusions: Quality of life in patients with breast cancer can be improved by participating in a nurse-led self-care education program. It is suggested that self-care education to be added to the routine nursing care delivered to these patients. PMID:27462612
Background Since the advent of smartphones, mHealth has risen to the attention of the health care system as something that could radically change the way health care has been viewed, managed, and delivered to date. This is particularly relevant for cancer, as one of the leading causes of death worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing side effects. Given adequate knowledge, they are able to expect appropriate assessments and interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health care professionals; for enabling early detection and intervention; for lowering costs; and achieving better quality of life. Given its great potential, it is important to evaluate the performance of mHealth. This can be considered from several perspectives, of which organizational performance is particularly relevant, since mHealth may increase the productivity of health care providers and as a result even the productivity of health care systems. Objective This paper aims to review studies on the evaluation of the performance of mHealth, with particular focus on cancer care and cancer supportive care processes, concentrating on its contribution to organizational performance, as well as identifying some indications for a further research agenda. Methods We carried out a review of literature, aimed at identifying studies related to the performance of mHealth in general or focusing on cancer care and cancer supportive care. Results Our analysis revealed that studies are almost always based on a single dimension of performance. Any evaluations of the performance of mHealth are based on very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails to consider the real contribution that mHealth can offer for improving the performance of health care providers, health care systems, and the quality of life in general. Conclusions Further research
Tice, Jeffrey A; Kerlikowske, Karla
Mammography remains the mainstay of breast cancer screening. There is little controversy that mammography reduces the risk of dying from breast cancer by about 23% among women between the ages of 50 and 69 years, although the harms associated with false-positive results and overdiagnosis limit the net benefit of mammography. Women in their 70s may have a small benefit from screening mammography, but overdiagnosis increases in this age group as do competing causes of death. While new data support a 16% reduction in breast cancer mortality for 40- to 49-year-old women after 10 years of screening, the net benefit is less compelling in part because of the lower incidence of breast cancer in this age group and because mammography is less sensitive and specific in women younger than 50 years. Digital mammography is more sensitive than film mammography in young women with similar specificity, but no improvements in breast cancer outcomes have been demonstrated. Magnetic resonance imaging may benefit the highest risk women. Randomized trials suggest that self-breast examination does more harm than good. Primary prevention with currently approved medications will have a negligible effect on breast cancer incidence. Public health efforts aimed at increasing mammography screening rates, promoting regular exercise in all women, maintaining a healthy weight, limiting alcohol intake, and limiting postmenopausal hormone therapy may help to continue the recent trend of lower breast cancer incidence and mortality among American women.
Gupta, Abha A; Papadakos, Janet K; Jones, Jennifer M; Amin, Leila; Chang, Eugene K; Korenblum, Chana; Santa Mina, Daniel; McCabe, Lianne; Mitchell, Laura; Giuliani, Meredith E
Literature regarding the development of adolescent and young adult (AYA) cancer programs has been dominantly informed by pediatric centers and practitioners. However, the majority of young adults are seen and treated at adult cancer centers, in which cancer volumes afford the development of innovative supportive care services. Although the supportive care services in adult cancer centers are helpful to AYAs, some of the most prominent and distinct issues faced by AYAs are not adequately addressed through these services alone. This article describes how the AYA Program at Princess Margaret Cancer Centre has collaborated with existing supportive care services in addition to supplying its own unique services to meet the comprehensive needs of AYAs in the domains of: symptom management (sexuality and fatigue), behavior modification (return to work and exercise), and health services (advanced cancer and survivorship). These collaborations are augmented by patient education interventions and timely referrals. The objective of this article was to assist other centers in expanding existing services to address the needs of AYA patients with cancer.
Desandes, Emmanuel; Lacour, Brigitte; Clavel, Jacqueline
In adolescents and young adults (AYA), cancers are rare but represent the third significant cause of death. The aim of this paper was to investigate epidemiological data and pathways of care of AYA in France. During the 2000-2008 period, overall age-standardized incidence rates (ASR) were 254.1/10(6) in 15-24-year-olds. The most frequently diagnosed cancers in male AYA were malignant gonadal germ-cell tumors and Hodgkin's lymphoma, and were melanoma, thyroid carcinoma and Hodgkin's disease in females. The ASR appeared stable over time. During the 2000-2004 period, the 5-year overall survival for all cancers was 81.8%, with differences between genders and age groups: 78.8% for males and 85.2% for females; 78.5% in 15-19-year-olds and 84.3% in 20-24-year-olds. Survival has significantly improved over time. During the 2006-2007 period, the pathways of care for French adolescent patients with cancer were heterogeneous: 82% were treated in an adult environment, 27% were included in clinical studies, and in 54% of cases the management decisions were taken in the context of a multidisciplinary team. Studies looking at management of AYA with cancer have shown a wide disparity and a lack of collaboration between adult oncologists and pediatric oncologist. An AYA cancer multidisciplinary interest group has been created to determine priorities and coordinate efforts to improve AYA cancer services and care.
Paudyal, Priyamvada; Flohr, Francesca D; Llewellyn, Carrie D
This systematic review summarised the literature on patient acceptability of screening for oral cancer outside dental care settings. A comprehensive search of relevant literature was performed in EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, CINAHAL, psycINFO, CANCERLIT and BNI to identify relevant articles published between 1975 and Dec 2013. Studies reporting acceptability of oral cancer screening to undiagnosed individuals attending non-dental settings were eligible for inclusion. A total of 2935 references were initially identified from the computerised search but 2217 were excluded after screening the titles. From the abstracts of the remaining 178 articles, 47 full text articles were retrieved for further scrutiny, and 12 studies were found to be eligible for inclusion. In these studies, knowledge about oral cancer, anxiety related to the screening process, preference for care provision, and financial cost were influencing factors for the acceptance of screening. Written information provided to patients in primary care was reported to boost immediate knowledge levels of oral cancer, lessen anxiety, and increase intentions for screening. The majority of screening methods were entirely acceptable to patients; lack of acceptability from the patients' viewpoint was not a significant barrier to carrying out opportunistic screening of high-risk populations. In conclusion, the available evidence suggests that acceptance of, and satisfaction with oral cancer screening is high, particularly where patients have previously been educated about oral cancer. Further research focusing on patient's preferences would enable streamlining of the approach to oral cancer screening taken by any national programme.
Zhou, Eric S.; Nekhlyudov, Larissa
There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in order are also described in order to emphasize the importance of PCPs initiating this important conversation. Next, we provide strategies and resources to help guide the PCP in the management of sexual dysfunction in cancer survivors. Finally, we discuss case examples of survivorship sexual health issues and highlight the role that a PCP can play in each of these case examples. PMID:26816826
Arredondo, Elva M.; Pollak, Kathryn I.; Costanzo, Philip; McNeilly, Maya; Myers, Evan
BACKGROUND: Cervical cancer screening rates in the United States are sub-optimal. Physician factors likely contribute to these lower rates. Previous studies provide inconclusive evidence about the association between physician characteristics and the likelihood of addressing cervical cancer. This report assesses potential mechanisms that explain why certain providers do not address cervical cancer screening. METHODS: One hundred primary care residents from various specialties were asked to indicate the preventive topics they would address with a hypothetical white female in her early 20s, who was portrayed as living a "high risk" lifestyle, and visiting her provider only for acute care reasons. RESULTS: Among the provider characteristics assessed, only residents' ethnicity was associated with the likelihood of and time spent addressing cervical cancer screening. In particular, Asian-American residents were least likely to address cervical cancer, while African-American residents were most likely. A mediation analyses revealed that perceived barriers for addressing cervical cancer accounted for this difference. CONCLUSIONS: Study results suggest that there may be cultural factors among health care providers that may account for differential referral and treatment practices. Findings from this study may help identify factors that explain why cervical cancer screening rates are not higher. PMID:12911255
Shigeishi, Hideo; Ohta, Kouji; Fujimoto, Shinichi; Nakagawa, Takayuki; Mizuta, Kuniko; Ono, Shigehiro; Shimasue, Hiroshi; Ninomiya, Yoshiaki; Higashikawa, Koichiro; Tada, Misato; Ishida, Fumi; Okui, Gaku; Okumura, Toshiya; Fukui, Akiko; Kubozono, Kazumi; Yamamoto, Kazuhiro; Ishida, Yoko; Seino, Sayaka; Hashikata, Miho; Sasaki, Kazuki; Naruse, Takako; Rahman, Mohammad Zeshaan; Uetsuki, Ryo; Nimiya, Akiko; Takamoto, Megumi; Dainobu, Kana; Tokikazu, Tomoko; Nishi, Hiromi; Sugiyama, Masaru; Takechi, Masaaki
The records of 70 patients with oral cancer who were treated at a single institution between 2008 and 2014 were reviewed. The body temperature, white blood cell count, and C-reactive protein (CRP) levels were compared between those who had received preoperative oral care (oral care group) and those who had not received any (non-oral care group). When the patients were divided into those who underwent minimally invasive surgery and those who underwent severely invasive surgery, the mean CRP level in the early postoperative period was lower in the oral care group as compared with the non-oral care group in those who underwent minimally invasive surgery as well as those who underwent severely invasive surgery. However, the mean CRP level was most evidently reduced in the severely invasive group on days 1 and 3–5. However, no significant differences were observed with regard to the percentage of postoperative infectious complications (for example, surgical site infection, anastomotic leak and pneumonia) between the oral care (13.6%) and non-oral care (20.8%) groups, though a reduced prevalence of postoperative complications following preoperative oral care was noted. The results of the present study suggest that preoperative oral care can decrease inflammation during the early postoperative stage in patients with oral cancer who undergo severely invasive surgery. PMID:27588111
Thomson, Maria D; Siminoff, Laura A
Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer symptoms. Using verbatim transcripts of the narratives collected from patients between 2008 and 2010, three themes were identified: insurance status as a barrier (discussed by n = 84; 100% of subsample), finding medical care (discussed by n = 30; 36% of subsample) and, insurance companies as barriers (discussed by n = 7; 8% of subsample). Our analysis revealed that insurance status is more nuanced than the categories insured/uninsured and differentially affects how patients attempt to secure health care. While barriers to medical care for the uninsured have been well documented, the experiences of those who are underinsured are less well understood. To improve outcomes in these patients it is critical to understand how financial barriers to medical care are manifested. Even with anticipated changes of the Affordable Care Act, it remains important to understand how perceived financial barriers may be influencing patient behaviors, particularly those who have limited health care options due to insufficient health insurance coverage.
Thomson, Maria D.; Siminoff, Laura A.
Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer symptoms. Using verbatim transcripts of the narratives collected from patients between 2008 and 2010, three themes were identified: insurance status as a barrier (discussed by n = 84; 100% of subsample), finding medical care (discussed by n = 30; 36% of subsample) and, insurance companies as barriers (discussed by n = 7; 8% of subsample). Our analysis revealed that insurance status is more nuanced than the categories insured/uninsured and differentially affects how patients attempt to secure health care. While barriers to medical care for the uninsured have been well documented, the experiences of those who are underinsured are less well understood. To improve outcomes in these patients it is critical to understand how financial barriers to medical care are manifested. Even with anticipated changes of the Affordable Care Act, it remains important to understand how perceived financial barriers may be influencing patient behaviors, particularly those who have limited health care options due to insufficient health insurance coverage. PMID:25394821
Background Due to changes in cancer-related risk factors, improvements in diagnostic procedures and treatments, and the aging of the population, in most developed countries cancer accounts for an increasing proportion of health care expenditures. The analysis of cancer-related costs is a topic of several economic and epidemiological studies and represents a research area of great interest to public health planners and policy makers. In Italy studies are limited either to some specific types of expenditures or to specific groups of cancer patients. Aim of the paper is to estimate the distribution of cancer survivors and associated health care expenditures according to a disease pathway which identifies three clinically relevant phases: initial (one year following diagnosis), continuing (between initial and final) and final (one year before death). Methods The methodology proposed is based on the reconstruction of patterns of care at individual level by combining different data sources, surveillance data and administrative data, in areas covered by cancer registration. Results A total colorectal cancer-related expenditure of 77.8 million Euros for 18012 patients (corresponding to about 4300 Euros per capita) is estimated in 2006 in two Italian areas located in Tuscany and Veneto regions, respectively. Cost of care varies according to the care pathway: 11% of patients were in the initial phase, and consumed 34% of total expenditure; patients in the final (6%) and in the continuing (83%) phase consumed 23% and 43% of the budget, respectively. There is an association between patterns of care/costs and patients characteristics such as stage and age at diagnosis. Conclusions This paper represents the first attempt to attribute health care expenditures in Italy to specific phases of disease, according to varying treatment approaches, surveillance strategies and management of relapses, palliative care. The association between stage at diagnosis, profile of therapies and
Wells, Diane Keegan; James, Kelly; Stewart, Janet L; Moore, Ida M; Kelly, Katherine Patterson; Moore, Barbara; Bond, Dana; Diamond, Joy; Hall, Brenda; Mahan, Rosemary; Roll, Lona; Speckhart, Beth
The growing societal trend toward delivering more and more illness-related care in the home, driven both by family preferences and by mandates from third-party reimbursers, places additional responsibilities for increasingly complex caregiving on parents of children with serious illness. This article reports on the development and initial field test of The Care of My Child with Cancer, a caregiving demand instrument specific to the childhood cancer population. The instrument demonstrated strong internal consistency and test-retest reliability, and exploratory factor analysis provided initial evidence for the instrument's construct validity. The instrument will now be applied in a collaborative program of nursing research to further investigate caregiving demand and ultimately to develop nursing interventions to maximize medical and quality of life outcomes for children with cancer and their families.
Sanches, Mariana Vendrami Parra; Nascimento, Lucila Castanheira; de Lima, Regina Aparecida Garcia
This study's objective was to investigate the experience of family members of children and adolescents with cancer in terms of palliative care, especially the care provided in the final stage of life. This is a descriptive and exploratory study with qualitative data analysis. A total of 14 family members participated in the study. They were the caregivers of children and adolescents with cancer who died, and were followed up by a teaching hospital in the state of São Paulo. Empirical data were organized around three themes: "The impact of the worsening of the disease on the family's dynamics", "Communicating bad news" and "The experience of the family concerning palliative care". This study is relevant to children and adolescents with cancer in the end-of life care because the complex, dynamics, and comprehensive experiences of families in the care of children and adolescents in this period can contribute to better understanding of the process of providing care in light of the fundamentals of palliative care.
Pollack, Craig Evan; Ross, Michelle E.; Armstrong, Katrina; Branas, Charles C.; Rhodes, Karin V.; Bekelman, Justin E.; Wentz, Alicia; Stillson, Christian; Radhakrishnan, Archana; Oyeniran, Enny; Grande, David
Purpose Prior work suggests that access to health care may influence the diagnosis and treatment of prostate cancer. Mystery-caller methods have been used previously to measure access to care for health services such as primary care, where patients’ self-initiate requests for care. We used a mystery-caller survey for specialized prostate cancer care to assess dimensions of access to prostate cancer care. Materials and Methods We created an inventory of urology and radiation oncology practices in southeastern Pennsylvania. Using a ‘mystery caller’ approach, a research assistant posing as a medical office scheduler in a primary care office, attempted to make a new patient appointment on behalf of a referred patient. Linear regression was used to determine the association between time to next available appointment with practice and census tract characteristics. Results We successfully obtained information on new patient appointments from 198 practices out of the 223 in the region (88.8%). Radiation oncology practices were more likely to accept Medicaid compared to urology practices (91.3% vs 36.4%) and had shorter mean wait times for new patient appointments (9.0 vs 12.8 days). We did not observe significant differences in wait times according to census tract characteristics including neighborhood socioeconomic status and the proportion of male African American residents. Conclusions Mystery-caller methods that reflect real-world referral processes from primary care offices can be used to measure access to specialized cancer care. We observed significant differences in wait times and insurance acceptance between radiation oncology and urology practices. PMID:27723780
Breast Carcinoma; Cancer Survivor; Depression; Fatigue; Leukemia; Lymphoma; Malignant Bone Neoplasm; Malignant Digestive System Neoplasm; Malignant Female Reproductive System Neoplasm; Malignant Male Reproductive System Neoplasm; Pain; Sleep Disorder; Soft Tissue Sarcoma
Rosenberg, Dori; Kadokura, Elyse A; Bouldin, Erin D; Miyawaki, Christina E; Higano, Celestia S.; Hartzler, Andrea L.
Prior research has not examined the acceptability of commercially available fitness tracking devices in men with prostate cancer, many of whom are at risk for conditions that physical activity could alleviate. We conducted an exploratory 3-week field study to examine acceptability of the Fitbit Zip and attitudes towards integrating fitness tracking into clinical care among men with prostate cancer. Twenty-six men used the Fitbit Zip for a one-week baseline phase followed by a 2-week optional use phase and then completed in-depth interviews. Interview data was analyzed using inductive thematic analysis. Participants found the device comfortable and easy to wear. Barriers to use included health and technology difficulties. Participants expressed value in sharing Fitbit data with their health care team. Findings support the use of easy to use and simple fitness trackers among men with prostate cancer and there could be opportunities to integrate fitness tracker data into clinical care. PMID:28269902
I discuss the physical wearing out of low-income cancer patients in the aftermath of the neoliberal restructuring of the Colombian health care system in 1993. The settings for this struggle are the hospitals and the health insurance companies; the actors are bodies with cancer, the physicians who diagnose people with cancer, and the relatives who care for them. I show how most low-income patients, instead of accessing complete anticancer treatments in a timely fashion, have to negotiate and confront health insurance companies and profit-making. This results in a wait, where the time needs of the bureaucracy of the health care system and the time needs of patients' bodies are discordant, at a cost to patients.
Rosenberg, Dori; Kadokura, Elyse A; Bouldin, Erin D; Miyawaki, Christina E; Higano, Celestia S; Hartzler, Andrea L
Prior research has not examined the acceptability of commercially available fitness tracking devices in men with prostate cancer, many of whom are at risk for conditions that physical activity could alleviate. We conducted an exploratory 3-week field study to examine acceptability of the Fitbit Zip and attitudes towards integrating fitness tracking into clinical care among men with prostate cancer. Twenty-six men used the Fitbit Zip for a one-week baseline phase followed by a 2-week optional use phase and then completed in-depth interviews. Interview data was analyzed using inductive thematic analysis. Participants found the device comfortable and easy to wear. Barriers to use included health and technology difficulties. Participants expressed value in sharing Fitbit data with their health care team. Findings support the use of easy to use and simple fitness trackers among men with prostate cancer and there could be opportunities to integrate fitness tracker data into clinical care.
as missing data. A test of the full model with all independent variables against the unconditional model was statistically reliable—chi square (11, N... statistical methods were tested to better examine the symptom trajectory among women with breast cancer over time by embedding an Item Response...the model . This con- straint reflects the belief that, given a symptom experience, random samples of women with breast cancer will experi- log a mijk
Chalmers, K I; Luker, K A
Breast cancer is a major threat to the health of women; two-thirds of women diagnosed with breast cancer are likely to die from the disease. In North America one woman in nine will experience breast cancer at some point in her lifetime. In the United Kingdom, the figure is somewhat lower, one in 12, and increasing. Increasing age and a family history of breast cancer are considered major risk factors. With no known primary prevention, early detection measures remain the main hope of decreasing mortality. Despite controversy surrounding the effectiveness of breast self-examination in reducing mortality, breast self-examination or breast self-'awareness' are advocated by health departments and voluntary cancer organizations. In this paper, breast self-care practices of women with a family history of breast cancer are reported. A descriptive study using in-depth semi-structured interviews as the prime data collection procedure was conducted with 55 women who had mothers, sister(s) or mothers and another primary relative with breast cancer. All interviews were tape recorded, transcribed and analysed using latent content analysis and constant comparison techniques. The findings revealed that women constructed their own personal meanings about the benefits and limitations of breast self-examination and their use of this self-care behaviour within their daily lives. Women used breast self-examination as a means of gaining control over their feelings of the threat of breast cancer. Women's earlier involvement with their relative during the cancer experience and their own processing of their personal risk for breast cancer influenced their breast self-care practices.
Kalavrezos, Nicholas; Scully, Crispian
A MEDLINE search early in 2015 revealed more than 250,000 papers on head and neck cancer; over 100,000 on oral cancer; and over 60,000 on mouth cancer. Not all publications contain robust evidence. We endeavour to encapsulate the most important of the latest information and advances now employed in practice, in a form comprehensible to healthcare workers, patients and their carers. This series offers the primary care dental team in particular, an overview of the aetiopathogenesis, prevention, diagnosis and multidisciplinary care of mouth cancer, the functional and psychosocial implications, and minimization of the impact on the quality of life of patient and family. Clinical Relevance: This article offers the dental team an overview of the multidisciplinary team (MDT; or multi-speciality team) and its roles, and an overview of the implications of therapies that are discussed more fully in future articles in the series.
Clark, Karen; Greene, Paul; DuHamel, Kate; Loscalzo, Matthew; Grant, Marcia; Glazier, Kim; Redd, William
For between one third and one half of all cancer survivors, disturbances in mood and cognition do not end with the conclusion of treatment. Recognizing this problem, the Institute of Medicine emphasized in its 2008 report, the importance of addressing psychosocial issues, such as distress, to providing quality cancer care. The National Cancer Institute (NCI) has recognized that there is a severe lack of trained professionals who can address these needs. In response to this need, an interactive training program was developed and implemented to teach frontline cancer care professionals Cognitive Behavioral Therapy (CBT) skills. This training includes a structured curriculum, centered around a 3-day training workshop that includes didactic discussion, small group interactive sessions, role playing, post course support, and follow-up evaluation. Four of the planned eight workshops have been conducted thus far and indicate successful recruitment and implementation of a unique training model related to the CBT skills learned.
Pandya, Hardik J.; Park, Kihan; Desai, Jaydev P.
The use of flexible micro-electro-mechanical systems (MEMS)-based devices provides a unique opportunity in bio-medical robotics such as the characterization of normal and malignant tissues. This paper reports on the design and development of a flexible MEMS-based sensor array integrating mechanical and electrical sensors on the same platform to enable the study of the change in electro-mechanical properties of benign and cancerous breast tissues. In this work, we present the analysis of the electrical characterization of the tissue specimens and also demonstrate the feasibility of using the sensor for the mechanical characterization of tissue specimens. Eight strain gauges acting as mechanical sensors were fabricated using poly(3,4-ethylenedioxythiophene) poly(styrenesulfonate) (PEDOT:PSS) conducting polymer on poly(dimethylsiloxane) (PDMS) as the substrate material. Eight electrical sensors were fabricated using SU-8 pillars on gold (Au) pads which were patterned on the strain gauges separated by a thin insulator (SiO2 1.0 μm). These pillars were coated with gold to make them conducting. The electro-mechanical sensors are integrated on the same substrate. The sensor array covers a 180 μm × 180 μm area and the size of the complete device is 20 mm in diameter. The diameter of each breast tissue core used in the present study was 1 mm and the thickness was 8 μm. The region of interest was 200 μm × 200 μm. A microindentation technique was used to characterize the mechanical properties of the breast tissues. The sensor is integrated with conducting SU-8 pillars to study the electrical property of the tissue. Through electro-mechanical characterization studies using this MEMS-based sensor, we were able to measure the accuracy of the fabricated device and ascertain the difference between benign and cancers breast tissue specimens.
King, Christopher J; Chen, Jie; Dagher, Rada K; Holt, Cheryl L; Thomas, Stephen B
More research is needed to identify factors that explain why minority cancer survivors ages 18 to 64 are more likely to delay or forgo care when compared with whites. Data were merged from the 2000-2011 National Health Interview Survey to identify 12 125 adult survivors who delayed medical care. The Fairlie decomposition technique was applied to explore contributing factors that explain the differences. Compared with whites, Hispanics were more likely to delay care because of organizational barriers (odds ratio = 1.38; P < .05), and African Americans were more likely to delay medical care or treatment because of transportation barriers (odds ratio = 1.54; P < .001). The predicted probability of not receiving timely care because of each barrier was lowest among minorities. Age, insurance, perceived health, comorbidity, nativity, and year were significant factors that contributed to the disparities. Although expanded insurance coverage through the Affordable Care Act is expected to increase access, organizational factors and transportation play a major role.
Dossett, Lesly A; Hudson, Janella N; Morris, Arden M; Lee, M Catherine; Roetzheim, Richard G; Fetters, Michael D; Quinn, Gwendolyn P
Although they are critical to models of coordinated care, the relationship and communication between primary care providers (PCPs) and cancer specialists throughout the cancer continuum are poorly understood. By using predefined search terms, the authors conducted a systematic review of the literature in 3 databases to examine the relationship and communication between PCPs and cancer specialists. Among 301 articles identified, 35 met all inclusion criteria and were reviewed in-depth. Findings from qualitative, quantitative, and disaggregated mixed-methods studies were integrated using meta-synthesis. Six themes were identified and incorporated into a preliminary conceptual model of the PCP-cancer specialist relationship: 1) poor and delayed communication between PCPs and cancer specialists, 2) cancer specialists' endorsement of a specialist-based model of care, 3) PCPs' belief that they play an important role in the cancer continuum, 4) PCPs' willingness to participate in the cancer continuum, 5) cancer specialists' and PCPs' uncertainty regarding the PCP's oncology knowledge/experience, and 6) discrepancies between PCPs and cancer specialists regarding roles. These data indicate a pervasive need for improved communication, delineation, and coordination of responsibilities between PCPs and cancer specialists. Future interventions aimed at these deficiencies may improve patient and physician satisfaction and cancer care coordination. CA Cancer J Clin 2017;67:156-169. © 2016 American Cancer Society.
Kayani, Noaman; Yun, Shumei
Introduction We compared behavioral risk factors and preventive measures among female breast cancer survivors, female survivors of other types of cancers, and women without a history of cancer. Survivorship health care indicators for the 2 groups of cancer survivors were compared. Methods Using data from the 2010 Behavioral Risk Factor Surveillance System, we calculated the proportion of women with risk factors and their engagement in preventive practices, stratified by cancer status (cancer survivors or women with no history of cancer), and compared the proportions after adjusting for sociodemographic characteristics. Results A significantly higher proportion of breast cancer survivors had mammography in the previous year (79.5%; 95% confidence interval [CI], 76.0%–83.0%) than did other cancer survivors (68.1%; 95% CI, 65.6%–70.7%) or women with no history of cancer (66.4%; 95% CI, 65.5%–67.3%). Breast cancer survivors were also more likely to have had a Papanicolaou (Pap) test within the previous 3 years than women with no history of cancer (89.4%; 95% CI, 85.9%–93.0 vs 85.1%; 95% CI, 84.4%–85.8%) and a colonoscopy within the previous 10 years (75.4%; 95% CI, 71.7%–79.0%) than women with no history of cancer (60.0%; 95% CI, 59.0%–61.0%). Current smoking was significantly lower among survivors of breast cancer (10.3%; 95% CI, 7.4%–13.2%) than other cancer survivors (20.8%; 95% CI, 18.4%–23.3%) and women with no history of cancer (18.3%; 95% CI, 17.5%–19.1%). After adjusting for sociodemographic characteristics, we found that breast cancer survivors were significantly more likely to have had mammography, a Pap test, and colonoscopy, and less likely to be current smokers. Conclusion Breast cancer survivors are more likely to engage in cancer screening and less likely to be current smokers than female survivors of other types of cancer or women with no history of cancer. PMID:26796517
Al-Jauissy, M S
This descriptive exploratory study was conducted to describe the health care needs and identify unmet needs of the caregivers of cancer patients in Jordan. A total of 82 caregivers accompanying patients to an outpatient chemotherapy clinic completed the 90-item caregiver need scale. Caregivers reported 75.6% of scale items as needs and rated these as "very important" needs on all 6 areas of the caregivers' need scale: personal care, activity management, involvement with health care, work, interpersonal interaction and finance. Unmet needs of caregivers were a higher proportion of identified needs (76.4%) than in similar studies elsewhere. The education and support needs of caregivers need to be considered when designing care plans for cancer patients.
Howard, Jocelyn R; Ramirez, Julia; Li, Yuelin; Gany, Francesca
This exploratory study assesses the dental care needs and access of low-income, mostly immigrant cancer patients enrolled in New York City's Integrated Cancer Care Action Network (ICCAN). A nested cohort of patients from ICCAN responded to a dental needs assessment that surveyed current dental health as well as access to, and use of, dental services. 373 patients participated. Self-report of having a dentist to visit, current dental problems, income, and insurance most significantly predicted a dentist visit in the past year. Discussing treatment-related oral side effects with the oncologist greatly increased the likelihood of seeing a dentist, but few patients reported having had this conversation. There is a lack of oral care information flowing from oncologists to low income patients. We found a high number of reported dental problems: concerning because of potential treatment interference and risk for infection. Finally, ability to pay largely determined dental care access in our study participants.
Kennedy, Martyn P T; Hall, Peter S; Callister, Matthew E J
Lung cancer diagnosis during emergency hospital admission has been associated with higher early secondary-care costs and lower longer-term costs than outpatient diagnoses. This retrospective cohort study analyses the secondary-care costs of 3274 consecutive patients with lung cancer. Patients diagnosed during emergency admissions incurred greater costs during the first month and had a worse prognosis compared with outpatient diagnoses. In patients who remained alive, costs after the first month were comparable between diagnostic routes. In addition to improving patient experience and outcome, strategies to increase earlier diagnosis may reduce the additional healthcare costs associated with this route to diagnosis.
O'Hanlon, E; Kennedy, N
Little is known about the extent of exercise prescription within cancer care. This cross-sectional survey aims to identify Irish oncology nurses and physiotherapists' current knowledge and practice in prescribing exercise for cancer care and barriers to such prescription. An online survey was distributed to the Chartered Physiotherapists in Oncology and Palliative Care (n = 35) and the Irish Association for Nurses in Oncology (n = 170). The response rate was 74% (26/35) for physiotherapists and 34% (58/170) for oncology nurses. Three quarters of physiotherapists recommended/prescribed exercise with 81% or more of cancer patients in the past 6 months, with the exercises prescribed largely in line with current guidelines. Patients' family/friends advising rest was the most commonly reported exercise barrier by physiotherapists [89% (17/19)], with a lack of exercise guidelines for cancer patients being most problematic for oncology nurses [93% (50/54)]. Only 33% (18/54) of oncology nurses felt they had sufficient knowledge regarding exercise in cancer care. In conclusion, exercise prescription by physiotherapists largely corresponds with current guidelines. A minority of nurses felt they had sufficient knowledge of exercise for this population. Further formal postgraduate educational opportunities are needed for oncology nurses and physiotherapists in this area.
Panagiotopoulou, N; Ghuman, N; Sandher, R; Herbert, M; Stewart, J A
Infertility is a potential late-effect of cancer treatment, which negatively impact on young cancer survivors' quality of life. This paper aims to synthesise factors that influence patients', carers' and healthcare professionals' decision to engage in fertility preservation programmes at the time of cancer diagnosis. Four databases and grey literature were systematically searched to identify qualitative and mixed-method studies published between 2000 and 2015. Thematic framework and synthesis were used to analyse and synthesise the data. Thirty-seven papers were selected and represented. Factors that affect engagement of patients, carers and healthcare providers in fertility preservation care can be grouped as intrinsic and extrinsic. Intrinsic factors include patients' attitudes, health beliefs and health literacy; clinicians' approaches and skills; as well as doctor-patient relationships. Extrinsic factors include fertility preservation care resources and institutional characteristics. We conclude that existing qualitative literature highlights the complex convergences of intrinsic and extrinsic factors that impede successful engagement in fertility preservation care. Addressing these factors could help cancer survivors achieve better health outcomes and improve their wellbeing. Potential solutions include attitudinal changes and organisational skill reforms across the health community that will help ensure a person's goals are always at the centre of their cancer care.
Callahan, Ryan; Darzi, Ara
The burden of cancer on public finances is a serious concern for policy makers. More people are developing cancer, and as standards of care have risen, more are surviving and requiring longer-term care. Precision medicine promises better outcomes but demands commensurately higher payments for care. As both incidence and per case costs rise, we suggest that the task of expanding access to high-quality cancer care poses a "value challenge" that policies in many countries are inadequate to meet. Policy makers should respond with a new approach. We explore questions that policy makers will need to consider regarding objectives, barriers, and levers for policy development. We use transparency and accountability as cornerstones of a new approach to promote value-based decision making. Although barriers to advancing this agenda are formidable, we recommend that governments define common standards for value-based accounting; serve as information brokers for evidence development; pioneer value-based procurement of goods and services; engage in deliberative democracy in cancer care; and educate communities to facilitate knowledge sharing between communities of patients, their caretakers, and researchers.
Hogg, Lori Hoffman
Prioritizing personalized, proactive, patient-driven health care is among the Veterans Health Administration's (VHA's) transformational initiatives. As one of the largest integrated healthcare systems, the VHA sets standards for performance measures and outcomes achieved in quality of care. Evidence-based practice (EBP) is a hallmark in oncology nursing care. EBP can be linked to positive outcomes and improving quality that can be influenced directly by nursing interventions. VHA oncology nurses had the opportunity to partner with the Oncology Nursing Society (ONS), ONS Foundation, and the Joint Commission in the multiyear development of a comprehensive approach to quality cancer care. Building on a platform of existing measures and refining measurement sets culminated in testing evidence-based, nursing-sensitive quality measures for reliability through the ONS Foundation-supported Breast Cancer Care (BCC) Quality Measures Set. The BCC Measures afforded the VHA to have its many sites collectively assess documentation of the symptoms of patients with breast cancer, the use of colony-stimulating factors, and education about neutropenia precautions provided. Parallel paths of the groups, seeking evidence-based measures, led to the perfect partnership in the VHA's journey in pilot testing the BCC Measures in veterans with breast cancer. This generated further quality assessments and continuous improvement projects for spread and sustainability throughout the VHA.
At the Institute for Palliative Medicine (IPM) in San Diego, medical residents are re-tooling for one of the most essential aspects of medicine: caring for seriously ill patients. “The goal is to teach them the core competencies in palliative care,” explained Dr. Charles von Gunten, the institute’s provost. |
Docherty, Sharron L.; Thaxton, Cheryl; Allison, Courtney; Barfield, Raymond C.; Tamburro, Robert F.
Palliative care for children and adolescents with cancer includes interventions that focus on the relief of suffering, optimization of function, and improvement of quality of life at any and all stages of disease. This care is most effectively provided by a multidisciplinary team. Nurses perform an integral role on that team by identifying symptoms, providing care coordination, and assuring clear communication. Several basic tenets appear essential to the provision of optimal palliative care. First, palliative care should be administered concurrently with curative therapy beginning at diagnosis and assuming a more significant role at end of life. This treatment approach, recommended by many medical societies, has been associated with numerous benefits including longer survival. Second, realistic, objective goals of care must be developed. A clear understanding of the prognosis by the patient, family, and all members of the medical team is essential to the development of these goals. The pediatric oncology nurse is pivotal in developing these goals and assuring that they are adhered to across all specialties. Third, effective therapies to prevent and relieve the symptoms of suffering must be provided. This can only be accomplished with accurate and repeated assessments. The pediatric oncology nurse is vital in providing these assessments and must possess a working knowledge of the most common symptoms associated with suffering. With a basic understanding of these palliative care principles and competency in the core skills required for this care, the pediatric oncology nurse will optimize quality of life for children and adolescents with cancer. PMID:23641169
Hayes, Daniel F.; Ramsey, Scott D.; Hortobagyi, Gabriel N.; Barlow, William E.; Gralow, Julie R.
Evidence-based guidelines for long-term follow-up of early-stage breast cancer patients developed by oncology societies in the United States and Europe recommend that breast cancer survivors undergo regular evaluation with history and physical examination, as well as annual mammography. Routine blood tests, circulating tumor markers, and/or surveillance imaging studies beyond mammography are not recommended in the absence of concerning symptoms or physical examination findings because of lack of supportive clinical evidence. Despite these guidelines, studies have shown that 20% to 40% of oncologists assess serum tumor markers as part of routine monitoring of early-stage breast cancer patients. As part of efforts to both address the financial challenges confronting the health-care system and optimize patient outcomes, the American Society of Clinical Oncology’s Cost of Care Task Force identified adherence to breast cancer surveillance guidelines as an opportunity to improve care and reduce cost. However, these recommendations are based on trials done in an era of outdated technology and limited therapeutic options. It is possible that recent improvements in diagnostics and treatments could make earlier detection of recurrent disease important for improving both survival and quality of life outcomes. Research is necessary to further inform optimal breast cancer follow-up strategies, which could impact these recommendations. At this time, outside of well-conducted clinical trials, there is no role for ordering routine serial blood or imaging tests in monitoring for recurrence in early-stage breast cancer patients. PMID:24627271
Rajandram, Rama Krsna; Jenewein, Josef; McGrath, Colman Patrick Joseph; Zwahlen, Roger Arthur
Recently the importance of posttraumatic growth (PTG), a phenomenon of positive psychological growth beyond baseline values, has been discovered in the field of oncology. An evidence based review of the literature regarding PTG was performed, both to support its understanding and to consider its application within the research field of oral cavity (OC) cancer. A Pubmed, Medline, PsycINFO search from the earliest date until April 2010 was carried out. Full articles meeting the inclusion and exclusion criteria were reviewed. The search yielded 852 papers, 91 'potentially relevant papers' and 29 'effective papers', the latter of which formed the basis of this review. PTG was assessed in twenty-eight studies with the Posttraumatic Growth Inventory and in only one study with the Perceived Benefits Scale (PBS). PTG in cancer patients has been reported in five main domains (i) appreciation of life, (ii) relating to others, (iii) increased personal sense, (iv) sense of new possibilities and (v) positive spiritual change. Socio-demographic factors, stressor characteristics and coping strategies influence and predict the development PTG. In the past decade an increasing interest in the concept of PTG in the field of oncology has emerged. This evidence based review presents PTG to the research community in the field of OC cancer, appraises its modification capacity of the treatment outcome in other cancer research fields and hypothesizes its eventual benefit in the field of OC cancer research.
Shanmugam, Nandhinee Radha; Muthukumar, Sriram; Prasad, Shalini
We demonstrate a flexible, mechanically stable, and disposable electrochemical sensor platform for monitoring cardiac troponins through the detection and quantification of cardiac Troponin-T (cTnT). We designed and fabricated nanostructured zinc oxide (ZnO) sensing electrodes on flexible porous polyimide substrates. We demonstrate ultrasensitive detection is capable at very low sample volumes due to the confinement phenomenon of target species within the ZnO nanostructures leading to enhancement of biomolecular binding on the sensor electrode surface. The performance of the ZnO nanostructured sensor electrode was evaluated against gold and nanotextured ZnO electrodes. The electrochemical sensor functions on affinity based immunoassay principles whereby monoclonal antibodies for cTnT were immobilized on the sensor electrodes using thiol based chemistry. Detection of cTnT in phosphate buffered saline (PBS) and human serum (HS) buffers was achieved at low sample volumes of 20 μL using non-faradaic electrochemical impedance spectroscopy (EIS). Limit of detection (LOD) of 1E-4 ng/mL (i.e. 1 pg/mL) at 7% CV (coefficient of variation) for cTnT in HS was demonstrated on nanostructured ZnO electrodes. The mechanical integrity of the flexible biosensor platform was demonstrated with cyclic bending tests. The sensor performed within 12% CV after 100 bending cycles demonstrating the robustness of the nanostructured ZnO electrochemical sensor platform. PMID:27634488
Shanmugam, Nandhinee Radha; Muthukumar, Sriram; Prasad, Shalini
We demonstrate a flexible, mechanically stable, and disposable electrochemical sensor platform for monitoring cardiac troponins through the detection and quantification of cardiac Troponin-T (cTnT). We designed and fabricated nanostructured zinc oxide (ZnO) sensing electrodes on flexible porous polyimide substrates. We demonstrate ultrasensitive detection is capable at very low sample volumes due to the confinement phenomenon of target species within the ZnO nanostructures leading to enhancement of biomolecular binding on the sensor electrode surface. The performance of the ZnO nanostructured sensor electrode was evaluated against gold and nanotextured ZnO electrodes. The electrochemical sensor functions on affinity based immunoassay principles whereby monoclonal antibodies for cTnT were immobilized on the sensor electrodes using thiol based chemistry. Detection of cTnT in phosphate buffered saline (PBS) and human serum (HS) buffers was achieved at low sample volumes of 20 μL using non-faradaic electrochemical impedance spectroscopy (EIS). Limit of detection (LOD) of 1E-4 ng/mL (i.e. 1 pg/mL) at 7% CV (coefficient of variation) for cTnT in HS was demonstrated on nanostructured ZnO electrodes. The mechanical integrity of the flexible biosensor platform was demonstrated with cyclic bending tests. The sensor performed within 12% CV after 100 bending cycles demonstrating the robustness of the nanostructured ZnO electrochemical sensor platform.
Welch, J P; Sims, N; Ford-Carlton, P; Moon, J B; West, K; Honore, G; Colquitt, N
The article describes a study conducted on general surgical and thoracic surgical floors of a 1000-bed hospital to assess the impact of a new network for portable patient care devices. This network was developed to address the needs of hospital patients who need constant, multi-parameter, vital signs surveillance, but do not require intensive nursing care. Bedside wall jacks were linked to UNIX-based workstations using standard digital network hardware, creating a flexible system (for general care floors of the hospital) that allowed the number of monitored locations to increase and decrease as patient census and acuity levels varied. It also allowed the general care floors to provide immediate, centralized vital signs monitoring for patients who unexpectedly became unstable, and permitted portable monitors to travel with patients as they were transferred between hospital departments. A disk-based log within the workstation automatically collected performance data, including patient demographics, monitor alarms, and network status for analysis. The log has allowed the developers to evaluate the use and performance of the system.
Nathan, Paul; Ahluwalia, Aneeta; Chorley, Wendy
Breast cancer is the most common cancer diagnosed in women, both in the UK and worldwide. A small proportion of women are at very high risk of breast cancer, having a particularly strong family history. The National Institute for Health and Clinical Excellence (NICE) has advised that practitioners should not, in most instances, actively seek to identify women with a family history of breast cancer. An audit was undertaken at an urban primary care practice of 15,000 patients, using a paper-based, self-administered questionnaire sent to patients identified with a personal history of breast cancer. The aim of this audit was to determine whether using targeted screening of relatives of patients with breast cancer to identify familial cancer risk is worthwhile in primary care. Since these patients might already expected to have been risk assessed following their initial diagnosis, this audit acts as a quality improvement exercise. The audit used a validated family history questionnaire and risk assessment tool as a screening approach for identifying and grading familial risk in line with the NICE guidelines, to guide referral to the familial cancer screening service. The response rate to family history questionnaires was 54 % and the majority of patients responded positively to their practitioner seeking to identify familial cancer risks in their family. Of the 57 returned questionnaires, over a half (54 %) contained pedigrees with individuals eligible for referral. Patients and their relatives who are often registered with the practice welcome the discussion. An appropriate referral can therefore be made. The findings suggest a role for primary care practitioners in the identification of those at higher familial risk. However integrated systems and processes need designing to facilitate this work.
Müller, Alice Mânica; Gazzana, Marcelo Basso; Silva, Denise Rossato
Objective This study aimed to evaluate the outcomes for patients with lung cancer admitted to intensive care units and assess their clinical and demographic profiles. Methods Retrospective, analytical, observational study, wherein the outcomes for patients diagnosed with lung cancer admitted to the intensive care unit of university hospital from January 2010 until February 2011 were evaluated. Results Thirty-four patients' medical records were included. Twenty-six (76.5%) patients received some type of ventilatory support, of whom 21 (61.8%) used invasive mechanical ventilation and 11 (32.4%) used noninvasive ventilation at some point during their stay at the intensive care unit. Regarding mortality, 12 (35.3%) patients died during hospitalization at the intensive care unit, totaling 15 (44.1%) deaths during the entire hospitalization period; 19 (55.9%) patients were discharged from the hospital. The analysis of the variables showed that the patients who died had remained on invasive mechanical ventilation for a longer period 5.0 (0.25 to 15.0) days than the survivors (1.0 (0 to 1.0) days) (p=0.033) and underwent dialysis during their stay at the intensive care unit (p=0.014). Conclusions The mortality of patients with lung cancer admitted to the intensive care unit is associated with the time spent on invasive mechanical ventilation and the need for dialysis. PMID:23887754
Okino, Takashi; Okino, Akie; Miyamoto, Hiroko; Yamawaki, Mitsuko; Yamamoto, Toshiyuki; Tanaka, Toshiki
Nine cancer patients who were treated at other medical facilities were referred to the Kohka Public Hospital (KPH) to receive further cancer treatment or terminal care. Of these patients, 7 were men and 2 were women, and their mean age was 58.8 years. All the patients had unresectable cancer invasion or metastases. Their Eastern Cooperative Oncology Group performance status was either 3 or 4. Six of the 9 patients were first admitted to KPH and then discharged to home care. Two of these 6 patients died at home. The other 4 patients were ultimately re-admitted. The problem was that prognosis was not predicted accurately in some of these patients. Two of the 9 patients were managed by home care and died on days 8 and 13 after the initiation of home care. One patient returned to the previous hospital with the hope of receiving further treatment and palliative care. Patient information had to be available at presentation to all persons involved in the management of the patient and we had to prepare for patient care. Additionally, patients should be informed about serious conditions and poor prognosis without delay.
Peace, G; Manasse, A
The use of complementary therapies in combination with conventional medicine is increasing. In cancer care, as at the Cavendish Centre for Cancer Care in Sheffield, the range of therapies offered can include aromatherapy, massage, reflexology, shiatsu, acupuncture, homeopathy, counselling, visualization, hypnotherapy, relaxation, healing and art therapy. Before offering any therapy careful assessment of patients' needs is important as patients seeking complementary therapies may present with unrealistic hopes and expectations of benefit. There are wide variations in provision of services offering complementary cancer care throughout the United Kingdom but few offer a comprehensive assessment which is used as a baseline for both planning treatment and evaluating its outcome and which is conducted by a trained and objective practitioner who has no investment in any specific therapy. We describe the model of care developed at the Cavendish Centre with particular emphasis on the assessment process. Our model of assessment provides an opportunity for patients to tell their story, make sense of the illness experience, construct meaning from it and set realistic expectations for the chosen intervention. It also offers patients involvement and choice in decisions about their care. In addition we present evaluative data from a case series of 157 patients, 138 of whom (88%) reported improvement in their main concern on MYMOP (Measure Your Medical Outcome Profile).
Montgomery, Guy H; Schnur, Julie B; Kravits, Kate
Answer questions and earn CME/CNE Hypnosis has been used to provide psychological and physical comfort to individuals diagnosed with cancer for nearly 200 years. The goals of this review are: 1) to describe hypnosis and its components and to dispel misconceptions; 2) to provide an overview of hypnosis as a cancer prevention and control technique (covering its use in weight management, smoking cessation, as an adjunct to diagnostic and treatment procedures, survivorship, and metastatic disease); and 3) to discuss future research directions. Overall, the literature supports the benefits of hypnosis for improving quality of life during the course of cancer and its treatment. However, a great deal more work needs to be done to explore the use of hypnosis in survivorship, to understand the mediators and moderators of hypnosis interventions, and to develop effective dissemination strategies.
Kearney, Julia A; Salley, Christina G; Muriel, Anna C
Parents and caregivers of children with cancer are both resilient and deeply affected by the child's cancer. A systematic review of published research since 1995 identified 138 studies of moderate quality indicating that parent distress increases around diagnosis, then returns to normal levels. Post-traumatic symptoms are common. Distress may be impairing for vulnerable parents and may impact a child's coping and adjustment. Moderate quality evidence and expert consensus informed a strong recommendation for parents and caregivers to receive early and ongoing assessment of their mental health needs with access to appropriate interventions facilitated to optimize parent, child, and family well being.
Salley, Christina G.; Muriel, Anna C.
Parents and caregivers of children with cancer are both resilient and deeply affected by the child's cancer. A systematic review of published research since 1995 identified 138 studies of moderate quality indicating that parent distress increases around diagnosis, then returns to normal levels. Posttraumatic symptoms are common. Distress may be impairing for vulnerable parents and may impact a child's coping and adjustment. Moderate quality evidence and expert consensus informed a strong recommendation for parents and caregivers to receive early and ongoing assessment of their mental health needs with access to appropriate interventions facilitated to optimize parent, child and family well-being. PMID:26700921
Shephard, Elizabeth; Neal, Richard; Rose, Peter; Walter, Fiona; Hamilton, William T
Background Kidney cancer accounts for over 4000 UK deaths annually, and is one of the cancer sites with a poor mortality record compared with Europe. Aim To identify and quantify all clinical features of kidney cancer in primary care. Design Case-control study, using General Practice Research Database records. Method A total of 3149 patients aged ≥40 years, diagnosed with kidney cancer between 2000 and 2009, and 14 091 age, sex and practice-matched controls, were selected. Clinical features associated with kidney cancer were identified, and analysed using conditional logistic regression. Positive predictive values for features of kidney cancer were estimated. Results Cases consulted more frequently than controls in the year before diagnosis: median 16 consultations (interquartile range 10–25) versus 8 (4–15): P<0.001. Fifteen features were independently associated with kidney cancer: visible haematuria, odds ratio 37 (95% confidence interval [CI] = 28 to 49), abdominal pain 2.8 (95% CI = 2.4 to 3.4), microcytosis 2.6 (95% CI = 1.9 to 3.4), raised inflammatory markers 2.4 (95% CI = 2.1 to 2.8), thrombocytosis 2.2 (95% CI = 1.7 to 2.7), low haemoglobin 1.9 (95% CI = 1.6 to 2.2), urinary tract infection 1.8 (95% CI = 1.5 to 2.1), nausea 1.8 (95% CI = 1.4 to 2.3), raised creatinine 1.7 (95% CI = 1.5 to 2.0), leukocytosis 1.5 (95% CI = 1.2 to 1.9), fatigue 1.5 (95% CI = 1.2 to 1.9), constipation 1.4 (95% CI = 1.1 to 1.7), back pain 1.4 (95% CI = 1.2 to 1.7), abnormal liver function 1.3 (95% CI = 1.2 to 1.5), and raised blood sugar 1.2 (95% CI = 1.1 to 1.4). The positive predictive value for visible haematuria in patients aged ≥60 years was 1.0% (95% CI = 0.8 to 1.3). Conclusion Visible haematuria is the commonest and most powerful single predictor of kidney cancer, and the risk rises when additional symptoms are present. When considered alongside the risk of bladder cancer, the overall risk of urinary tract cancer from haematuria warrants referral. PMID:23540481
Clayton, Josephine; Butow, Phyllis N; Silvester, William; Detering, Karen; Hall, Jane; Kiely, Belinda E; Cebon, Jonathon; Clarke, Stephen; Bell, Melanie L; Stockler, Martin; Beale, Phillip; Tattersall, Martin H N
Introduction There is limited evidence documenting the effectiveness of Advance Care Planning (ACP) in cancer care. The present randomised trial is designed to evaluate whether the administration of formal ACP improves compliance with patients' end-of-life (EOL) wishes and patient and family satisfaction with care. Methods and analysis A randomised control trial in eight oncology centres across New South Wales and Victoria, Australia, is designed to assess the efficacy of a formal ACP intervention for patients with cancer. Patients with incurable cancer and an expected survival of 3–12 months, plus a nominated family member or friend will be randomised to receive either standard care or standard care plus a formal ACP intervention. The project sample size is 210 patient–family/friend dyads. The primary outcome measure is family/friend-reported: (1) discussion with the patient about their EOL wishes and (2) perception that the patient's EOL wishes were met. Secondary outcome measures include: documentation of and compliance with patient preferences for medical intervention at the EOL; the family/friend's perception of the quality of the patient's EOL care; the impact of death on surviving family; patient–family and patient–healthcare provider communication about EOL care; patient and family/friend satisfaction with care; quality of life of patient and family/friend subsequent to trial entry, the patient's strength of preferences for quality of life and length of life; the costs of care subsequent to trial entry and place of death. Ethics and dissemination Ethical approval was received from the Sydney Local Health District (RPA Zone) Human Research Ethical Committee, Australia (Protocol number X13-0064). Study results will be submitted for publication in peer-reviewed journals and presented at national and international conferences. Trial registration number Pre-results; ACTRN12613001288718. PMID:27909034
Phillips, Kelly-Anne; Steel, Emma J; Collins, Ian; Emery, Jon; Pirotta, Marie; Mann, G Bruce; Butow, Phyllis; Hopper, John L; Trainer, Alison; Moreton, Jane; Antoniou, Antonis C; Cuzick, Jack; Keogh, Louise
To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease.
Recent studies demonstrated that family members of a cancer patient show as much or even higher psychological distress as the cancer patients themselves. There are several reasons for psychological distress among family members. The family of the cancer patient is expected to provide patient care. There are shared responsibilities for decision-making, providing concrete care-giving, meeting the financial and social costs, maintaining stability and adapting to change. In addition, some family caregivers are involved in direct patient care. These responsibilities place both physical and emotional burdens on the family members. It has been shown that spouses demonstrate levels of emotional and functional disruption as great or greater than that of the patient and that these problems often worsen with time, independent of the patient's mood or health. Health problems of caregivers have a very important influence on their ability to meet these demands and it is reported that care-giving affects the physical health of spouse caregivers. Some caregivers may be physically weak or sick, and some may also demonstrate symptoms of cancer. Based on these findings, family members of the cancer patient are called "second-order patients". Therefore, various kinds of care programs are needed to provide support for family members and such interventions are aimed at psychiatric, physical, socio-economic problems. Bereavement is one of the most striking events in human experience. Although bereavement is not a disease, it is associated with excess risk of mortality and morbidity. Bereaved individuals show various physical and psychological symptoms and some of the bereaved individuals develop psychiatric disorders such as bereavement reaction, major depression and post-traumatic stress disorder. Therefore, psychiatric interventions are needed for these bereaved individuals. In the bereavement care clinic, interventions are aimed at psychiatric, physical, socio-economical problems
There exists support for euthanasia or physician-assisted suicide (PAS) in cases of terminal cancer. One of the premises for this approach is the goal of the alleviation of suffering. Do current means of pain control in the greater overall setting of palliative care serve as a desirable alternative? A contrast comparison may be drawn between the above approaches using both theological and medical sources to show that the enlightened use of both interventional and non-interventional pain medicine approaches in an integrated palliative care setting are a theologically grounded and medically feasible alternative to euthanasia or PAS in this population. Lay summary: Patients suffering from terminal cancer often have pain. Some have advocated euthanasia or physician-assisted suicide as a potential way of alleviating this suffering. Further examination of this topic, however, shows this approach may be essentially utilitarian and fail to consider the inherent value of human life. There has been significant development in recent years in the fields of pain medicine and palliative care, which afford alternate means of addressing suffering in this patient population.
There exists support for euthanasia or physician-assisted suicide (PAS) in cases of terminal cancer. One of the premises for this approach is the goal of the alleviation of suffering. Do current means of pain control in the greater overall setting of palliative care serve as a desirable alternative? A contrast comparison may be drawn between the above approaches using both theological and medical sources to show that the enlightened use of both interventional and non-interventional pain medicine approaches in an integrated palliative care setting are a theologically grounded and medically feasible alternative to euthanasia or PAS in this population. Lay summary: Patients suffering from terminal cancer often have pain. Some have advocated euthanasia or physician-assisted suicide as a potential way of alleviating this suffering. Further examination of this topic, however, shows this approach may be essentially utilitarian and fail to consider the inherent value of human life. There has been significant development in recent years in the fields of pain medicine and palliative care, which afford alternate means of addressing suffering in this patient population. PMID:25999611
Salamonsen, Anita; Kiil, Mona A; Kristoffersen, Agnete Egilsdatter; Stub, Trine; Berntsen, Gro R
Background The concept of “patient pathways” in cancer care is most commonly understood as clinical pathways, operationalized as standardized packages of health care based on guidelines for the condition in question. In this understanding, patient pathways do not address multimorbidity or patient experiences and preferences. This study explored patient pathways understood as the individual and cultural life course, which includes both life and health events. The overall aim was to contribute to supportive and targeted cancer care. Materials and methods Nine Norwegian patients recently diagnosed with rectal cancer Tumor-Node-Metastasis stage I–III participated in qualitative interviews, five times over 1 year. Five patients later participated in a workshop where they made illustrations of and discussed patient pathways. Results Patient pathways including both health and life events were illustrated and described as complex and circular. Stress, anxiety, and depression caused by life events had significant disruptive effects and influenced patient-defined health care needs. The participants experienced the Norwegian public health service as focused on hospital-based standardized cancer care. They expressed unmet health care needs in terms of emotional and practical support in their everyday life with cancer, and some turned to complementary and alternative medicine. Conclusion This study suggests that acknowledging life course disruption before cancer diagnosis may have significant relevance for understanding complex patient pathways and individual health care needs. Approaching patient pathways as individual and socially constructed may contribute important knowledge to support targeted cancer care. PMID:27574408
Goyal, Sandeep; Tiwari, Vijay Kumar; Nair, Kesavan Sreekantan; Raj, Sherin
The present study conducted with 100 oral cancer patients at a private tertiary care hospital in Delhi demonstrated that stage III cancer was associated with longer use of tobacco and poor oral hygiene. There was also statistically significant association (p<.05) between consumption of tobacco and alcohol. More than 60% treatment expenditure was on surgery followed by accommodation (9%) and investigations (8%). The effect of tobacco was well known among patients as 76% of the patients knew that common cancer in tobacco chewer is 'oral cancer', 22% of the patients however responded that they did not know which cancer is common in tobacco chewers. 58% said that they learnt about ill effects of tobacco from media while 24% said they learnt from family and friends. Out of 78 tobacco users, 60 (77%) said that they never received help to quit tobacco while 18(23%) have received help to quit.
Uzzo, Robert G; Horwitz, Eric M; Plimack, Elizabeth R
Founded in 1904, Fox Chase Cancer Center remains committed to its mission. It is one of 41 centers in the country designated as a Comprehensive Cancer Center by the National Cancer Institute, is a founding member of the National Comprehensive Cancer Network, holds the magnet designation for nursing excellence, is one of the first to establish a family cancer risk assessment program, and has achieved national distinction because of the scientific discoveries made there that have advanced clinical care. Two of its researchers have won Nobel prizes. The Genitourinary Division is nationally recognized and viewed as one of the top driving forces behind the growth of Fox Chase due to its commitment to initiating and participating in clinical trials, its prolific contributions to peer-reviewed publications and presentations at scientific meetings, its innovations in therapies and treatment strategies, and its commitment to bringing cutting-edge therapies to patients.
Allison, Amanda L; Ishihara-Wong, Debra D M; Domingo, Jermy B; Nishioka, Jocelyn; Wilburn, Andrea; Tsark, JoAnn U; Braun, Kathryn L
Research suggests that cancer patient navigation improves care, but few reports describe the variety of patients managed by a hospital-based navigation program. Differences in navigated patients by the intensity (low, medium, or high) of navigation services they received were examined. The 835 clients seen by the navigators in a hospital-based cancer center were first stratified by quarter and by four ethnic groups. Randomized selection from each group assured there would be equal representation for analysis of Hawaiians, Filipinos, Japanese, and Whites and even numbers over all time intervals. Five professionals extracted data from these case records on demographics, type/stage of cancer, diagnosis and treatment dates, barriers, and navigator actions. Clients had breast (30.0%), lung (15.8%), esophageal (6.7%), colon (5.8%), ovarian (4.2%), prostate (3.3%), and other cancers (34.2%). The median number of actions taken on behalf of a client was 4 (range 1-83), and the median number of days a case was open was 14 (range 1-216). High intensity cases (those receiving more assistance over longer periods of time) were more likely than low-intensity cases to need help with education and reassurance, transportation, care coordination, and covering costs. Although there were no demographic differences across intensity groups, Neighbor Island patients from Hawai'i, Maui, Moloka'i, Lana'i and Kaua'i were more likely to need help with arranging travel, care coordination, and costs associated with getting treatment (all at P=.05), and patients on public insurance were more likely to have stage 4 cancer (P=.001) and to need help with costs (P=.006). Findings suggest that this hospital-based navigation program is filling a real need of patients across the cancer care continuum. A triage protocol and an integrated data capture system could help improve the targeting and documentation of cancer patient navigation services.
Resources, national Research Council (NIH Publication No. 86-23, Revised 1985). •ZFor the protection of human subjects, the investigator(s) adhered to...Cancer: Complications of Axillary Management. Acta Radiologica Oncology. 1986; 25:105-108. 16. Christenson SB and Lundgren E. Sequelae of Axillary
Frederick Tims, PhD, RMT-BC, on music therapy , Daniel Murman, MD, MS, on impaired cognition in cancer patients, Michigan State University, East...the 1998 Summer Research Series, with presentations by Cathy Bradley, PhD, MPA, on health costs, Frederick Tims, PhD, RMT-BC, on music therapy , Daniel
Treatments for head and neck cancers are generally complex and debilitating. Surgery, often mutilating, profoundly affects the relationship between oneself and others and causes verbal communication, breathing and swallowing difficulties. The functional and aesthetic sequelae are a constant reminder to the patient of the disease and make them conscious of their appearance.
Pfaff, Valerie Kalsbeck
Music therapy, the systematic application of music and musical activities to elicit specific changes in emotional, physical, or social behavior, can help pediatric cancer patients to decrease their anxiety and cope with hospitalization. Because music is a nonverbal means of expression, it is an especially effective medium for young children who…
Penberthy L, Desch CE, Retchin SM, Whit- predictor of diagnostic and initial treatment intensity in newl dignosd beas caner atiets.I Grontl 189; temore M. The...cancer-related information. J Be- temore M. The effect of age and comorbidity in the treat- hay Med 1992;15:429-45. ment of elderly women with
Ross, Jonathan H
At most institutions, pediatric urologists play a limited role in the care of children with cancer. Pediatric urologists have a unique experience and skill set to contribute to the care of these patients. Interested pediatric urologists should become experts in pediatric urologic oncology and demonstrate this interest by participating in tumor board and relevant academic activities. They should advocate for a collaborative approach with pediatric general surgeons in the surgical management of children with genitourinary as such an approach benefits patient care, contributes to professional development of all parties, and develops relationships that contribute to programmatic development for the institution in oncology and other areas.
Huang, Kun-Siang; Wang, Shih-Ho; Chuah, Seng-Kee; Rau, Kun-Ming; Lin, Yu-Hung; Hsieh, Meng-Che; Shih, Li-Hsueh; Chen, Yen-Hao
Background Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients. Methods A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81). Results Among the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, p<0.001), intubation (1% vs 27%, p<0.001), cardiopulmonary-cerebral resuscitation (0% vs 11%, p = 0.001), ventilator use (1% vs 27%, p<0.001), inotropic agent use (8% vs 46%, p<0.001), total or partial parenteral nutrition use (38% vs. 58%, p = 0.029), and blood transfusion (45% vs 74%, p<0.001). Besides, the hospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR) orders (95% vs 37%, p<0.001), receiving home hospice care (16% vs 1%, p<0.001), and indicating home as the realistically preferred place of death (41% vs 19%, p = 0.001). The hospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014. Conclusion The use of hospice-shared care for gastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life. PMID:28158232
Napoles, Tessa M.; Banks, Priscilla J.; Orenstein, Fern S.; Luce, Judith A.; Joseph, Galen
Purpose Despite the Institute of Medicine’s (IOM) 2005 recommendation, few care organizations have instituted standard survivorship care plans (SCPs). Low health literacy and low English proficiency are important factors to consider in SCP development. Our study aimed to identify information needs and survivorship care plan preferences of low literacy, multi-lingual patients to support the transition from oncology to primary care and ongoing learning in survivorship. Methods We conducted focus groups in five languages with African American, Latina, Russian, Filipina, White, and Chinese medically underserved breast cancer patients. Topics explored included the transition to primary care, access to information, knowledge of treatment history, and perspectives on SCPs. Results Analysis of focus group data identified three themes: 1) the need for information and education on the transition between “active treatment” and “survivorship”; 2) information needed (and often not obtained) from providers; and 3) perspectives on SCP content and delivery. Conclusions Our data point to the need to develop a process as well as written information for medically underserved breast cancer patients. An SCP document will not replace direct communication with providers about treatment, symptom management and transition, a communication that is missing in participating safety-net patients’ experiences of cancer care. Women turned to peer support and community-based organizations in the absence of information from providers. Implications for Cancer Survivors “Clear and effective” communication of survivorship care for safety-net patients requires dedicated staff trained to address wide-ranging information needs and uncertainties. PMID:27992491
Shiraishi, Ko; Chigira, Mayumi; Tsuyuki, Naoko; Hozaki, Kyoko; Murotsu, Keizo; Umeki, Mikiko; Harada, Naohiro; Hirata, Satomi; Otsuka, Yuko; Hara, Hiroko
It has been recommended that terminal cancer patients be shifted from the hospital to their homes. In our hospital, a visitor palliative care team was started for the purpose of the early introduction of palliative care, and home shifts were promoted. The results of home shifts by the visitor palliative care team from 2008 to 2012 were examined. Home shifts were possible for 27 cases out of 108 cases intervened. In 12 cases, there were at-home deaths, and the median at-home period was 55 days. In the group that could not be shifted, the at-home death rate and application rate of nursing care insurance were low. Additionally, the length of stay (median) for patients who died in hospitalization was 8 days for the group that could be shifted and 17 days for the group that could not be shifted. It was felt that effective communication with local health care facilities is important for a successful home shift. Early and adequate preparations for the treatment and care of terminal cancer patients undergoing home shift are important, and in this regard, a review of the current provisions of nursing care insurance is necessary.
The attitudes of hospice nurses towards psychosexual issues in palliative care were surveyed. Sexuality was acknowledged to be both important and relevant in hospice nursing. A high level of awareness of sexual and relationship issues was apparent, reflecting broadly liberal attitudes.
Gonçalves, Carla Vitola; Duarte, Geraldo; da Costa, Juvenal Soares Dias; Quintana, Silvana Maria; Marcolin, Alessandra Cristina
Pregnancy constitutes an excellent opportunity for the prevention of cervical carcinoma since the gynecological examination is part of routine prenatal care. A transversal study was conducted in which a total of 445 postnatal women were interviewed using standardized questionnaires. The prevalence of an up-to-date cytopathological exam was 38.9% at the beginning of pregnancy, reaching 59.1% during the postnatal period (p>0.001). Postnatal women aged 19 years or less, non-white, with less than 11 years schooling, family income of less than one minimum wage, sexually active at 15 years of age or less, with the beginning of prenatal care after the 1st trimester, and receiving prenatal care at healthcare units of the Unified Health System had a lower prevalence of cytopathological examination. Adjusted analysis revealed that the variables under study were not significantly associated with cytopathological coverage, though the incidence of prenatal care showed a prevalence ratio of 1.18 (95% CI: 0.98-1.42). The local health service proved ineffective, recvealing the need to increase cytopathological coverage and train health professionals regarding the importance of routine prenatal procedures.
Alsirafy, Samy A; Abou-Alia, Ahmad M; Ghanem, Hafez M
Hospital length of stay (LoS) may be used to assess end-of-life care aggressiveness and health care delivery efficiency. We describe the terminal hospitalization LoS of patients with cancer managed by a hospital-based palliative care (PC) program comprising a palliative care consultation (PCC) service and an inpatient palliative care unit (PCU). A total of 328 in-hospital cancer deaths were divided into 2 groups. The PCU group included patients admitted by the PC team directly to the PCU. The PCC group included patients admitted by other specialties and referred to the PCC team. The LoS of the PCU group was significantly shorter than that of the PCC group (9.9 [±9.4] vs 17.8 [±19.7] days, respectively; P < .001). Direct terminal hospitalization to PCU is not associated with longer LoS among cancer deaths managed by a hospital-based PC service.
Death, an unavoidable event in the human experience, causes physical as well as mental and spiritual suffering. This paper reports on a nursing experience giving spiritual care to a terminal liver cancer patient between January 17 and February 9, 2009. Eleven nursing logs were used as the source of data for daily information. During the care period, patient religious needs featured prominently, including his desire to become a Christian and his eagerness to know about and help in the arrangement of his funeral. Taking the initiative, the nurse helped link him with religious resources, arranged a minister for his baptism ceremony, had the priest explain funeral proceedings, and assisted with the completion of his entrusted plans. The function of this nursing care intervention was to provide a personal touch to a patient who was in desperate need of warm spiritual care. It is hoped that this report can help caregivers increase their sensitivity toward patient spiritual needs and enhance routine nursing care quality.
Kahana, Eva; Kahana, Boaz; Wykle, May; Kulle, Diana
This paper offers a stress theory based conceptual framework for understanding proactive options for care-getting for patients living with cancer that is also relevant to patients living with other chronic or life threatening illnesses. Barriers and facilitators to active efforts for obtaining responsive care from both informal and formal sources are discussed. This “Care-Getting” model explores benefits of proactive care-getting for diminishing physical discomfort/suffering, burden of illness and disability, and psychological distress. We highlight unique issues in care-getting that patients face at different stages of the life course. Implications of prior research related to the model for practice and intervention are discussed. PMID:20107524
Wood, Carol A.; Dodge, Richard K.
To define the educational goals and problems of nurses caring for cancer patients in Vermont, a survey was conducted. The most heavily favored topics were those related to helping the patient adapt to illness. Commonly cited difficulties were poor communication with doctors and negative attitudes of coworkers. (Author/SK)
Love, Richard R.; And Others
A cancer attitude survey is analyzed that was administered to residents and faculty physicians in the departments of Family Medicine, Internal Medicine, and Human Oncology at the University of Wisconsin. Categories surveyed include opinions about the benefits of prevention, risk management, early detection and screening, treatment and care, and…
Oh, Hyunsung; Ell, Kathleen
Objective: This study assessed whether perceived social support (PSS) is a factor in improving physical and functional well-being observed among cancer patients receiving collaborative depression care. Methods: A secondary analysis was conducted of data collected in a randomized clinical trial testing the effectiveness of collaborative depression…
Beale, Ivan L.; Marin-Bowling, Veronica M.; Guthrie, Nicole: Kato, Pamela M.
A video game called "Re-Mission" has recently been investigated with adolescent and young adult cancer patients enrolled in a multi-site randomized controlled evaluation of the game as a psycho-educational intervention. The main focus of the trial was to determine effects of the game on self-care and other health-related outcomes. It was…
Ft Detrick, MD. THIS PAGE IS UNCLASSIFIED AAD GRANT NUMBER DAMDI7-94-J-4043 TITLE: Surveillance After Initial Treatment for Breast Cancer: A...NUMBERS Surveillance After Initial Treatment for Breast Cancer: DAMDI7-94-J-4043 A Population-Based Study of Variation In and Outcomes of Care 6. AUTHOR(S...ABSTRACT (Maximum 200 We have utilized SEER and Medicare data bases to study patterns of care related to the treatment of local/regional breast cancer. In
Magnuson, Allison; Allore, Heather; Cohen, Harvey Jay; Mohile, Supriya G.; Williams, Grant R.; Chapman, Andrew; Extermann, Martine; Olin, Rebecca L.; Targia, Valerie; Mackenzie, Amy; Holmes, Holly M.; Hurria, Arti
Older adults with cancer represent a complex patient population. Geriatric assessment (GA) is recommended to evaluate the medical and supportive care needs of this group. “GA with management” is a term encompassing the resultant medical decisions and interventions implemented in response to vulnerabilities identified on GA. In older, non-cancer patients, GA with management has been shown to improve a variety of outcomes, such as reducing functional decline and health care utilization. However, the role of GA with management in the older adult with cancer is less well established. Rigorous clinical trials of GA with management are necessary to develop an evidence base and support its use in the routine oncology care of older adults. At the recent U-13 conference, “Design and Implementation of Intervention Studies to Improve or Maintain Quality of Survivorship in Older and/or Frail Adults with Cancer,” a session was dedicated to developing research priorities in GA with management. Here we summarize identified knowledge gaps in GA with management studies for older patients with cancer and propose areas for future research. PMID:27197915
The U.S. spends far more per person than any other country in the world in treating cancer, without demonstrably superior results. Though the pursuit and pace of innovation in oncology are perhaps unmatched and promise great benefit for cancer patients, this explosion of innovation has been accompanied by dramatic increases in cost, often without significant increases in patient survival. These trends have led to a growing interest in addressing value--understood as treatment benefits or quality weighed against economic cost--in cancer care. In February 2009, the Institute of Medicine convened a group of experts with diverse perspectives, including those of clinical oncology, patient advocacy, the insurance industry, pharmaceutical manufacturing, health economics, and bioethics, to identify challenges to value in cancer care, suggest potential solutions, and discuss what value entails in oncology. This article presents many of the ideas that emerged from this symposium, including ways to correct misaligned economic incentives, improve clinical communication, and generate evidence to promote value in cancer care.
The management of patients with pancreatic cancer requires an individualised approach and the support of a multidisciplinary team to accurately stage patients and determine their suitability for curative treatment. Guidelines have been developed in Australasia to define the operability for patients who have been diagnosed with pancreatic cancer. This is supported by advances in pancreatic cancer genetics, which show potential for developing targeted therapies for pancreatic cancer. Both surgery and targeted therapies aim to extend the overall survival of patients. Patients who are cured of their cancer may live with permanent changes in gut anatomy and physiology leading to distressing symptoms that may not be addressed. Patients who cannot be cured of pancreatic cancer may have supportive care issues that are often complex, and a strategic approach to manage these needs for patients with pancreatic cancer is underdeveloped in Australasia. Supportive care services need to be in a position to adapt patient care as the evidence base develops. PMID:28105071
Cancer Survivor; Healthy Subject; Stage I Colorectal Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIA Colorectal Cancer; Stage IIB Breast Cancer; Stage IIB Colorectal Cancer; Stage IIC Colorectal Cancer; Stage IIIA Breast Cancer; Stage IIIA Colorectal Cancer; Stage IIIB Breast Cancer; Stage IIIB Colorectal Cancer; Stage IIIC Breast Cancer; Stage IIIC Colorectal Cancer
Freyer, David R.
Purpose Young adult survivors of childhood and adolescent cancer are an ever-growing population of patients, many of whom remain at lifelong risk for potentially serious complications of their cancer therapy. Yet research shows that many of these older survivors have deficient health-related knowledge and are not engaging in recommended health promotion and screening practices that could improve their long-term outcomes. The purpose of this review is to address these disparities by discussing how formal transition of care from pediatric to adult-focused survivorship services may help meet the unique medical, developmental, and psychosocial challenges of these young adults. Design Literature review and discussion. Results This article summarizes current research documenting the medical needs of young adult survivors, their suboptimal compliance with recommended follow-up, and the rationale, essential functions, current models, and innovative approaches for transition of follow-up care. Conclusion Systematic health care transition constitutes the standard of care for young adult survivors of childhood cancer. In developing a transitional care program, it is necessary to consider the scope of services to be provided, available resources, and other local exigencies that help determine the optimal model for use. Additional research is needed to improve health services delivery to this population. Effective advocacy is needed, particularly in the United States, to ensure the availability of uninterrupted health insurance coverage for survivorship services in young adulthood. PMID:20351333
Koshino, Miki; Sakai, Chie; Ogura, Takafumi; Kawasaki, Akiko; Fukuzato, Fumiko; Miyazaki, Yasuhiro
Stomatitis is a common side effect during cancer chemotherapy. We hypothesized that careful oral cavity care using patient guidance and cleanliness index prevents stomatitis in cancer chemotherapy. We introduced oral care patient guidance including teaching good brushing methods, O'Leary's Plaque Control Record(PCR)as a cleanliness index, and Eilers' Oral Assessment Guide(OAG)as an overall index after April 2006. We evaluated the incidence of stomatitis in 20 patients(10 patients between April 2004 to May 2006 and 10 patients after April 2006)with esophageal cancer who received chemotherapy including 5-FU and CDDP. Patients receiving brushing training after 2006 were evaluated regarding cleanliness of their oral cavities using PCR index and OAG index. The rates of stomatitis were 60%(6/10)and 40%(4/10)before and after the introduction of oral care patient guidance. The average of PCR index decreased from 82% to 46% after teaching good brushing method to the patients. The average of OAG index after brushing training was 9.14 which was better score compared with previous reports. Introduction of oral care patient guidance decreased the incidence of stomatitis. Both PCR and OAG indexes were useful in evaluating the objective condition of the oral cavity and in sharing patients' information among a medical team. These indexes encouraged the patients to clean their oral cavities.
Glenny, A M; Gibson, F; Auld, E; Coulson, S; Clarkson, J E; Craig, J V; Eden, O B; Worthington, H V; Pizer, B
The aim of the study was to establish current UK oral care practice for children with cancer. A telephone survey of all 22 United Kingdom Children's Cancer Study Group (UKCCSG) centres was undertaken. Nineteen (86%) of the centres reported using guidelines/protocols for mouth care. The use of routine preventive oral care therapies showed the greatest variation between centres. Four centres (18%) did not use any prophylactic oral care therapy other than basic oral hygiene, whereas seven (32%) routinely used a combination of three or more agents. Chlorhexidine was the most frequently administered prophylactic therapy (17/22 centres, 77%), followed by nystatin (11/22 centres, 50%). There was little variation in advice given to parents/patients on basic oral hygiene. Regarding dental check-ups, 9/22 centres (41%) recommended children to attend a hospital-linked dental clinic. Only at 8/22 centres (36%) did children undergo a dental check-up before commencing cancer treatment. The survey identified significant variation in preventive oral care therapies and dental check-ups at the UKCCSG centres. Attention needs to be given to establishing evidence based, effective strategies.
Delibegovic, Adnan; Sinanovic, Osman; Galic, Gordan; Sabic, Adela; Sabic, Dzevad
Objective: Objective of this work is to determine influence of palliative care on the quality of life in patients with lung cancer. Subjects and Methods: Our study group included 40 patients, consecutively selected, which is determined by symptomatic treatment and hospitalized at the Department of Palliative Care of University Clinical Center Tuzla. The control group consisted of 40 patients who had a diagnosis of lung cancer treated at home by an authorized ambulance Health Center Tuzla. Tests in both groups were carried out using the test SF-36 scale for assessing quality of life in period of two weeks. Two-stage test was performed, initially, immediately after disease was diagnosed, and two weeks later. Results: All life quality parameters (general, physical and emotional) were better in second test, in patients who were situated in the department of palliative care (study group) (p<0.0001). In the area of physical health (physical function, physical limitations, pain, general health), in patients who have resided in the department of palliative care (study group), showed a statistically significant improvement in all the aspects (p<0.0001). In the study patients all aspects of mental health were statistically significantly improved after two weeks being in department (p<0.0001). Conclusion: Two weeks treatment of patients with lung cancer in the Department of Palliative Care significantly improve all general aspects of quality of life. PMID:28144191
patient at course completion and 1 year later. A randomized trial of the effect of same-day mammography on patient compliance, utilizing different practice...which includes information on risk factors, method of diagnosis, local and systemic therapy , and outcomes for cancer patients treated at the Center. A...health practices. (4) We also proposed to compare the effect of PE intervention on health beliefs
Proiect 7 125 Appendix 1: Morrow M et al. Is core biopsy the diagnostic procedure of choice 126 for all mammographic abnormalities? Proc Am Soc Clin Oncol...intermediate biomarkers for the dietary intervention. Project #6: Multidisciplinary Networked Breast Cancer Conference PI: William Gradishar MD The specific aim...and strategies. One recent example is appended . 4. Interim findings To date, 991 women have had at least one documented teaching contact. This total
Tavakoli, Javad; Miar, Solaleh; Majid Zadehzare, Mohammad; Akbari, Hossein
Based on a common belief, herbal medicine with the least possible side effects should be the center of attention in cancer care; however, in many cases they have not been properly studied with reliable clinical trials in human subjects. In this review, it was attempted to identify the available evidence on the use and clinical effects of herbs in cancer care. The research consists of two major parts including immunomodulator and chemopreventive herbal compounds whose mechanism, biological response, anticancer element of extract and related benefits were completely studied. Also, the safety of herbal anticancer compounds was discussed. Although the use of herbal medicines in treating cancer shows less chemotherapy-induced, toxicity, more researches are required to reach their full therapeutic potentials. PMID:25628834
Jandorf, Lina; Freemantle, Hurdley; Sly, Jamilia; Ellison, Jennie; Wong, Carrie R.; Villagra, Cristina; Hong, Joseph; Kaleya, Sara; Poultney, Madrid; Villegas, Carmen; Brenner, Barbara; Bickell, Nina
In the largely African American and Hispanic communities of East and Central Harlem in New York City (NYC), health inequities are glaring. Mortality from cancer is 20–30 % higher than in Manhattan and 30–40 % higher than rates in the general population in NYC. Despite advances in risk assessment, early detection, treatment, and survivorship, individuals in Harlem and similar urban communities are not benefiting equally. Guided by community-based participatory research, this study serves as an important step in understanding cancer care needs and the range of factors that impact the disparate rates of cancer in East and Central Harlem. Forty individual interviews were conducted with community leaders and residents. Major themes included: need for appropriate supportive services; health care access and financial challenges; beliefs related to stigma, trust, and accountability; and the impact of the physical environment on health. Education was seen as a critical area of need and intervention. PMID:23108854
Macbeth, Fergus R; Abratt, Raymond P; Cho, Kwan H; Stephens, Richard J; Jeremic, Branislav
Lung cancer is a major cause of cancer death worldwide and is becoming an increasing problem in developing countries. It is important that, in countries where health care resources are limited, these resources are used most effectively and cost-effectively. The authors, with the support of the International Atomic Energy Agency, drew on existing evidence-based clinical guidelines, published systematic reviews and meta-analyses, as well as recent research publications, to summarise the current evidence and to make broad recommendations on the non-surgical treatment of patients with lung cancer. Tables were constructed which summarise the different treatment options for specific groups of patients, the increase in resource use for and the likely additional clinical benefit from each option. These tables can be used to assess the cost-effectiveness and appropriateness of different interventions in a particular health care system and to develop local clinical guidelines.
Spirituality and religiosity have been defined by several governing bodies to mean everything from purpose in life, beliefs, faith, and hope, to transcendence with a higher being. The absence of uniformity regarding the components of spirituality and religiosity has created a barrier for professional caregivers in identifying, assessing, and providing spiritual needs. The diagnosis of cancer often leads patients to contemplate their own mortality and frequently presents unique challenges to their belief system. Spirituality is a unique component of holistic care. When appropriately addressed, it may strongly influence positive patient outcomes during the cancer journey. Consequently, nurses should actively participate in and incorporate the provision of spiritual care into the treatment plan for each patient with cancer or at least be able to assess those needs and make sure they are being addressed.
Mantovan, Franco; Rauter, Elisabeth; Müller, Irene
In palliative care between 13.9 and 25 percent of all patients suffering from cancer show signs of anxiety disorders. Up to 75 percent of these patients suffer from non-pathologic anxiety, which has a negative impact on the patients' quality of life. Therefore it is important to provide interventions that are able to reduce anxiety of cancer patients. Massage and music therapy are effective interventions for minimizing anxiety of cancer patients in palliative care. An empathic attitude of the nurse increases the effect of the mentioned interventions. While there is evidence of the interventions mentioned it is yet necessary to further explore these in additional clinical trials to consolidate the already existing results.
Laudicella, Mauro; Walsh, Brendan; Burns, Elaine; Smith, Peter C
Background: Health systems are facing the challenge of providing care to an increasing population of patients with cancer. However, evidence on costs is limited due to the lack of large longitudinal databases. Methods: We matched cost of care data to population-based, patient-level data on cancer patients in England. We conducted a retrospective cohort study including all patients age 18 and over with a diagnosis of colorectal (275 985 patients), breast (359 771), prostate (286 426) and lung cancer (283 940) in England between 2001 and 2010. Incidence costs, prevalence costs, and phase of care costs were estimated separately for patients age 18–64 and ⩾65. Costs of care were compared by patients staging, before and after diagnosis, and with a comparison population without cancer. Results: Incidence costs in the first year of diagnosis are noticeably higher in patients age 18–64 than age ⩾65 across all examined cancers. A lower stage diagnosis is associated with larger cost savings for colorectal and breast cancer in both age groups. The additional costs of care because of the main four cancers amounts to £1.5 billion in 2010, namely 3.0% of the total cost of hospital care. Conclusions: Population-based, patient-level data can be used to provide new evidence on the cost of cancer in England. Early diagnosis and cancer prevention have scope for achieving large cost savings for the health system. PMID:27070711
Sachs, G A
There are no simple solutions to difficult ethical problems. Advance directives, however, offer a way to help prevent ethical dilemmas from occurring in the care of older cancer patients. Studies show that there is overwhelming support from both older patients and physicians for advance treatment planning through the use of living wills, durable powers of attorney for health care, and less formal means. Despite this support, few physicians and patients discuss advance directives. This paper discusses potential barriers to this dialogue and suggests specific ways to incorporate advance directive into routine cancer care of older patients. The Patient Self-Determination Act of 1990 represents additional pressure from society on the medical profession to carry out advance directive discussions.
Simon, Melissa A.; Samaras, Athena T.; Nonzee, Narissa J.; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S.; Dong, XinQi
Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients’ interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus–community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented. PMID:27594792
da Silva, Josiane Travençolo; Matheus, Maria Clara Cassuli; Fustinoni, Suzete Maria; de Gutiérrez, Maria Gaby Rivero
The present article discusses a qualitative study which aimed to understand the typical of nurses' professional practice caring for patient with cancer in general hospitals. In order to find out the reasons that motivate nurse's action, and to put in evidence what is original, significant, specific and typical about this phenomenon, we have taken into consideration the premises of the philosopher Alfred Schütz, which provide us with subsidies to unveil them. The data collected through semi-structured interviews reported that nurses admit not having the required theoretical knowledge and experience or enough practice to take care of a cancer patient. Thus, they don't feel capable of developing actions which may positively influence care on patients and their family members.
Magni, Chiara; Veneroni, Laura; Silva, Matteo; Casanova, Michela; Chiaravalli, Stefano; Massimino, Maura; Clerici, Carlo Alfredo; Ferrari, Andrea
Adolescents and young adults (AYA) with cancer form a particular group of patients with unique characteristics, who inhabit a so-called “no man’s land” between pediatric and adult services. In the last 10 years, the scientific oncology community has started to pay attention to these patients, implementing dedicated programs. A standardized model of care directed toward patients in this age range has yet to be developed and neither the pediatric nor the adult oncologic systems perfectly fit these patients’ needs. The Youth Project of the Istituto Nazionale Tumori in Milan, dedicated to AYA with pediatric-type solid tumors, can be seen as a model of care for AYA patients, with its heterogeneous multidisciplinary staff and close cooperation with adult medical oncologists and surgeons. Further progress in the care of AYA cancer patients is still needed to improve their outcomes. PMID:27606308
Apolone, G; Corli, O; Caraceni, A; Negri, E; Deandrea, S; Montanari, M; Greco, M T
Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8-55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes.
Apolone, G; Corli, O; Caraceni, A; Negri, E; Deandrea, S; Montanari, M; Greco, M T
Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8–55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes. PMID:19401688
Jorgensen, Mikaela L; Young, Jane M; Solomon, Michael J
Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. With population aging and increases in survival, the number of CRC survivors is projected to rise dramatically. The time following initial treatment is often described as a period of transition from intensive hospital-based care back into “regular life.” This review provides an overview of recommended follow-up care for people with CRC who have been treated with curative intent, as well as exploring the current state of the research that underpins these guidelines. For patients, key concerns following treatment include the development of recurrent and new cancers, late and long-term effects of cancer and treatment, and the interplay of these factors with daily function and general health. For physicians, survivorship care plans can be a tool for coordinating the surveillance, intervention, and prevention of these key patient concerns. Though much of the research in cancer survivorship to date has focused on surveillance for recurrent disease, many national guidelines differ in their conclusions about the frequency and timing of follow-up tests. Most CRC guidelines refer only briefly to the management of side effects, despite reports that many patients have a range of ongoing physiological, psychosocial, and functional needs. Guidance for surveillance and intervention is often limited by a small number of heterogeneous trials conducted in this patient group. However, recently released survivorship guidelines emphasize the potential for the effectiveness of secondary prevention strategies, such as physical activity, to improve patient outcomes. There is also emerging evidence for the role of primary care providers and nurse coordinated care to support the transition and increase the cost-effectiveness of follow-up. The shift in focus from recurrence alone to the assessment and management of a range of survivorship issues will be important for ensuring that this growing group of
with degrees): Marva L. Mizell Price, DrPH, MPH, FNP , FAANP, FAAN Primary academic appointment: School of Nursing Secondary appointment (if any...Based Approaches to Health Care 3 Credits Fall 2008 N449 Family Nurse Practitioner ( FNP ) Residency, 4 Credits Fall 2008 N449 FNP Residency, 4...Credits Spring 2008 N303 Program Planning and Evaluation, 3 Credits Spring 2008 N449 FNP Residency 4 Credits Fall 2007 N301 Population Based
Walker, Deborah Kirk; Hardeman, Amber; Owen, Larry; Frank, Jennifer Sandson
The purpose of this project was to design, develop, and modify a cancer resource application (app) that providers, patients, and caregivers could use to locate local and national cancer resources. The project design used a modified version of the Questionnaire for User Interaction Survey 7.0 to gather information from a convenience sample of nurses and community participants regarding their perception of the app. These data helped to identify gaps in resources and modifications needed to make the app more user-friendly. The current cancer care system is complex, and patients often complain of uncoordinated care, lack of information, and insufficient psychosocial support. Cancer centers are working to meet the American College of Surgeons 2015 recommendation of psychosocial assessment and referrals; the Cancer Resource APP described here provides the resources to meet this need. Prototypes of the app were tested in practice and community settings, then solicited feedback guided needed technology modifications. The resulting Cancer Resource APP provides the healthcare community with information to make timely and consistent referrals for patients and caregivers.
Background Oesophago-gastric cancer services in England have been extensively reorganised since 2001 to deliver a centralised, specialist-led service. Our aim was to assess how well the National Health Service (NHS) in England met organisational standards for oesophago-gastric cancer care. Methods Questionnaires that asked about the provision of staging investigations, curative and palliative treatments and key personnel were sent in September 2007 to the lead clinician for oesophago-gastric cancer at all 30 cancer networks and 156 NHS acute trusts in England. Results Responses were received from all networks and 81% of NHS trusts. All networks provided essential staging investigations and a range of endoscopic palliative therapies. Only 16 of the 30 cancer networks discussed all patients at the specialist multi-disciplinary team meeting and 11 networks had not fully centralised curative surgery. There was also variation between NHS trusts in the integration of the palliative care team, the availability of nurse specialists and the use of dieticians to provide nutritional support. Conclusion There has been considerable progress in reforming oesophago-gastric cancer services but the process of reorganisation is still incomplete and regional differences in service provision exist that may lead to variation in patient outcomes. PMID:19909525
Lim, Richard B L
Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline. Once the needs are recognized, the second key area is appropriate communication, where the clinician should assist patients and family members in understanding where they are in the disease trajectory and what to expect. This involves developing rapport, breaking bad news, managing expectations and navigating care plans. Subsequently, the third key area is symptom management that focuses on the goals to first and foremost provide comfort and dignity. Symptoms that are common towards the end of life in lung cancer include pain, dyspnoea, delirium and respiratory secretions. Such symptoms need to be anticipated and addressed promptly with appropriate medications and explanations to the patient and family. Lastly, in order for physicians to provide quality end-of-life care, it is necessary to understand the ethical principles applied to end-of-life-care interventions. Misconceptions about euthanasia versus withholding or withdrawing life-sustaining treatments may lead to physician distress and inappropriate decision making.
Truccolo, Ivana; Cipolat Mis, Chiara; Cervo, Silvia; Dal Maso, Luigino; Bongiovanni, Marilena; Bearz, Alessandra; Sartor, Ivana; Baldo, Paolo; Ferrarin, Emanuela; Fratino, Lucia; Mascarin, Maurizio; Roncadin, Mario; Annunziata, Maria Antonietta; Muzzatti, Barbara; De Paoli, Paolo
In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of their own health conditions in particular. The National Cancer Institute in the USA and the Organization of European Cancer Institutes encourage comprehensive cancer centers in providing educational programs conceived to overcome these gaps. The goal of this paper is to identify and describe the key elements necessary to develop a global patient education program and provide recommendations for strategies with practical examples for implementation in the daily activities of cancer institutes. A multidisciplinary committee was established for patient education, including patient representatives as equal partners, to define, implement, verify, and evaluate the fundamental steps for establishing a comprehensive education program. Six essential topics were identified for the program: appropriate communication of cancer epidemiology, clinical trial information, new therapeutic technologies, support in the use of medicines, psycho-oncological interventions, age-personalized approaches, and training programs for healthcare providers. Integration of these topics along with patient feedback is the key to a successful model for educational programs. An integrated educational program can transform a comprehensive cancer center to an institution that provides research and care for and with patients.
De Rosa, Marina; Rega, Daniela; Costabile, Valeria; Duraturo, Francesca; Niglio, Antonello; Izzo, Paola; Pace, Ugo; Delrio, Paolo
Colorectal cancer has been ranked the third and second most prevalent of all cancers in men and women, respectively, and it represents the fourth most common cause of cancer deaths. In 2012, there were 1.4 million estimated cases of colorectal cancer worldwide, and 700,000 estimated deaths, which implies significant impact on public health, especially in economically-developed countries. In recent years, there has been an increase in the number of tumors, although this has been accompanied by decreased mortality, due to more appropriate and available information, earlier diagnosis, and improvements in treatment. Colorectal cancers are characterized by great genotypic and phenotypic heterogeneity, including tumor microenvironment and interactions between healthy and cancer cells. All of these traits confer a unique peculiarity to each tumor, which can thus be considered as an individual disease. Well conducted molecular and clinical characterization of each colorectal cancer is essential with a view to the implementation of precision oncology, and thus personalized care. This last aims at standardization of therapeutic plans chosen according to the genetic background of each specific neoplasm, to increase overall survival and reduce treatment side effects. Thus, prognostic and predictive molecular biomarkers assume a critical role in the characterization of colorectal cancer and in the determination of the most appropriate therapy. PMID:27803741
Lau, Charlotte H. Y.; Wu, Xinyin; Chung, Vincent C. H.; Liu, Xin; Hui, Edwin P.; Cramer, Holger; Lauche, Romy; Wong, Samuel Y. S.; Lau, Alexander Y. L.; Sit, Regina S. T.; Ziea, Eric T. C.; Ng, Bacon F. L.; Wu, Justin C. Y.
Abstract Available systematic reviews showed uncertainty on the effectiveness of using acupuncture and related therapies for palliative cancer care. The aim of this systematic review and meta-analysis was to summarize current best evidence on acupuncture and related therapies for palliative cancer care. Five international and 3 Chinese databases were searched. Randomized controlled trials (RCTs) comparing acupuncture and related therapies with conventional or sham treatments were considered. Primary outcomes included fatigue, paresthesia and dysesthesias, chronic pain, anorexia, insomnia, limb edema, constipation, and health-related quality of life, of which effective conventional interventions are limited. Thirteen RCTs were included. Compared with conventional interventions, meta-analysis demonstrated that acupuncture and related therapies significantly reduced pain (2 studies, n = 175, pooled weighted mean difference: −0.76, 95% confidence interval: −0.14 to −0.39) among patients with liver or gastric cancer. Combined use of acupuncture and related therapies and Chinese herbal medicine improved quality of life in patients with gastrointestinal cancer (2 studies, n = 111, pooled standard mean difference: 0.75, 95% confidence interval: 0.36–1.13). Acupressure showed significant efficacy in reducing fatigue in lung cancer patients when compared with sham acupressure. Adverse events for acupuncture and related therapies were infrequent and mild. Acupuncture and related therapies are effective in reducing pain, fatigue, and in improving quality of life when compared with conventional intervention alone among cancer patients. Limitations on current evidence body imply that they should be used as a complement, rather than an alternative, to conventional care. Effectiveness of acupuncture and related therapies for managing anorexia, reducing constipation, paresthesia and dysesthesia, insomnia, and limb edema in cancer patients is uncertain, warranting
Hassona, Y; Scully, C; Shahin, A; Maayta, W; Sawair, F
The purposes of this study are to determine early detection practices performed by primary healthcare professionals, to compare medical and dental sub-groups, and to identify factors that influence the ability of medical and dental practitioners to recognize precancerous changes and clinical signs of oral cancer. A 28-item survey instrument was used to interview a total of 330 Jordanian primary health-care professionals (165 dental and 165 medical). An oral cancer knowledge scale (0 to 31) was generated from correct responses on oral cancer general knowledge. An early detection practice scale (0 to 24) was generated from the reported usage and frequency of procedures in oral cancer examination. Also, a diagnostic ability scale (0 to 100) was generated from correct selections of suspicious oral lesions. Only 17.8 % of the participants reported that they routinely performed oral cancer screening in practices. Their oral cancer knowledge scores ranged from 3 to 31 with a mean of 15.6. The early detection practice scores ranged from 2 to 21 with a mean of 11.6. A significant positive correlation was found between knowledge scores and early detection practice scores (r = 0.22; p < 0.001). The diagnostic ability scores ranged from 11.5 to 96 with a mean of 43.6. The diagnostic ability score was significantly correlated with knowledge scores (r = 0.39; p < 0.001), but not with early detection practice scores (r = 0.01; p = 0.92). Few significant differences were found between medical and dental primary care professionals. Continuous education courses on early diagnosis of oral cancer and oral mucosal lesions are needed for primary health-care professionals.
Kehl, Kenneth L.; Landrum, Mary Beth; Kahn, Katherine L.; Gray, Stacy W.; Chen, Aileen B.; Keating, Nancy L.
Purpose: Multidisciplinary tumor board meetings are common in cancer care, but limited evidence is available about their benefits. We assessed the associations of tumor board participation and structure with care delivery and patient outcomes. Methods: As part of the CanCORS study, we surveyed 1,601 oncologists and surgeons about participation in tumor boards and specific tumor board features. Among 4,620 patients with lung or colorectal cancer diagnosed from 2003 to 2005 and seen by 1,198 of these physicians, we assessed associations of tumor board participation with patient survival, clinical trial enrollment, guideline-recommended care, and patient-reported quality, adjusting for patient and physician characteristics. Results: Weekly physician tumor board participation (v participation less often or never) was not associated with patient survival, although in exploratory subgroup analyses, weekly participation was associated with lower mortality for extensive-stage small-cell lung cancer and stage IV colorectal cancer. Patients treated by the 54% of physicians participating in tumor boards weekly (v less often or never) were more likely to enroll onto clinical trials (odds ratio [OR], 1.6; 95% CI, 1.1 to 2.2). Patients with stage I to II non–small-cell lung cancer (NSCLC) whose physicians participated in tumor boards weekly were more likely to undergo curative-intent surgery (OR, 2.9; 95% CI, 1.3 to 6.8), although those with stage I to II NSCLC whose physicians' meetings reviewed > one cancer site were less likely to undergo curative-intent surgery (OR, 0.1; 95% CI, 0.03 to 0.4). Conclusion: Among patients with lung or colorectal cancer, frequent physician tumor board engagement was associated with patient clinical trial participation and higher rates of curative-intent surgery for stage I to II NSCLC but not with overall survival. PMID:25922221
Nadpara, Pramit A.; Madhavan, S. Suresh; Tworek, Cindy; Sambamoorthi, Usha; Hendryx, Michael; Almubarak, Mohammed
Objectives In the United States (US), the elderly carry a disproportionate burden of lung cancer. Although evidence-based guidelines for lung cancer care have been published, lack of high quality care still remains a concern among the elderly. This study comprehensively evaluates the variations in guideline-concordant lung cancer care among elderly in the US. Materials and Methods Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2002–2007), we identified elderly patients (aged ≥65 years) with lung cancer (n = 42,323) and categorized them by receipt of guideline-concordant care, using evidence-based guidelines from the American College of Chest Physicians. A hierarchical generalized logistic model was constructed to identify variables associated with receipt of guideline-concordant care. Kaplan–Meier analysis and Log Rank test were used for estimation and comparison of the three-year survival. Multivariate Cox proportional hazards model was constructed to estimate lung cancer mortality risk associated with receipt of guideline-discordant care. Results Only less than half of all patients (44.7%) received guideline-concordant care in the study population. The likelihood of receiving guideline-concordant care significantly decreased with increasing age, non-white race, higher comorbidity score, and lower income. Three-year median survival time significantly increased (exceeded 487 days) in patients receiving guideline-concordant care. Adjusted lung cancer mortality risk significantly increased by 91% (HR = 1.91, 95% CI: 1.82–2.00) among patients receiving guideline-discordant care. Conclusion This study highlights the critical need to address disparities in receipt of guideline-concordant lung cancer care among elderly. Although lung cancer diagnostic and management services are covered under the Medicare program, underutilization of these services is a concern. PMID:25604094
Background: Self-care is a frequently used concept in both the theory and the clinical practice of nursing and is considered an element of nursing theory by Orem. The aim of this paper is to identify the core attributes of the self-care concept in cancer patients. Materials and Methods: We used Rodgers’ evolutionary method of concept analysis. The articles published in English language from 1980 to 2015 on nursing and non-nursing disciplines were analyzed. Finally, 85 articles, an MSc thesis, and a PhD thesis were selected, examined, and analyzed in-depth. Two experts checked the process of analysis and monitored and reviewed the articles. Results: The analysis showed that self-care concept is determined by four attributes of education, interaction, self-control, and self-reliance. Three types of antecedents in the present study were client-related (self-efficacy, self-esteem), system-related (adequate sources, social networks, and cultural factors), and healthcare professionals-related (participation). Conclusion: The self-care concept has considerably evolved among patients with chronic diseases, particularly cancer, over the past 35 years, and nurses have managed to enhance their knowledge about self-care remarkably for the clients so that the nurses in healthcare teams have become highly efficient and able to assume the responsibility for self-care teams. PMID:27803559
Fisch, Michael J; Chung, Arlene E; Accordino, Melissa K
Digital engagement has become pervasive in the delivery of cancer care. Internet- and cellular phone-based tools and systems are allowing large groups of people to engage with each other and share information. Health systems and individual health professionals are adapting to this revolution in consumer and patient behavior by developing ways to incorporate the benefits of technology for the purpose of improving the quality of medical care. One example is the use of social media platforms by oncologists to foster interaction with each other and to participate with the lay public in dialogue about science, medicine, and cancer care. In addition, consumer devices and sensors (wearables) have provided a new, growing dimension of digital engagement and another layer of patient-generated health data to foster better care and research. Finally, electronic health records have become the new standard for oncology care delivery, bringing new opportunities to measure quality in real time and follow practice patterns, as well as new challenges as providers and patients seek ways to integrate this technology along with other forms of digital engagement to produce more satisfaction in the process of care along with measurably better outcomes.
Fernandes, Maria Andréa; Evangelista, Carla Braz; Platel, Indiara Carvalho dos Santos; Agra, Glenda; Lopes, Marineide de Souza; Rodrigues, Francileide de Araújo
This study sought to assess the perception of nurses with respect to cancer patients under palliative care. It is an exploratory study with a qualitative approach conducted with nurses from a hospital attending cancer patients under palliative care located in the city of João Pessoa, State of Paraíba. The study included nine nurses who worked in the hospital. The empirical material was collected using the technique of semi-structured interviews and analyzed using the content analysis technique. The interpretative analysis of the interviews led to the definition of three categories: Improving the quality of life through the alleviation of pain and suffering; Palliative Care: a multi-professional study of terminal patients and their families in the grieving process; Communication: a source of dignity in the terminal care process. The conclusion reached is that the study revealed that the nurses involved acknowledge the importance of the multidisciplinary team. It enables the nurses to reflect on the use of communication as an essential element of care for patient and family under palliative care. It is hoped that the data obtained may foster further research on the topic.
Optimal oncologic care of older men with prostate cancer, including effective prevention and management of the disease and treatment side effects (so-called best supportive care measures) can prolong survival, improve quality of life, and reduce depressive symptoms. In addition, the proportion of treatment discontinuations can be reduced through early reporting and management of side effects. Pharmacologic care may be offered to manage the side effects of androgen-deprivation therapy and chemotherapy, which may include hot flashes, febrile neutropenia, fatigue, and diarrhea. Nonpharmacologic care (e.g., physical exercise, acupuncture, relaxation) has also been shown to benefit patients. At the Georges Pompidou European Hospital, the Program of Optimization of Chemotherapy Administration has demonstrated that improved outpatient follow-up by supportive care measures can reduce the occurrence of chemotherapy-related side effects, reduce cancellations and modifications of treatment, reduce chemotherapy wastage, and reduce the length of stay in the outpatient unit. The importance of supportive care measures to optimize management and outcomes of older men with advanced prostate cancer should not be overlooked. PMID:23015682
Prevost, V; Grach, M-C
In palliative care, the nutrition provided has to be tailored to the patient's needs, enhancing patient comfort and quality of life (QoL). We conducted a literature search to review methods of measuring QoL, and modalities of nutritional intervention and their influence on QoL of cancer patients in palliative care. Original papers published in English were selected from PubMed database by using the search terms, palliative medicine, cancer, nutrition and quality of life. Specific tools that are particularly recommended to assess QoL in a palliative care setting are reviewed. The main goal in palliative care is to maintain oral nutrition by providing nutritional counselling. Enteral nutritional support showed inconsistent effects on survival and QoL. An evidence-base for parenteral nutrition is still lacking. Ethical considerations concerning provision of food and hydration in end-of-life care are discussed. Nutritional status should be assessed early and regularly during treatment using appropriate tools. In the particularly acute context of palliative care, optimal patient management requires adequate education and counselling to patients and families. Meaningful interactions between the patient, caregivers and medical team would also increase the chance of resolving nutrition-related issues and help to fulfil each patient's specific nutritional needs and thus improve the QoL.
Lung cancer is a serious/medical and social problem. It belongs to the most common cancers. In the past decades, lung cancer has steadily held a leading place in the structure of cancer morbidity and mortality in our country and in the majority of European countries. Cigarette smoking remains to be the major if not only risk factor for lung cancer. Many attempts were previously made to set up systems for the early (timely) lung cancerdetection in risk groups through cytological and radiological examinations. Prophylactic fluorography and X-ray study have long been an important screening procedure in Russia and foreign countries. Recently this procedure has transformed into digital lung radiography. However, there have been no conclusive proofs for its efficiency in the early detection of lung cancer for a few decades. In the past decade, large-scale prospective randomized trials of low-dose computed tomography (CT) have been performed to screen lung cancer. These have shown that this technology can potentially reduce mortality from this disease. This encouraging result has caused a substantial change in the tactics of examining people at high risk for lung cancer. CT has fully replaced linear tomography and all others special X-ray procedures in the verified diagnosis of lung cancer. The indications for pre-examination CT have been considerably expanded in patients with X-ray detected pathology. The tactics for estimating the small lung tissue foci found at CT has been changed. Availability of CT, clear clinical indications for the study, and observance of the standard procedure have become important elements of the entire system for the early identification of lung cancer. These clinical recommendations largely deal just with organizational and methodological issues. The authors hope that the recommendations will serve as a guide for primary care physicians (therapists, pulmonologists,and radiologists) in the early diagnosis of lung cancer and in the optimization
Blanch-Hartigan, Danielle; Forsythe, Laura P.; Alfano, Catherine M.; Smith, Tenbroeck; Nekhlyudov, Larissa; Ganz, Patricia A.; Rowland, Julia H.
Purpose Survivorship care planning should involve discussions between providers and cancer survivors to address survivors' needs and optimize adherence. We examined the frequency and factors associated with oncologists' and primary care physicians' (PCPs) reports of provision of written survivorship care plans (SCPs) and discussion of survivorship care recommendations with survivors. Methods A nationally representative sample of 1,130 oncologists and 1,020 PCPs was surveyed about survivorship care practices with survivors. Logistic regression models predicted multilevel factors associated with providing SCPs or discussing recommendations with survivors. Results Although a majority of oncologists (64%) reported always/almost always discussing survivorship care recommendations with survivors, fewer also discussed who survivors should see for cancer-related and other follow-up care (32%); fewer still also provided a written SCP to the survivor (< 5%). Survivorship care recommendations and provider responsibility were not regularly discussed by PCPs and survivors (12%). Oncologists who reported detailed training about late and long-term effects of cancer were more likely to provide written SCPs (odds ratio [OR], 1.73; 95% CI, 1.22 to 2.44) and discuss survivorship care planning with survivors (OR, 2.02; 95% CI, 1.51 to 2.70). PCPs who received SCPs from oncologists were 9× more likely (95% CI, 5.74 to 14.82) to report survivorship discussions with survivors. Conclusion A minority of both PCPs and oncologists reported consistently discussing and providing SCPs to cancer survivors. Training and knowledge specific to survivorship care and coordinated care between PCPs and oncologists were associated with increased survivorship discussions with survivors. These nationally representative data provide a useful benchmark to assess implementation of new efforts to improve the follow-up care of survivors. PMID:24752057
Background Colorectal cancer (CRC) is the second most prevalent type of cancer in Europe. A single flexible sigmoidoscopy (FS) screening at around the age of 60 years prevents about one-third of CRC cases. However, FS screens only the distal colon, and thus mortality from proximal CRC is unaffected. Computed tomography colonography (CTC) is a highly accurate examination that allows assessment of the entire colon. However, the benefit of CTC testing as a CRC screening test is uncertain. We designed a randomized trial to compare participation rate, detection rates, and costs between CTC (with computer-aided detection) and FS as primary tests for population-based screening. Methods/Design An invitation letter to participate in a randomized screening trial comparing CTC versus FS will be mailed to a sample of 20,000 people aged 58 or 60 years, living in the Piedmont region and the Verona district of Italy. Individuals with a history of CRC, adenomas, inflammatory bowel disease, or recent colonoscopy, or with two first-degree relatives with CRC will be excluded from the study by their general practitioners. Individuals responding positively to the invitation letter will be then randomized to the intervention group (CTC) or control group (FS), and scheduled for the screening procedure. The primary outcome parameter of this part of the trial is the difference in advanced neoplasia detection between the two screening tests. Secondary outcomes are cost-effectiveness analysis, referral rates for colonoscopy induced by CTC versus FS, and the expected and perceived burden of the procedures. To compare participation rates for CTC versus FS, 2,000 additional eligible subjects will be randomly assigned to receive an invitation for screening with CTC or FS. In the CTC arm, non-responders will be offered fecal occult blood test (FOBT) as alternative screening test, while in the FS arm, non-responders will receive an invitation letter to undergo screening with either FOBT or CTC
Al Lamki, Zakiya
Cancer is a global health problem particularly in developing countries where the burden of cancer is ever increasing and claiming the lives of about 100,000 children under the age of 15 years every year. Majority of these occur in the Low and Middle Income Countries (LMICs) where 90% of world children live. Contributing factors to this trend is the reduction of communicable diseases and emergence of new infections, improvement of nutrition and socio-economic conditions, industrialization and urbanization. However, due to its complexity, childhood cancer is given the least priority by the governments' funding. The weak health systems, poor and late access to diagnosis and care, fewer numbers of trained health care professionals and lack of cancer drugs are amongst the many challenges faced. A major challenge for the future is extending the work to reach the many children who die without access to cancer treatment and palliation. Given the inequalities in the survival rates of children with cancer there is therefore an urgent need to close the gap between developed and developing countries. Strategies at individual, institutional, country, regional and global levels must be implemented to improve cancer survival and its effects on human suffering. These strategies are able to strengthen the health systems, improve care and research, increase awareness and coordinate training of professionals thus meeting the challenges. Financial support should be an integral part of the strategy as the cost of drugs is often a substantial barrier to treatment of cancer in poor countries. However, in resource-limited settings without specialized services, much can still be done to support and offer curative and palliative treatment. As have been shown for several cancers, life can be extended with low-tech treatment protocols which are effective at the same time, decrease sepsis and toxicity. The concept of twinning with privileged nations is paramount to the success of any national
Morita, Tatsuya; Fujimoto, Koji; Imura, Chizuru; Nanba, Miki; Fukumoto, Naoko; Itoh, Tomoko
Knowledge and skill deficits about palliative care in medical professionals are among the most common barriers to quality palliative care. This study in a Japanese regional cancer center was conducted to clarify nurses' self-reported practices, confidence, and knowledge, and the changes in these parameters after the 1-year educational and clinical activity of a palliative care team. Questionnaires were distributed to 134 nurses before and after a palliative care team conducted 6-topic educational programs and clinical consultation activity throughout the year. The nurses were asked to report their practices, confidence, and knowledge about palliative care in 5 fields (pain, dyspnea, delirium, communication, and dying-phase). In some areas of palliative care, hospital nurses did not adhere to recommended practices, had knowledge deficits, and were not generally confident with palliative care practices. However, daily palliative care team activities, including educational programs and clinical consultation service, could improve their practice and knowledge levels.
Howitt, Peter J; Kerr, Karen; Al Kuwari, Hanan; Mohamed Husain Ali, Faleh; Knuth, Alexander; Darzi, Ara
The World Health Organization recommends that all countries develop a cancer control program. Qatar is the first country in the Gulf Cooperation Council to develop such a plan, with its National Cancer Strategy 2011-2016. Three years into implementation, meaningful progress has been made, particularly in reducing patient waiting times, creating a multidisciplinary approach to cancer treatment, and fostering international research collaboration. Challenges include attracting sufficient numbers of trained health care workers, reaching a diverse population with messages tailored to their needs, and emphasizing cancer prevention and early detection in addition to research and treatment. Qatar's example shows that best practices developed in North America, Western Europe, and Australasia can be assimilated in a very different demographic and cultural context when such approaches are tailored to local characteristics and circumstances.
Duineveld, Laura A M; Wieldraaijer, Thijs; Wind, Jan; Verdonck-de Leeuw, Irma M; van Weert, Henk C P M; van Uden-Kraan, Cornelia F
Objectives The aim of this study was to explore the perspectives of general practitioners (GPs) regarding their current and future role in survivorship care of patients with colon cancer, and to assess their perspectives on patients’ self-management capacities and the value of the eHealth application Oncokompas2.0 used by patients. Setting GPs from the central part of the Netherlands were interviewed at their location of preference. Participants 20 GPs participated (10 men, 10 women, age range 34–65 years, median age 49.5 years). The median years of experience as a GP was 14.5 years (range 3–34 years). Results GPs indicated attempting to keep in contact with patients after colon cancer treatment and mentioned being aware of symptoms of recurrent disease. Most participants would have liked to be more involved and expected to be able to provide survivorship care of colon cancer. Requirements mentioned were agreements with secondary care and a protocol. GPs considered Oncokompas2.0, which stimulates patients to structure their own survivorship care, as a useful additional tool for a specific group of patients (ie, young and highly-educated patients). Conclusions Based on the perspectives of the GPs, survivorship care of colon cancer in primary care is deemed feasible and the use of an eHealth application such as Oncokompas2.0 is expected to benefit specific groups of patients after colon cancer treatment. PMID:27126977
Silbermann, M.; Arnaout, M.; Daher, M.; Nestoros, S.; Pitsillides, B.; Charalambous, H.; Gultekin, M.; Fahmi, R.; Mostafa, K.A.H.; Khleif, A.D.; Manasrah, N.; Oberman, A.
Background In larger parts of the Middle East palliative care is still misunderstood among health professionals, cancer patients and the public at large. One reason to that is because the term does not obviously communicate the intent of this clinical discipline, which is lending better quality of life while combating cancer. Further, culture, tradition and religion have contributed to this misgiving and confusion especially at the terminal stage of the disease. Methods The Middle East Cancer Consortium jointly with the American Society of Clinical Oncology, the American Oncology Nursing Society, the San Diego Hospice Center for Palliative Medicine and the Children's Hospital & Clinics of Minnesota initiated a series of training courses and workshops in the Middle East to provide updated training to physicians, nurses, social workers and psychologists from throughout the region with basic concepts of palliative care and pain managements in adults and children cancers. Results During the past 6 years hundreds of professionals took part in these educational and training activities, thereby creating the core of trained caregivers who start to make the change in their individual countries. Conclusions The outcome of consecutive training activities can overcome geopolitical instabilities, and yield a genuine change in approach of both regulators, medical administrators, medical staff and the public; as to the important contribution of palliative care services to the welfare of the patient and his/her family. PMID:22628412
Steel, Jennifer; Geller, David A; Tsung, Allan; Marsh, J Wallis; Dew, Mary Amanda; Spring, Michael; Grady, Jonathan; Likumahuwa, Sonja; Dunlavy, Andrea; Youssef, Michael; Antoni, Michael; Butterfield, Lisa H; Schulz, Richard; Day, Richard; Helgeson, Vicki; Kim, Kevin H; Gamblin, T Clark
Background Collaborative care interventions to treat depression have begun to be tested in settings outside of primary care. However, few studies have expanded the collaborative care model to other settings and targeted comorbid physical symptoms of depression. Purpose The aims of this report were to: (1) describe the design and methods of a trial testing the efficacy of a stepped collaborative care intervention designed to manage cancer-related symptoms and improve overall quality of life in patients diagnosed with hepatobiliary carcinoma; and (2) share the lessons learned during the design, implementation, and evaluation of the trial. Methods The trial was a phase III randomized controlled trial testing the efficacy of a stepped collaborative care intervention to reduce depression, pain, and fatigue in patients diagnosed with advanced cancer. The intervention was compared to an enhanced usual care arm. The primary outcomes included the Center for Epidemiological Studies-Depression scale, Brief Pain Inventory, and Functional Assessment of Cancer Therapy (FACT)-Fatigue, and the FACT-Hepatobiliary. Sociodemographic and disease-specific characteristics were recorded from the medical record; Natural Killer cells and cytokines that are associated with these symptoms and with disease progression were assayed from serum. Results and Discussion The issues addressed include: (1) development of collaborative care in the context of oncology (e.g., timing of the intervention, tailoring of the intervention, ethical issues regarding randomization of patients, and changes in medical treatment over the course of the study); (2) use of a website by chronically ill populations (e.g., design and access to the website, development of the website and intervention, ethical issues associated with website development, website usage, and unanticipated costs associated with website development); (3) evaluation of the efficacy of intervention (e.g., patient preferences, proxy raters
Kai, J; Beavan, J; Faull, C
Background: Evidence concerning the influence of ethnic diversity on clinical encounters in cancer care is sparse. We explored health providers' experiences in this context. Methods: Focus groups were conducted with a purposeful sample of 106 health professionals of differing disciplin