Models for delivering survivorship care Oeffinger, Kevin C; McCabe, Mary S
Journal of clinical oncology,
2006-Nov-10, Letnik:
24, Številka:
32
Journal Article
Recenzirano
Survivors of adult cancer face lifetime health risks that are dependent on their cancer, cancer treatment exposures, comorbid health conditions, genetic predispositions, and lifestyle behaviors. ...Content, intensity, and frequency of health care that addresses these risks vary from survivor to survivor. The aims of this article are to provide a rationale for survivor health care and to articulate a taxonomy of models of survivor care that is applicable to both community practices and academic institutions.
Survivorship care plans in research and practice Salz, Talya; Oeffinger, Kevin C.; McCabe, Mary S. ...
CA: a cancer journal for clinicians,
March/April 2012, Letnik:
62, Številka:
2
Journal Article
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.
The National Cancer Policy Forum of the National Academies of Sciences, Engineering and Medicine sponsored a workshop on July 24 and 25, 2017 on Long-Term Survivorship after Cancer Treatment. The ...workshop brought together diverse stakeholders (patients, advocates, academicians, clinicians, research funders, and policymakers) to review progress and ongoing challenges since the Institute of Medicine (IOM)'s seminal report on the subject of adult cancer survivors published in 2006. This commentary profiles the content of the meeting sessions and concludes with recommendations that stem from the workshop discussions. Although there has been progress over the past decade, many of the recommendations from the 2006 report have not been fully implemented. Obstacles related to the routine delivery of standardized physical and psychosocial care services to cancer survivors are substantial, with important gaps in care for patients and caregivers. Innovative care models for cancer survivors have emerged, and changes in accreditation requirements such as the Commission on Cancer's (CoC) requirement for survivorship care planning have put cancer survivorship on the radar. The Center for Medicare & Medicaid Innovation's Oncology Care Model (OCM), which requires psychosocial services and the creation of survivorship care plans for its beneficiary participants, has placed increased emphasis on this service. The OCM, in conjunction with the CoC requirement, is encouraging electronic health record vendors to incorporate survivorship care planning functionality into updated versions of their products. As new models of care emerge, coordination and communication among survivors and their clinicians will be required to implement patient- and community-centered strategies.
Cancer survivors face substantial risks for morbidity, reduced quality of life, and premature mortality related to the cancer itself and/or the interventions undertaken to control cancer. Risk-based ...care that involves a personalized systematic plan of periodic screening, surveillance, and prevention relevant to the cancer experience is recommended to address the comprehensive health needs of the growing population of cancer survivors. Risk-based care and coordination between oncology and primary care providers have been identified as important metrics of quality cancer survivorship care. Various models of survivorship care, treatment summaries, and survivorship care plans have been promoted as methods to facilitate communication among providers across care transitions and improve survivor access to quality survivorship care. However, research supporting the feasibility of implementing these practices and their effectiveness in enhancing health outcomes is limited. This article reviews key concepts underpinning clinical and research initiatives endeavoring to improve access to quality care among long-term survivors and summarizes results of intervention studies implementing these elements in transitioning survivors from oncology to primary care providers for long-term follow-up care.
To present key recommendations from a recently released Institute of Medicine (IOM) report on high-quality cancer care.
The recommendations were derived from the IOM report Delivering High-Quality ...Cancer Care: Charting a New Course for a System in Crisis.
The authors reviewed each of the recommendations to identify implications for oncology nurses.
Nurses will play a vital role in the future design and delivery of high-quality cancer care.
Oncology nurses should use the IOM recommendations in their settings to prepare for the delivery of oncology care amidst health system challenges, including an aging society.
The IOM recommendations identify key areas of concern to nurses. Key aspects of nursing practice, including involvement in advanced care planning, patient-centered care, and evidence-based practice, are essential for high-quality care. Oncology nurses will be centrally involved in healthcare innovations, such as rapid learning systems, and as key members of a well-trained workforce.
To review advanced practice nursing roles in planning, implementing, and evaluating survivorship care.
Review of the literature, published articles, government and organizational reports.
The ...increased focus on improving post-treatment cancer care presents opportunities for advanced practice nurses to meet the physical and psychosocial needs of cancer survivors.
As experts in the comprehensive delivery of care, oncology advanced practice nurses are positioned to initiate, deliver, and evaluate survivorship care through innovative models.
Background/objectives
Ethical challenges in pediatric oncology arise at every stage of illness. However, there are sparse data on the content of and reason for ethics consultations in the field. We ...sought to evaluate the content and characteristics of ethics consultations in pediatric patients at a cancer center.
Design/methods
We retrospectively identified ethics consultations performed for patients diagnosed with cancer at ≤21 years of age who were treated in the Department of Pediatrics from 2007 to 2017. Using an established coding schema, two independent reviewers analyzed the content of ethics consultation notes and identified core ethical issues and relevant contextual issues. Demographic, clinical, and consultation‐specific data were also collected.
Results
Thirty‐five consultations were performed for 32 unique patients. The most commonly identified ethical issues were obligation to provide nonbeneficial treatment (29%) and resuscitation preferences (26%). Communication conflicts were the most commonly identified contextual issue (40%). There were two themes that emerged repeatedly but were not a part of the original coding schema—four consultations (11%) that involved physicians questioning their obligation to provide potentially toxic treatment in the setting of poor patient/parent compliance, and two consultations (6%) related to complex risk‐benefit analysis in the setting of an invasive procedure with uncertain benefit.
Conclusions
Pediatric ethics consultations are infrequent at this specialty cancer hospital. Ethical issues focused on treatment and end‐of‐life care and included a diversity of communication conflicts.
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