Background
The impact of cancer and its treatment on employment and financial burden in adolescents/young adults (AYAs) is not fully known.
Methods
Eligibility for this cross‐sectional study of AYA ...cancer survivors included the diagnosis of a malignancy between ages 18 and 39 years and survey completion within 1 to 5 years from diagnosis and ≥1 year after therapy completion. Participants were selected randomly from the tumor registries of 7 participating sites and completed an online patient‐reported outcomes survey to assess employment and financial concerns. Treatment data were ed from medical records. Data were analyzed across diagnoses and by tumor site using logistic regression and Wald‐based 95% confidence intervals adjusting for age (categorized), sex, insurance status, education (categorized), and treatment exposures.
Results
Participants included 872 survivors (breast cancer, n = 241; thyroid cancer, n = 126; leukemia/lymphoma, n = 163; other malignancies, n = 342). Exposure to chemotherapy in breast cancer survivors was associated with an increase in self‐reported mental impairment in work tasks (odds ratio OR, 2.66) and taking unpaid time off (OR, 2.62); survivors of “other” malignancies reported an increase in mental impairment of work tasks (OR, 3.67) and borrowing >$10,000 (OR, 3.43). Radiation exposure was associated with an increase of mental impairment in work tasks (OR, 2.05) in breast cancer survivors, taking extended paid time off work in thyroid cancer survivors (OR, 5.05), and physical impairment in work tasks in survivors of “other” malignancies (OR, 3.11). Finally, in survivors of “other” malignancies, having undergone surgery was associated with an increase in physical (OR, 3.11) and mental impairment (OR, 2.31) of work tasks.
Conclusions
Cancer treatment has a significant impact on AYA survivors’ physical and mental work capacity and time off from work.
In a multicenter, cross‐sectional study of adolescent and young adult cancer survivors between ages 18 and 39 years, from 1 to 5 years after diagnosis, and greater than 1 year after therapy completion, the associations of treatment‐related factors with the likelihood of physical and mental impairment of work tasks as well as the likelihood of changes in employment, including any time off from work, are evaluated. Findings reveal that cancer treatment has significant financial and employment implications as well as a significant impact on adolescent and young adult survivors’ physical and mental work capacity.
Funded by the Centers for Disease Control and Prevention (CDC), the mission of the Cancer Prevention and Control Research Network (CPCRN)1 is to accelerate the adoption and implementation of ...evidence-based cancer prevention and control strategies in communities and clinical care settings across the U.S., with a special focus on underserved populations. On the basis of a long-term collaboration, Risendal et al.2 outline how evidence-based cancer prevention and control strategies can inform the public health response to coronavirus disease 2019 (COVID-19) and reduce disparities. Applying the Quality Cancer Survivorship Care Framework3 while adapting to COVID-19 to promote quality healthcare delivery to cancer survivors, the objective of this article is to address the implications for cancer survivorship care on the basis of CPCRN experience. In this paper, the importance of bidirectional knowledge sharing and strategic communications between cancer survivors, as defined by the National Cancer Institute,4 and the healthcare system are underscored. This document represents a consensus across the CPCRN Cancer Survivorship Working Group, a subgroup of CPCRN members who represent all stakeholder groups within the network, and was supported by the CPCRN Steering Committee.
Purpose
This study describes the experiences of early implementers of primary care-focused cancer survivorship delivery models.
Methods
Snowball sampling was used to identify innovators. Twelve ...participants (five cancer survivorship primary care innovators and seven content experts) attended a working conference focused on cancer survivorship population strategies and primary care transformation. Data included meeting discussion transcripts/field notes, transcribed in-depth innovator interviews, and innovators’ summaries of care models. We used a multistep immersion/crystallization analytic approach, guided by a primary care organizational change model.
Results
Innovative practice models included: (1) a consultative model in a primary care setting; (2) a primary care physician (PCP)-led, blended consultative/panel-based model in an oncology setting; (3) an oncology nurse navigator in a primary care practice; and (4) two subspecialty models where PCPs in a general medical practice dedicated part of their patient panel to cancer survivors. Implementation challenges included (1) lack of key stakeholder buy-in; (2) practice resources allocated to competing (non-survivorship) change efforts; and (3) competition with higher priority initiatives incentivized by payers.
Conclusions
Cancer survivorship delivery models are potentially feasible in primary care; however, significant barriers to widespread implementation exist. Implementation efforts would benefit from increasing the awareness and potential value-add of primary care-focused strategies to address survivors’ needs.
Implications for Cancer Survivors
Current models of primary care-based cancer survivorship care may not be sustainable. Innovative strategies to provide quality care to this growing population of survivors need to be developed and integrated into primary care settings.
Cardiac Care of Childhood Cancer Survivors Kondapalli, Lavanya; Overholser, Linda; Lenneman, Carrie
Journal of the American College of Cardiology,
02/2024, Letnik:
83, Številka:
8
Journal Article
Survivorship: cognitive function, version 1.2014 Denlinger, Crystal S; Ligibel, Jennifer A; Are, Madhuri ...
Journal of the National Comprehensive Cancer Network
12, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Cognitive impairment is a common complaint among cancer survivors and may be a consequence of the tumors themselves or direct effects of cancer-related treatment (eg, chemotherapy, endocrine therapy, ...radiation). For some survivors, symptoms persist over the long term and, when more severe, can impact quality of life and function. This section of the NCCN Guidelines for Survivorship provides assessment, evaluation, and management recommendations for cognitive dysfunction in survivors. Nonpharmacologic interventions (eg, instruction in coping strategies; management of distress, pain, sleep disturbances, and fatigue; occupational therapy) are recommended, with pharmacologic interventions as a last line of therapy in survivors for whom other interventions have been insufficient.
Describe the development and evolution of a primary-care-based, multidisciplinary clinic to support the ongoing care of adult survivors of childhood cancer.
A consultative clinic for adult survivors ...of childhood cancer has been developed that is located in an adult, academic internal medicine setting and is based on a long-term follow-up clinic model available at Children's Hospital Colorado.
The clinic opened in July 2008. One hundred thirty-five patients have been seen as of April 2014. Referrals and clinic capacity have gradually increased over time, and a template has been developed in the electronic medical record to help facilitate completion of individualized care plan letters.
A primary care-based, multidisciplinary consultative clinic for adults with a history of childhood cancer survivor is feasible and actively engages adult primary care resources to provide risk-based care for long-term pediatric cancer survivors. This model of care planning can help support adult survivors of pediatric cancer and their primary care providers in non-academic, community settings as well.
•Adults with a history of pediatric cancer have unique long-term health care needs.•Primary care-based resources can be leveraged to support ongoing care after transition.•The TACTIC clinic model can serve as a model for other care disciplines.•Adult primary care providers can be actively engaged in survivorship care planning.•Adult primary care providers are a necessary stakeholder in the transition process.
Electronic health records (EHR) and data warehouses contain large amounts of data that hold promise for understanding and improving population health management. Utilizing the Health Data Compass ...(HDC) warehouse, a comprehensive and novel database of adult Coloradans who have completed curative-intent cancer treatment within a health care system was created. By analyzing patient demographics and health care utilization among this group, gaps in and barriers to coordinated care post-active cancer treatment may be identified and better understood.
A survivorship database (HDC-SD) was built from the Health Data Compass (HDC) warehouse by identifying individuals with histories of cancer who received treatment summary care plans (TSCPs) through the University of Colorado Cancer Center (UCCC) between January 1, 2020, and December 31, 2021. Patient sociodemographic characteristics, disease characteristics, and health maintenance were described and compared between urban and rural settings using chi-square tests.
The HDC-SD includes 1933 records representing 13 categories of cancers. The majority live in an urban setting (89.8%). Patients in HDC-SD living in urban areas had higher rates of completing recommended colorectal screening, mammography, Prostate-Specific Antigen (PSA) tests, flu shots, and COVID-19 vaccination. Additionally, emergency department visits occurred at a statistically significant higher level for those living in urban areas.
Creating and analyzing a comprehensive database of individuals who have completed active cancer treatment may highlight gaps in care within complex health care systems. Engaging different stakeholders to address these issues may help improve and enhance systematic population management for cancer survivors.
Completed treatment summary care plans may be used to increase the completion of individual health maintenance recommendations and potentially population health maintenance recommendations.
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