WorldWideScience

Sample records for cancer care good

  1. Lung cancer management in limited resource settings: guidelines for appropriate good care.

    Science.gov (United States)

    Macbeth, Fergus R; Abratt, Raymond P; Cho, Kwan H; Stephens, Richard J; Jeremic, Branislav

    2007-02-01

    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.

  2.  Cancer palliation in primary care - what is good and bad?

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn

    to the phenomenological approach.The interviews will form the basis of a survey of 500 episodes of palliative home care as evaluated by relatives, GPs and district nurses.Results. These results are the preliminary results from the first interviews with GPs. Three themes emerged from the interviews: 1) The key persons...... sectors. Methods. A series of focus group interviews is presently being conducted with participation of relatives of recently deceased cancer patients, GPs, community nurses and hospital physicians working with palliative patients. The interviews are transcribed and analysed  according...

  3. Is quality of colorectal cancer care good enough? Core measures development and its application for comparing hospitals in Taiwan

    Directory of Open Access Journals (Sweden)

    Cheng Skye H

    2010-01-01

    Full Text Available Abstract Background Although performance measurement for assessing care quality is an emerging area, a system for measuring the quality of cancer care at the hospital level has not been well developed. The purpose of this study was to develop organization-based core measures for colorectal cancer patient care and apply these measures to compare hospital performance. Methods The development of core measures for colorectal cancer has undergone three stages including a modified Delphi method. The study sample originated from 2004 data in the Taiwan Cancer Database, a national cancer data registry. Eighteen hospitals and 5585 newly diagnosed colorectal cancer patients were enrolled in this study. We used indicator-based and case-based approaches to examine adherences simultaneously. Results The final core measure set included seventeen indicators (1 pre-treatment, 11 treatment-related and 5 monitoring-related. There were data available for ten indicators. Indicator-based adherence possesses more meaningful application than case-based adherence for hospital comparisons. Mean adherence was 85.8% (79.8% to 91% for indicator-based and 82.8% (77.6% to 88.9% for case-based approaches. Hospitals performed well (>90% for five out of eleven indicators. Still, the performance across hospitals varied for many indicators. The best and poorest system performance was reflected in indicators T5-negative surgical margin (99.3%, 97.2% - 100.0% and T7-lymph nodes harvest more than twelve(62.7%, 27.6% - 92.2%, both of which related to surgical specimens. Conclusions In this nationwide study, quality of colorectal cancer care still shows room for improvement. These preliminary results indicate that core measures for cancer can be developed systematically and applied for internal quality improvement.

  4. Does good documentation equate to good nursing care?

    Science.gov (United States)

    Bosek, Marcia Sue DeWolf; Ring, Marcia Ellen

    2010-01-01

    Good documentation does not necessarily equate to good care. This article explores the potential underpinnings of poor documentation from an ethical decision-making lens. Nursing standards of care related to documentation are reviewed. The internal and external constraints of moral distress are considered, as is moral residue. Finally, the roles of the nurse administrator as well as specific remedial and restorative measures are suggested.

  5. Appropriateness and variation of surgical treatment of breast cancer in Italy: when excellence in clinical research does not match with generalized good quality care. Progetto Oncologia Femminile.

    Science.gov (United States)

    Scorpiglione, N; Nicolucci, A; Grilli, R; Angiolini, C; Belfiglio, M; Carinci, F; Cubasso, D; Filardo, G; Labbrozzi, D; Mainini, F

    1995-03-01

    To assess appropriateness of surgical care delivered to breast cancer patients in Italy and quantify the use of unnecessary radical procedures, a retrospective charts review of patients treated in 1988-1989 was conducted. A series of 1724 consecutive patients (median age 61 years; range 17-89) treated in 63 hospitals selected from within 8 regions with newly diagnosed operable breast carcinoma was evaluated. Overall, 541 (38%) patients had inappropriate surgery with more than two thirds of it being accounted for by the use of unnecessary mutilating Halsted mastectomy. Substantial geographic variation emerged in the overall rates of appropriateness (range 88-52%) which were not substantially affected by allowance for imbalances in patient- and hospital-related variables. Despite the important contribution given by Italian clinical researchers to the demonstration that less radical surgery can be as good as more radical procedures, still a substantial proportion of breast cancer patients are treated too aggressively. Besides pointing to the urgent need of interventions aimed at facilitating the process of technology transfer in order to promote more appropriate surgical care, these results suggest that efforts to increase patients' participation into treatment decision and awareness about alternative treatment options are warranted.

  6. Midwives benefit from good postnatal care, too.

    Science.gov (United States)

    Cameron, Helen

    2014-01-01

    Appropriate, timely and responsive postnatal care can help women and families negotiate the major life transition that childbirth brings. However, women's experiences of postnatal care are often negative and our increasingly biomedical approach to birth means that greater emphasis is placed on antenatal and intrapartum care at the expense of postnatal care. Good postnatal care is essential not only for women, but for midwives too, and our failure to acknowledge the significance of birth, and our contribution to that event can diminish us as people and midwives.

  7. Your cancer care team

    Science.gov (United States)

    ... gov/ency/patientinstructions/000929.htm Your cancer care team To use the sharing features on this page, ... help your body heal. Working with Your Care Team Each member of your care team plays an ...

  8. Euthanasia: the role of good care.

    Science.gov (United States)

    Seale, C; Addington-Hall, J

    1995-03-01

    The results from two surveys in England of relatives and others who knew people in samples drawn from death certificates are reported. The main focus is on a sample of 3696 people dying in 1990 in 20 health authorities, with supporting analysis from an earlier national sample of 639 people dying in 1987. The argument that good care and, in particular, hospice care is effective in reducing the desire for euthanasia has been proposed as an argument against the legalization of voluntary euthanasia. The findings suggest that the picture is in fact more complex. People who received hospice care were, if anything, more likely to have respondents who felt that it would have been better if they had died earlier. The latter held when controlling for other variables found to influence respondents' views, such as the level of distress and dependency experienced by the dying person. It appears possible that the same may apply to the dying peoples' own wishes, although here the time order of events could not be controlled for in the data. It is suggested that this may be due to hospice care being geared to helping patients express their fears and exercise choice. The wish for euthanasia may then be an assertion of personal control, rather than an act of surrender. Alternatively, people (and their relatives) who accept hospice care may be predisposed to consider the benefits of an earlier death.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Your cancer survivorship care plan

    Science.gov (United States)

    ... ency/patientinstructions/000822.htm Your cancer survivorship care plan To use the sharing features on this page, ... get one. What Is a Cancer Survivorship Care Plan? A cancer survivorship care plan is a document ...

  10. Quality of care: how good is good enough?

    Directory of Open Access Journals (Sweden)

    Chassin Mark R

    2012-01-01

    Full Text Available Abstract Israel has made impressive progress in improving performance on key measures of the quality of health care in the community in recent years. These achievements are all the more notable given Israel's modest overall spending on health care and because they have accrued to virtually the entire population of the country. Health care systems in most developed nations around the world find themselves in a similar position today with respect to health care quality. Despite significantly increased improvement efforts over the past decade, routine safety processes, such as hand hygiene and medication administration, fail routinely at rates of 30% to 50%. People with chronic diseases experience preventable episodes of acute illness that require hospitalization due to medication mix-ups and other failures of outpatient management. Patients continue to be harmed by preventable adverse events, such as surgery on the wrong part of the body and fires in operating theaters. Health care around the world is not nearly as safe as other industries, such as commercial aviation, that have mastered highly effective ways to manage serious hazards. Health care organizations will have to undertake three interrelated changes to get substantially closer to the superlative safety records of other industries: leadership commitment to zero major quality failures, widespread implementation of highly effective process improvement methods, and the adoption of all facets of a culture of safety. Each of these changes represents a major challenge to the way today's health care organizations plan and carry out their daily work. The Israeli health system is in an enviable position to implement these changes. Universal health insurance coverage, the enrolment of the entire population in a small number of health plans, and the widespread use of electronic health records provide advantages available to few other countries. Achieving and sustaining levels of safety comparable

  11. Do new cancer drugs offer good value for money? The perspectives of oncologists, health care policy makers, patients, and the general population

    Directory of Open Access Journals (Sweden)

    Dilla T

    2015-12-01

    Full Text Available Tatiana Dilla,1 Luís Lizan,2 Silvia Paz,2 Pilar Garrido,3 Cristina Avendaño,4 Juan J Cruz-Hernández,5 Javier Espinosa,6 José A Sacristán1 1Medical Department, Lilly, Madrid, 2Outcomes’10, Jaime I University, Castellón, 3Medical Oncology Department, University Hospital Ramon y Cajal, Madrid, 4Clinical Pharmacology Department, Puerta de Hierro-Majadahonda Hospital, Madrid, 5Salamanca Institute for Biomedical Research, University Hospital of Salamanca, Salamanca, 6Medical Oncology Department, General Hospital Ciudad Real, Ciudad Real, Spain Background: In oncology, establishing the value of new cancer treatments is challenging. A clear definition of the different perspectives regarding the drivers of innovation in oncology is required to enable new cancer treatments to be properly rewarded for the value they create. The aim of this study was to analyze the views of oncologists, health care policy makers, patients, and the general population regarding the value of new cancer treatments. Methods: An exploratory and qualitative study was conducted through structured interviews to assess participants’ attitudes toward cost and outcomes of cancer drugs. First, the participants were asked to indicate the minimum survival benefit that a new treatment should have to be funded by the Spanish National Health System (NHS. Second, the participants were requested to state the highest cost that the NHS could afford for a medication that increases a patient’s quality of life (QoL by twofold with no changes in survival. The responses were used to calculate incremental cost-effectiveness ratios (ICERs. Results: The minimum improvement in patient survival means that justified inclusions into the NHS were 5.7, 8.2, 9.1, and 10.4 months, which implied different ICERs for oncologists (€106,000/quality-adjusted life year [QALY], patients (€73,520/QALY, the general population (€66,074/QALY, and health care policy makers (€57,471/QALY, respectively

  12. CancerCare

    Science.gov (United States)

    ... E-News Blog En Español Facebook Twitter YouTube Instagram LinkedIn National Family Caregivers Month Find resources and ... HOPE (4673) info@cancercare.org Facebook Twitter YouTube Instagram LinkedIn © 2016 Cancer Care ® — All Rights Reserved Copyright ...

  13. Through the looking glass: good looks and dignity in care.

    Science.gov (United States)

    Pols, Jeannette

    2013-11-01

    There are roughly two meanings attached to the concept of dignity: humanitas and dignitas. Humanitas refers to ethical and juridical notions of equality, autonomy and freedom. Much less understood is the meaning of dignitas, which this paper develops as peoples' engagement with aesthetic values and genres, and hence with differences between people. Departing from a critical reading of Georgio Agamben's notion of 'bare life', I will analyze a case where aesthetics are quite literally at stake: women who lost their hair due to cancer treatment. The analysis shows a complicated interplay between varying evaluations of female baldness by the self and others, mediated by (often strongly negative) cultural imaginaries, and aesthetic genres depicting conventional ways of 'looking good'. The paper concludes by arguing for a reconnection of the two notions of dignity, and for a rehabilitation of aesthetics in daily life and care as fundamental values for organizing our societies.

  14. Understanding Nursing Home Worker Conceptualizations about Good Care

    Science.gov (United States)

    Chung, Gawon

    2013-01-01

    This study explored how direct care workers in nursing homes conceptualize good care and how their conceptualizations are influenced by external factors surrounding their work environment and the relational dynamics between them and residents. Study participants were drawn from a local service employees' union, and in-depth interviews were…

  15. Autophagy in cancer: good, bad, or both?

    Science.gov (United States)

    Hippert, Melanie M; O'Toole, Patrick S; Thorburn, Andrew

    2006-10-01

    Autophagy has been recognized as an important cellular process for at least 50 years; however, it is only with the recent identification of key regulators of autophagy (Atg genes) that we have begun a mechanistic exploration of its importance in cancer. Recent studies suggest that autophagy may be important in the regulation of cancer development and progression and in determining the response of tumor cells to anticancer therapy. However, the role of autophagy in these processes is complicated and may, depending on the circumstances, have diametrically opposite consequences for the tumor. In this article, we discuss recent discoveries regarding autophagy in cancer.

  16. Modularity in Cancer Care Provision

    DEFF Research Database (Denmark)

    Gobbi, Chiara; Hsuan, Juliana

    2012-01-01

    The paper presents the findings of a case study research conducted within the Danish healthcare system aimed at analyzing how modularity is deployed in the process of delivery cancer care. Three cancer packages are presented into detailed describing the process of defining the diagnosis and treat...

  17. Why Good Quality Care Needs Philosophy More Than Compassion

    Science.gov (United States)

    Leget, Carlo

    2015-01-01

    Although Marianna Fotaki’s Editorial is helpful and challenging by looking at both the professional and institutional requirements for reinstalling compassion in order to aim for good quality healthcare, the causes that hinder this development remain unexamined. In this commentary, 3 causes are discussed; the boundary between the moral and the political; Neoliberalism; and the underdevelopment of reflection on the nature of care. A plea is made for more philosophical reflection on the nature of care and its implications in healthcare education. PMID:26673178

  18. Cancer care in Singapore

    OpenAIRE

    Tey, J; Baggarley, S; Lee, KM

    2008-01-01

    Singapore is a small country, but it is ideally and centrally located to conveniently serve not only its population but also patients from the surrounding regions. It’s economy is sufficiently strong to maintain highly sophisticated and expensive equipment to manage a high level of healthcare, including oncology services. Cancer incidences in Singapore are on an upward trend based on the report of the Singapore Cancer Registry for the period of 2001-2005. Cancer is the number one cause of dea...

  19. Most Adult Survivors of Childhood Cancers Enjoy Good Sexual Health

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_163439.html Most Adult Survivors of Childhood Cancers Enjoy Good Sexual ... toxic treatments were tied to later issues, but most rated sex lives as positive To use the ...

  20. Older people's views of a good death in heart failure: implications for palliative care provision.

    Science.gov (United States)

    Gott, M; Small, Neil; Barnes, Sarah; Payne, Sheila; Seamark, David

    2008-10-01

    Palliative care in the UK has been developed to meet the needs of predominantly middle aged and younger old people with cancer. Few data are available regarding the extent to which services respond to the specific needs of an older group of people with other illnesses. This paper draws on in-depth interviews conducted with 40 people (median age 77) with advanced heart failure and poor prognosis to explore the extent to which older people's views and concerns about dying are consistent with the prevalent model of the 'good death' underpinning palliative care delivery. That prevalent model is identified as the "revivalist" good death. Our findings indicate that older people's views of a 'good death' often conflict with the values upon which palliative care is predicated. For example, in line with previous research, many participants did not want an open awareness of death preceded by acknowledgement of the potential imminence of dying. Similarly, concepts of autonomy and individuality appeared alien to most. Indeed, whilst there was evidence that palliative care could help improve the end of life experiences of older people, for example in initiating discussions around death and dying, the translation of other aspects of specialist palliative care philosophy appear more problematic. Ultimately, the study identified that improving the end of life experiences of older people must involve addressing the problematised nature of ageing and old age within contemporary society, whilst recognising the cohort and cultural effects that influence attitudes to death and dying.

  1. Spirituality in childhood cancer care

    Directory of Open Access Journals (Sweden)

    Lima NN

    2013-10-01

    Full Text Available Nádia Nara Rolim Lima,1 Vânia Barbosa do Nascimento,1 Sionara Melo Figueiredo de Carvalho,1 Modesto Leite Rolim Neto,2 Marcial Moreno Moreira,2 Aline Quental Brasil,2 Francisco Telésforo Celestino Junior,2 Gislene Farias de Oliveira,2 Alberto Olavo Advíncula Reis3 1Health Sciences Postgraduate Program, ABC Region Medical School, Santo André, São Paulo, Brazil; 2Department of Medicine, Federal University of Ceará, Barbalha, Ceará, Brazil; 3Public Health Postgraduate Program, University of São Paulo, São Paulo, Brazil Abstract: 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

  2. What Makes for Good Collaboration and Communication in Maternity Care? A Scoping Study

    NARCIS (Netherlands)

    van Helmond, L.; Korstjens, I.; Mesman, J.; Nieuwenhuijze, M.; Horstman, K.; Scheepers, H.; Spaanderman, M.; Keulen, J.; de Vries, R.

    2015-01-01

    BACKGROUND: Good communication and collaboration are critical to safe care for mothers and babies. OBJECTIVE: To identify factors associated with good collaboration and communication among maternity care professionals and between both professionals and parents. METHOD: Scoping study. We searched Pub

  3. Translating genomics in cancer care.

    Science.gov (United States)

    Bombard, Yvonne; Bach, Peter B; Offit, Kenneth

    2013-11-01

    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

  4. Integration of genomics in cancer care

    DEFF Research Database (Denmark)

    Santos, Erika Maria Monteiro; Edwards, Quannetta T; Floria-Santos, Milena

    2013-01-01

    cancer syndromes, epigenetics factors, and management of care considerations. METHODS: Peer-reviewed literature and expert professional guidelines were reviewed to address concepts of genetics-genomics in cancer care. FINDINGS: Cancer is now known to be heterogeneous at the molecular level, with genetic...

  5. Integrating yoga into cancer care.

    Science.gov (United States)

    DiStasio, Susan A

    2008-02-01

    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.

  6. Nationwide quality improvement in lung cancer care

    DEFF Research Database (Denmark)

    Jakobsen, Erik Winther; Green, Anders; Oesterlind, Kell

    2013-01-01

    To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry...... was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and monitoring result and process indicators....

  7. Primary care perspectives on prostate cancer screening.

    Science.gov (United States)

    Skolarus, Ted A; Holmes-Rovner, Margaret; Northouse, Laurel L; Fagerlin, Angela; Garlinghouse, Carol; Demers, Raymond Y; Rovner, David R; Darwish-Yassine, May; Wei, John T

    2011-06-01

    Although the effectiveness of prostate cancer screening is controversial, screening rates have risen dramatically among primary care providers in the United States. The authors' findings suggest more collaboration among primary care and specialty organizations, especially with respect to decision aid endorsement, is needed to achieve more discriminatory and patient-centered prostate cancer screening.

  8. Spirituality in Cancer Care (PDQ)

    Science.gov (United States)

    ... as cancer, may cause spiritual distress. Religious and spiritual values are important to patients coping with cancer. ... both. Serious illness, such as cancer, may cause spiritual distress. Serious illnesses like cancer may cause patients ...

  9. What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit.

    Directory of Open Access Journals (Sweden)

    Eva K Masel

    Full Text Available The aims of the study were to examine a patients' knowledge of palliative care, b patients' expectations and needs when being admitted to a palliative care unit, and c patient's concept of a good palliative care physician.The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients during the first three days after admission to the unit and after one week, recorded digitally, and transcribed verbatim. Data were analyzed using NVivo 10 software, based on thematic analysis enhanced with grounded theory techniques.The results revealed four themes: (1 information about palliative care, (2 supportive care needs, (3 being treated in a palliative care unit, and (4 qualities required of palliative care physicians. The data showed that patients lack information about palliative care, that help in social concerns plays a central role in palliative care, and attentiveness as well as symptom management are important to patients. Patients desire a personal patient-physician relationship. The qualities of a good palliative care physician were honesty, the ability to listen, taking time, being experienced in their field, speaking the patient's language, being human, and being gentle. Patients experienced relief when being treated in a palliative care unit, perceived their care as an interdisciplinary activity, and felt that their burdensome symptoms were being attended to with emotional care. Negative perceptions included the overtly intense treatment.The results of the present study offer an insight into what patients expect from palliative care teams. Being aware of patient's needs will enable medical teams to improve professional and individualized care.

  10. Optimizing Cancer Care Delivery through Implementation Science

    Directory of Open Access Journals (Sweden)

    Heather B Neuman

    2016-01-01

    Full Text Available 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 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.

  11. Supportive care needs of Iranian cancer patients

    Directory of Open Access Journals (Sweden)

    Azad Rahmani

    2014-01-01

    Full Text Available Background: A supportive needs assessment is an essential component of any care program. There is no research evidence regarding the supportive care needs of cancer patients in Iran or other Middle Eastern countries. Aims: The aim of this study was to determine the supportive care needs of Iranian cancer patients. Materials and Methods: This descriptive study was conducted in a referral medical center in the northwest of Iran. A total of 274 cancer patients completed the Supportive Care Needs Survey (SCNS-59. Descriptive statistics were used for data analysis. Results: In 18 items of the SCNS, more than 50% of the participants reported that their needs were unmet. Most frequently, unmet needs were related to the health system, information, physical, and daily living domains, and most met needs were related to sexuality, patient care, and support domains. Conclusions: Iranian cancer patients experience many unmet needs and there is an urgent need for establishing additional supportive care services in Iran.

  12. Importance of good teamwork in urgent care services.

    Science.gov (United States)

    Meier, Curtis

    2014-11-01

    High quality, safe care for patients depends on effective teamwork, and where multi-professional teams work together there is higher patient satisfaction, increased staff innovation, less stress and more communication ( West 2013 ). Conversely, lapses in teamwork and poor communication can result in adverse events ranging from retained foreign objects to perinatal events and medication errors ( Peter and Pronovost 2013 ), and even the death of patients ( Resuscitation Council UK 2011 ). Teamwork requires a set of skills and behaviours that, once learned by clinicians, can save lives ( Peter and Pronovost 2013 ). This article refers to a case study to explore the topic of teamwork in a tertiary care emergency setting.

  13. Perspectives on personalized cancer care

    Science.gov (United States)

    Dancik, Garrett M.; Theodorescu, Dan

    2017-01-01

    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

  14. A Good Supervisor--Ten Facts of Caring Supervision

    Science.gov (United States)

    Määttä, Kaarina

    2015-01-01

    This article describes the elements of caring supervision of doctoral theses. The purpose was to describe the best practices as well as challenges of supervision especially from the supervisor's perspective. The analysis is based on the author's extensive experience as a supervisor and related data obtained for research and developmental purposes.…

  15. High mortality despite good care-seeking behaviour

    DEFF Research Database (Denmark)

    Sodemann, Morten; Jakobsen, M S; Mølbak, Kare

    1997-01-01

    The care-seeking behaviour of mothers of 125 children deceased aged 1-30 months was investigated by verbal autopsy in an urban area of Guinea-Bissau. A total of 93% of the children were seen at a health centre or hospital during the 2 weeks before death. In a previous survey covering the period...

  16. Cancer care for individuals with schizophrenia.

    Science.gov (United States)

    Irwin, Kelly E; Henderson, David C; Knight, Helen P; Pirl, William F

    2014-02-01

    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.

  17. Virtue Ethics, Care Ethics, and "The Good Life of Teaching"

    Science.gov (United States)

    Silverman, Marissa

    2012-01-01

    In "The Good Life of Teaching: An Ethics of Professional Practice," Chris Higgins (2011) reminds people that "self-interest and altruism, personal freedom and social roles, and practical wisdom and personhood" have been ancient philosophical topics that remain vitally important in the practice of contemporary teaching and learning. One of the most…

  18. Health care as a community good. Many dimensions, many communities, many views of justice.

    Science.gov (United States)

    Galarneau, Charlene A

    2002-01-01

    We often speak of health care as a social good. What kind of good it is--and what justice requires of us in making it available to the members of society--depends on how society understands it. Yet the value of health care may be understood in many different ways within society.

  19. Do patients "like" good care? measuring hospital quality via Facebook.

    Science.gov (United States)

    Timian, Alex; Rupcic, Sonia; Kachnowski, Stan; Luisi, Paloma

    2013-01-01

    With the growth of Facebook, public health researchers are exploring the platform's uses in health care. However, little research has examined the relationship between Facebook and traditional hospital quality measures. The authors conducted an exploratory quantitative analysis of hospitals' Facebook pages to assess whether Facebook "Likes" were associated with hospital quality and patient satisfaction. The 30-day mortality rates and patient recommendation rates were used to quantify hospital quality and patient satisfaction; these variables were correlated with Facebook data for 40 hospitals near New York, NY. The results showed that Facebook "Likes" have a strong negative association with 30-day mortality rates and are positively associated with patient recommendation. These exploratory findings suggest that the number of Facebook "Likes" for a hospital may serve as an indicator of hospital quality and patient satisfaction. These findings have implications for researchers and hospitals looking for a quick and widely available measure of these traditional indicators.

  20. Home Care Nursing Improves Cancer Symptom Management

    Science.gov (United States)

    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.

  1. Nutrition in Cancer Care (PDQ)

    Science.gov (United States)

    ... Surgery increases the body's need for nutrients and energy. The body needs extra energy and nutrients to ... the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest ...

  2. Music therapy in supportive cancer care.

    Science.gov (United States)

    Stanczyk, Malgorzata Monika

    2011-06-08

    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.

  3. Good practice in health care for migrants: views and experiences of care professionals in 16 European countries

    Directory of Open Access Journals (Sweden)

    Stankunas Mindaugas

    2011-03-01

    Full Text Available Abstract Background Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care. Methods Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240 were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis. Results Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different

  4. Hospice in Assisted Living: Promoting Good Quality Care at End of Life

    Science.gov (United States)

    Cartwright, Juliana C.; Miller, Lois; Volpin, Miriam

    2009-01-01

    Purpose: The purpose of this study was to describe good quality care at the end of life (EOL) for hospice-enrolled residents in assisted living facilities (ALFs). Design and Methods: A qualitative descriptive design was used to obtain detailed descriptions of EOL care provided by ALF medication aides, caregivers, nurses, and hospice nurses in…

  5. Good end-of-life care according to patients and their GPs.

    NARCIS (Netherlands)

    Borgsteede, S.D.; Graafland-Riedstra, C.; Deliens, L.; Francke, A.L.; Eijk, J.T.M. van; Willems, D.L.

    2006-01-01

    Background: Most patients prefer to die at home, where a GP provides end-of-life care. A few previous studies have been directed at the GPs' values on good end-of-life care, yet no study combined values of patients and their own GP. Aim: To explore the aspects valued by both patients and GPs in end-

  6. A good molecular target for prostate cancer chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Sidney R Grimes

    2011-01-01

    @@ An exciting new basic medical research study shows that inhibition of the activity of the kinesin spindle protein Eg5 effectively blocks cell division and induces cell death in prostate cancer cells.1 The potent anticancer drug S-(methoxytrityl)-L-cysteine(S(MeO)TLC)spe-cifically blocks activity of Eg5 in prostate cancer cells, arrests cell division, induces cell death during mitosis and inhibits prostate cancer cells in a mouse model of prostate cancer.

  7. Childhood cancer survivor care: development of the Passport for Care.

    Science.gov (United States)

    Poplack, David G; Fordis, Michael; Landier, Wendy; Bhatia, Smita; Hudson, Melissa M; Horowitz, Marc E

    2014-12-01

    Survivors of childhood cancer are at risk of long-term adverse effects and late effects of the disease and/or its treatment. In response to national recommendations to improve evidence-based follow-up care, a web-based support system for clinical decision making, the Passport for Care (PFC), was developed for use at the point of care to produce screening recommendations individualized to the survivor. To date, the PFC has been implemented in over half of the nearly 200 clinics affiliated with the Children's Oncology Group across the USA. Most clinician users report that the PFC has been integrated into clinic workflows, and that it fosters improved conversations with survivors about the potential late effects a survivor might experience and about the screening and/or behavioural interventions recommended to improve health status. Furthermore, clinicians using the PFC have indicated that they adhered more closely to follow-up care guidelines. Perspectives on the challenges encountered and lessons learned during the development and deployment of the PFC are reviewed and contrasted with other nationwide approaches to the provision of guidance on survivor follow-up care; furthermore, the implications for the care of childhood cancer survivors are discussed.

  8. Danish cancer patients’ perspective on health care

    DEFF Research Database (Denmark)

    Sandager, Mette; Sperling, Cecilie; Jensen, Henry;

    2015-01-01

    of the health care they have received, in regard to access to diagnostics, coordination and continuity of care, information and communication and involvement of patients and relatives. Questions and the opportunity to comment in free text were distributed to 6,720 newly diagnosed cancer patients in the summer...... for improvements with regard to better access to diagnostics, healthcare professionals’ responsiveness to patients, improved coordination and involvement of patient and relatives. There is a need to focus more on individual needs and patient-centered care.......Patient’s experiences and patient surveys are increasingly being used for the evaluation of the quality of health care. Patient information is valuable input when we aim to improve healthcare services. The aim of this study was to assess Danish cancer patients’ experiences and assessment...

  9. Taking good care of myself: a qualitative study on self-care behavior among Chinese persons with a permanent colostomy.

    Science.gov (United States)

    Tao, Hui; Songwathana, Praneed; Isaramalai, Sang-arun; Wang, Qingxi

    2014-12-01

    In Chinese culture, as a possible consequence of Confucianism, caring for the sick is considered a moral obligation of family members, while self-care is only the basis of fulfilling filial piety. This qualitative study aims to explore the self-care behavior among persons with a permanent colostomy in a Chinese cultural context of emphasizing the role of family caregiving. Data from in-depth interviews with seven Chinese adults at a university hospital in southwest China were analyzed using content analysis. Informants' self-care behavior was characterized by "taking good care of myself," which underlined individuals' efforts to manage colostomy-related impacts involving: (i) taking care of my colostomy with a proper degree of independence; (ii) taking care of my life by dealing with limitations; (iii) taking care of my mood in a positive way. Findings revealed that informants' self-care behavior was linked to their Confucian beliefs in family obligations, and also influenced by a happy-go-lucky outlook of life, a likely product of Taoism. The information is useful for nurses to design a culturally appropriate care plan to improve self-care behavior and proper family caregiving.

  10. In palliative cancer care symptoms mean everything

    NARCIS (Netherlands)

    Teunissen, S.C.C.M.

    2007-01-01

    The thesis aims to provide deeper insight into symptoms of cancer patients in palliative care, in order to improve the adequacy of decision-making for optimizing symptom control. Several aspects of symptoms and symptom management were investigated as were some aspects of communication and consultati

  11. Personal autonomy, good care, informed consent and human dignity--some reflections from a European perspective.

    Science.gov (United States)

    Hendriks, Aart

    2009-09-01

    Respecting and protecting personal autonomy requires that autonomy is interpreted in conjunction with the principle of good care in a way consistent with (the aspirations enshrined in) human dignity. This leads to a principled and relational approach towards personal autonomy. This implies an active role of health care providers, as councillors of patients, and a personalised way of obtaining informed consent, to maximally ensure the enjoying personal autonomy.

  12. Goodness-of-Fit in Center Day Care: Relations of Temperament, Stability, and Quality of Care with the Child's Adjustment

    Science.gov (United States)

    De Schipper, J. Clasien; Tavecchio, Louis W. C.; Van IJzendoorn, Marinus H.; Van Zeijl, Jantien

    2004-01-01

    In this study, the concept of "goodness-of-fit" between the child's temperament and the environment, introduced by Thomas and Chess [Temperament and Development, Brunner/Mazel, New York, 1977], is applied within the setting of center day care. Mothers and primary professional caregivers of 186 children, aged 6-30 months, participated in this…

  13. MARKET RESEARCH OF CARE GOODS FOR NEWBORNS AND FIRST YEAR CHILDREN

    Directory of Open Access Journals (Sweden)

    A. I. Ovod

    2015-01-01

    Full Text Available Comparative results of marketing research of care goods for newborns and first year children conducted in 2009 and 2014 showed that there were changes in the range of products and consumer preferences. The analysis revealed that the economic situation affected the determinants of choice in this category of goods and the location of purchasing. The findings should be considered by pharmaceutical companies in their procurement in order to improve their competitive position. 

  14. Governing Ideals of Good Care: Quality improvement in mental health care

    NARCIS (Netherlands)

    T. Broer (Tineke)

    2012-01-01

    textabstractIn the spring of 2008 I attended a conference on the use of coercion in mental health care. A healthcare worker who was also a “practicing patient”, as the program told us, held an impressive lecture that captured the audience from the moment the woman walked to the front. She referred t

  15. Repaving the Road of Good Intentions: LGBT Health Care and the Queer Bioethical Lens.

    Science.gov (United States)

    Wahlert, Lance; Fiester, Autumn

    2014-09-01

    As the saying goes, "The road to hell is paved with good intentions." And in the recent burst of clinical attention being paid to the needs of lesbian, gay, bisexual, and transgender patients, good intentions abound. But while this long-overdue interest in LGBT health care aims to highlight important gaps and bring into relief serious issues in health care delivery for LGBT persons, such work can inadvertently reinforce both the marginalization of sexual minorities and the cultural norms related to sexuality, gender identity, and the conventional family. To ensure that positive outcomes for LGBT patients are inextricably paired with those noble intentions, we advocate for a new, queer bioethics-a methodology of scholastic, bioethical, and critical scrutiny that not only addresses the needs of LGBT persons in health care settings but also considers the perspectives, histories, and feelings of such parties.

  16. Taking personal responsibility: Nurses' and assistant nurses' experiences of good nursing practice in psychiatric inpatient care.

    Science.gov (United States)

    Gabrielsson, Sebastian; Sävenstedt, Stefan; Olsson, Malin

    2016-10-01

    Therapeutic nurse-patient relationships are considered essential for good nursing practice in psychiatric inpatient care. Previous research suggests that inpatient care fails to fulfil patients' expectations in this regard, and that nurses might experience the reality of inpatient care as an obstruction. The aim of the present study was to explore nurses' and assistant nurses' experiences of good nursing practice in the specific context of psychiatric inpatient care. Qualitative interviews were conducted with 12 skilled, relationship-oriented nurses and assistant nurses in order to explore their experiences with nursing practice related to psychiatric inpatient care. Interviews were transcribed and analysed using an interpretive descriptive approach. Findings describe good nursing practice as a matter of nurses and assistant nurses taking personal responsibility for their actions and for the individual patient as a person. Difficulties in providing dignified nursing care and taking personal responsibility cause them to experience feelings of distress and frustration. Shared values and nursing leadership supports being moral and treating patients with respect, having enough time supports being present and connecting with patients, and working as a part of a competent team with critical daily discussions and diversity supports being confident and building trust. The findings suggest that taking personal responsibility is integral to good nursing practice. If unable to improve poor circumstances, nurses might be forced to promote their own survival by refuting or redefining their responsibility. Nurses need to prioritize being with patients and gain support in shaping their own nursing practice. Nursing leadership should provide moral direction and defend humanistic values.

  17. Cultural aspects of communication in cancer care.

    Science.gov (United States)

    Surbone, Antonella

    2008-03-01

    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.

  18. Tocotrienols are good adjuvants for developing cancer vaccines

    Directory of Open Access Journals (Sweden)

    Radhakrishnan Ammu

    2010-01-01

    Full Text Available Abstract Background Dendritic cells (DCs have the potential for cancer immunotherapy due to their ability to process and present antigens to T-cells and also in stimulating immune responses. However, DC-based vaccines have only exhibited minimal effectiveness against established tumours in mice and humans. The use of appropriate adjuvant enhances the efficacy of DC based cancer vaccines in treating tumours. Methods In this study we have used tocotrienol-rich fraction (TRF, a non-toxic natural compound, as an adjuvant to enhance the effectiveness of DC vaccines in treating mouse mammary cancers. In the mouse model, six-week-old female BALB/c mice were injected subcutaneously with DC and supplemented with oral TRF daily (DC+TRF and DC pulsed with tumour lysate from 4T1 cells (DC+TL. Experimental mice were also injected with DC pulsed with tumour lysate and supplemented daily with oral TRF (DC+TL+TRF while two groups of animal which were supplemented daily with carrier oil (control and with TRF (TRF. After three times vaccination, mice were inoculated with 4T1 cells in the mammary breast pad to induce tumour. Results Our study showed that TRF in combination with DC pulsed with tumour lysate (DC+TL+TRF injected subcutaneously significantly inhibited the growth of 4T1 mammary tumour cells as compared to control group. Analysis of cytokines production from murine splenocytes showed significant increased productions of IFN-γ and IL-12 in experimental mice (DC+TL+TRF compared to control, mice injected with DC without TRF, mice injected with DC pulsed with tumour lysate and mice supplemented with TRF alone. Higher numbers of cytotoxic T cells (CD8 and natural killer cells (NK were observed in the peripheral blood of TRF adjuvanted DC pulsed tumour lysate mice. Conclusion Our study show that TRF has the potential to be an adjuvant to augment DC based immunotherapy.

  19. “Like a Dance”: Performing Good Care for Persons with Dementia Living in Institutions

    Directory of Open Access Journals (Sweden)

    Kristin Mjelde Helleberg

    2014-01-01

    Full Text Available Dementia care is demanding, and health care workers can become emotionally exhausted and frustrated. Particularly, demanding aspects of dementia care include patient agitation and care-resistant behaviour. The aim of this study is to describe skilled staff’s understanding of high-quality praxis in dementia care units in nursing homes. Eight nurses and care workers were individually interviewed, and a qualitative design was used. Participants were recruited from two nursing homes in two towns in eastern Norway. The data were analysed following the hermeneutic tradition inspired by Kvale. The analyses revealed three main findings describing good care: (a to find: to identify the patient’s personal characteristics, state, and needs, (b to follow: to choose the right time and the tempo and to adapt to the patient’s sensitivity, and (c to lead: to be in the forefront and prepared and to change the patient’s state. An overall interpretation of the findings is described by the metaphor of a dance between the patient and the caregiver.

  20. Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care

    Science.gov (United States)

    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.

  1. [Quality of life and supportive care in head and neck cancers].

    Science.gov (United States)

    Babin, Emmanuel; Heutte, Natacha; Grandazzi, Guillaume; Prévost, Virginie; Robard, Laetitia

    2014-05-01

    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.

  2. The patient's perspective of the quality of breast cancer care: the developement of an instrument to measure quality of care through focus groups and concept mapping with breast cancer patients.

    NARCIS (Netherlands)

    Kok, M. de; Scholte, R.W.; Sixma, H.J.; Weijden, T. van der; Spijkers, K.F.; Velde, C.J.H. van de; Roukema, J.A.; Ent, F.W. van der; Bell, A.V.R.J.; Meyenfeldt, M.F. von

    2007-01-01

    Quality of care is often described by professionals. However, in this study breast cancer patients participated in developing an instrument that reflects quality of care from the patient's perspective. Through focus groups and concept mapping patients' ideas on determinants of good quality of care w

  3. Determinants of increased primary health care use in cancer survivors.

    NARCIS (Netherlands)

    Heins, M.; Schellevis, F.; Rijken, M.; Hoek, L. van der; Korevaar, J.

    2012-01-01

    Purpose: The number of cancer survivors is increasing, and patients with cancer often experience long-lasting consequences of cancer and its treatment. Because of the variety of health problems and high prevalence of comorbidity, primary care physicians (PCPs) seem obvious candidates to take care of

  4. Palliative care for cancer patients in a primary health care setting:Bereaved relatives' experience, a qualitative group interview study

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde;

    2008-01-01

    Background: Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primar...... improvement and attention should be drawn to the "professionalization" of the relatives and the need to strike a balance between their needs, wishes and resources in end-of-life care and bereavement.......Background: Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary...... care setting to explore barriers and facilitators for delivery of good palliative home care. Methods: Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results: Three main categories of experience were identified: 1) The health professionals' management, where...

  5. Quality and Safety in Health Care, Part IV: Quality and Cancer Care.

    Science.gov (United States)

    Harolds, Jay A

    2015-11-01

    The 1999 Institute of Medicine report Ensuring Quality Cancer Care discussed the difference between the actual cancer care received in the United States and the care that the patients should get, as well as some points to consider in delivering optimum care. In 2012, a follow-up review article in the journal Cancer entitled "Ensuring quality cancer care" indicated that there had been some interval progress, but more are needed to be done. The 2013 Institute of Medicine report Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis indicated that there are continuing major problems with cancer care and that they advocated a national system of quality reporting and a major information technology system to capture and help assess the data.

  6. The European initiative for quality management in lung cancer care.

    Science.gov (United States)

    Blum, Torsten G; Rich, Anna; Baldwin, David; Beckett, Paul; De Ruysscher, Dirk; Faivre-Finn, Corinne; Gaga, Mina; Gamarra, Fernando; Grigoriu, Bogdan; Hansen, Niels C G; Hubbard, Richard; Huber, Rudolf Maria; Jakobsen, Erik; Jovanovic, Dragana; Konsoulova, Assia; Kollmeier, Jens; Massard, Gilbert; McPhelim, John; Meert, Anne-Pascale; Milroy, Robert; Paesmans, Marianne; Peake, Mick; Putora, Paul-Martin; Scherpereel, Arnaud; Schönfeld, Nicolas; Sitter, Helmut; Skaug, Knut; Spiro, Stephen; Strand, Trond-Eirik; Taright, Samya; Thomas, Michael; van Schil, Paul E; Vansteenkiste, Johan F; Wiewrodt, Rainer; Sculier, Jean-Paul

    2014-05-01

    Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe.

  7. The European initiative for quality management in lung cancer care

    DEFF Research Database (Denmark)

    Blum, Torsten G; Rich, Anna; Baldwin, David

    2014-01-01

    . The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility...... study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide...... countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe....

  8. Mind-body practices in cancer care.

    Science.gov (United States)

    Chaoul, Alejandro; Milbury, Kathrin; Sood, Anil K; Prinsloo, Sarah; Cohen, Lorenzo

    2014-12-01

    Being diagnosed with a life-threatening disease such as cancer and undergoing treatment can cause unwanted distress and interferes with quality of life. Uncontrolled stress can have a negative effect on a number of biological systems and processes leading to negative health outcomes. While some distress is normal, it is not benign and must be addressed, as failure to do so may compromise health and QOL outcomes. We present the evidence for the role of stress in cancer biology and mechanisms demonstrating how distress is associated with worse clinical outcomes. The National Comprehensive Cancer Network states that all patients be screened with the single-item distress thermometer and to also indicate the source of distress and to get appropriate referral. In addition to the many conventional approaches for managing distress from the fields of psychology and psychiatry, many patients are seeking strategies to manage their distress that are outside conventional medicine such as mind-body techniques. Mind-body techniques such as meditation, yoga, tai chi, and qigong have been found to lower distress and lead to improvements in different aspects of quality of life. It is essential that the standard of care in oncology include distress screening and the delivery of different techniques to help patients manage the psychosocial challenges of diagnosis and treatment of cancer.

  9. Could a Computer Someday Guide Breast Cancer Care?

    Science.gov (United States)

    ... medlineplus.gov/news/fullstory_162465.html Could a Computer Someday Guide Breast Cancer Care? 'Watson Oncology' agreed ... Dec. 9, 2016 (HealthDay News) -- An artificially intelligent computer system is making breast cancer treatment recommendations on ...

  10. Trajectories of personal control in cancer patients receiving psychological care

    NARCIS (Netherlands)

    Zhu, Lei; Schroevers, Maya J.; van der Lee, Marije; Garssen, Bert; Stewart, Roy E.; Sanderman, Robbert; Ranchor, Adelita V.

    2015-01-01

    Objective: This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential pattern

  11. Trajectories of personal control in cancer patients receiving psychological care

    NARCIS (Netherlands)

    Zhu, Lei; Schroevers, Maya J.; Lee, van der Marije; Garssen, Bert; Stewart, Roy E.; Sanderman, R.; Ranchor, A.V.

    2015-01-01

    Objective This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential patterns

  12. Why Good Quality Care Needs Philosophy More Than Compassion: Comment on "Why and How Is Compassion Necessary to Provide Good Quality Healthcare?".

    Science.gov (United States)

    Leget, Carlo

    2015-06-30

    Although Marianna Fotaki's Editorial is helpful and challenging by looking at both the professional and institutional requirements for reinstalling compassion in order to aim for good quality healthcare, the causes that hinder this development remain unexamined. In this commentary, 3 causes are discussed; the boundary between the moral and the political; Neoliberalism; and the underdevelopment of reflection on the nature of care. A plea is made for more philosophical reflection on the nature of care and its implications in healthcare education.

  13. Bicalutamide 150 mg plus standard care vs standard care alone for early prostate cancer

    DEFF Research Database (Denmark)

    McLeod, David G; Iversen, Peter; See, William A;

    2006-01-01

    To evaluate, in the ongoing Early Prostate Cancer (EPC) trial programme, the efficacy and tolerability of bicalutamide 150 mg once daily in addition to standard care for localized or locally advanced, nonmetastatic prostate cancer....

  14. Representing and intervening: 'doing' good care in first trimester prenatal knowledge production and decision-making

    DEFF Research Database (Denmark)

    Schwennesen, Nete; Koch, Lene

    2012-01-01

    attention to the active engagement of health professionals in this process. Current professional and policy debate over the use of prenatal testing emphasises the need for informed choice making and for services that provide prospective parents with what is referred to as 'non-directive counselling...... modes of 'doing' good care: attuning expectations and knowledge, allowing resistance and providing situated influence in the relationship between the pregnant woman and the professional. Such practices may not be seen as immediately compatible with the non-directive ethos, but they express ways...... of reducing emotional suffering and supporting a pregnant woman's ability to make meaningful choices on the basis of uncertain knowledge. As such, these practices can be seen as representing another (caring) solution to the problem of paternalism and authoritarian power. In opposition to an ethics aiming...

  15. Palliative care for cancer patients in a primary health care setting: Bereaved relatives' experience, a qualitative group interview study

    Directory of Open Access Journals (Sweden)

    Jensen Anders

    2008-01-01

    Full Text Available Abstract Background Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary care setting to explore barriers and facilitators for delivery of good palliative home care. Methods Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results Three main categories of experience were identified: 1 The health professionals' management, where a need to optimize was found. 2 Shared care, which was lacking. 3 The relatives' role, which needs an extra focus. Conclusion Relatives experience insufficient palliative care mainly due to organizational and cultural problems among professionals. Palliative care in primary care in general needs improvement and attention should be drawn to the "professionalization" of the relatives and the need to strike a balance between their needs, wishes and resources in end-of-life care and bereavement.

  16. Integration of early specialist palliative care in cancer care: Survey of oncologists, oncology nurses, and patients

    Directory of Open Access Journals (Sweden)

    Naveen Salins

    2016-01-01

    Conclusion: Oncologists, oncology nurses, and patients felt that integration of early specialist palliative care in cancer improves symptom control, end-of-life care, health-related communication, and continuity of care. The perceptions of benefit of the palliative care intervention in the components surveyed, differed among the three groups.

  17. Primary care for young adult cancer survivors: an international perspective.

    NARCIS (Netherlands)

    Holge-Hazelton, B.; Blake-Gumbs, L.; Miedema, B.; Rijswijk, E. van

    2010-01-01

    PURPOSE: Internationally, family physicians (FP) are not routinely involved in young adult cancer (YAC) care. In this short report, we would like to make a compelling argument for primary care involvement. METHODS: Comparative descriptions and literature review. RESULTS: Cancer among YAs is rare and

  18. Challenges in volunteering from cancer care volunteers perspectives.

    Science.gov (United States)

    Kamaludin, Kauthar Mohamad; Muhammad, Mazanah; Wahat, Nor Wahiza Abdul; Ibrahim, Rahimah

    2013-01-01

    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.

  19. Diet and Nutrition in Cancer Survivorship and Palliative Care

    Directory of Open Access Journals (Sweden)

    Anthony J. Bazzan

    2013-01-01

    Full Text Available The primary goal of palliative cancer care is typically to relieve suffering and improve quality of life. Most approaches to diet in this setting have focused only on eating as many calories as possible to avoid cachexia. However, as the concept of palliative care has evolved to include all aspects of cancer survivorship and not just end of life care, there is an increasing need to thoughtfully consider diet and nutrition approaches that can impact not only quality of life but overall health outcomes and perhaps even positively affect cancer recurrence and progression. In this regard, there has been a recent emphasis in the literature on nutrition and cancer as an important factor in both quality of life and in the pathophysiology of cancer. Hence, the primary purpose of this paper is to review the current data on diet and nutrition as it pertains to a wide range of cancer patients in the palliative care setting.

  20. Caring for Patients with Advanced Breast Cancer: The Experiences of Zambian Nurses

    Science.gov (United States)

    Maree, Johanna Elizabeth; Mulonda, Jennipher Kombe

    2017-01-01

    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

  1. Living on Hold in Palliative Cancer Care

    Directory of Open Access Journals (Sweden)

    Anna Sandgren, RN, M.Sc.N., Ph.D. Student

    2010-02-01

    Full Text Available The aim of this study was to develop a classic grounded theory of palliative cancer patients and their relatives in the context of home care. We analyzed interviews and data related to the behaviour of both patients and relatives. “Living on hold” emerged as the pattern of behaviour through which the patients and relatives deal with their main concern, being put on hold. Living on Hold involves three modes: Fighting, Adjusting and Surrendering. Mode being may change during a trajectory depending on many different factors. There are also different triggers that can start a reconciling process leading to a change of mode. This means that patients and relatives can either be in the same mode or in different modes simultaneously. More or less synchronous modes may lead to problems and conflicts within the family, or with the health professionals.

  2. Hyperprolactinemic breast cancer in radiooncologic care

    Energy Technology Data Exchange (ETDEWEB)

    Schlegel, G.; Luethgens, M.; Schoen, H.D.

    1986-02-01

    Serum prolactin has been determined in 334 patients with breast cancer within the radiooncologic care. In addition 54 healthy female blood donors were analysed as controls. Values above 600 mU/l were called hyperprolactinemic. 15% of the patients showed elevated prolactin levels, 25% of which coincided with recurrent disease. Preoperative evaluation of prolactin in combination with TPA and CEA may be an aid in selecting a special group of patients with poor prognosis. Following 31 patients under therapy it could be demonstrated that any successful treatment modality leads to a normalization of elevated prolactin levels. In refractory cases addition of bromocriptine may be effective. Furthermore, drug induced hyperprolactinemia ought to be treated.

  3. Primary care physicians' cancer screening recommendation practices and perceptions of cancer risk of Asian Americans.

    Science.gov (United States)

    Kwon, Harry T; Ma, Grace X; Gold, Robert S; Atkinson, Nancy L; Wang, Min Qi

    2013-01-01

    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.

  4. Information communication technology: new approach for rural cancer care improvement.

    Science.gov (United States)

    Maserat, Elham

    2008-01-01

    Cancer control aims to reduce the incidence, morbidity, and mortality of cancer and to improve the quality of life of cancer patients. For rural populations this presents particular problems. This article covers challenges of oncology care in rural areas and solutions via applying information communication technology with specialty telemedicine for overcoming problems in prevention, early diagnosis, treatment, and palliative care. In addition, telecommunications infrastructures and frameworks for implementation of telemedicine are described.

  5. Scientific Evidence on the Supportive Cancer Care with Chinese Medicine

    Directory of Open Access Journals (Sweden)

    William CS CHO

    2010-03-01

    Full Text Available Complementary and alternative medicine has been increasingly utilized by cancer patients in developed countries. Among the various forms of complementary and alternative medicine, Traditional Chinese Medicine is one of the few that has a well constructed theoretical framework and established treatment approaches for diseases including cancer. Recent research has revealed growing evidence suggesting that Traditional Chinese Medicine is effective in the supportive care of cancer patients during and after major conventional cancer treatments. This paper succinctly summarizes some published clinical evidence and meta-analyses which support the usage of various Traditional Chinese Medicine treatment strategies including Chinese herbal medicine, acupuncture and Qigong in supportive cancer care.

  6. Patterns of cancer occurrence in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Atla Bhagyalakshmi

    2016-06-01

    Conclusions: The current study mainly summarizes the different patterns of cancer incidence in the tertiary care centre region. Cancer incidence is increasing gradually among the population and there is raise of cancer incidence in females compared to their counterparts. [Int J Res Med Sci 2016; 4(6.000: 2153-2163

  7. Palliative care in cancer: managing patients' expectations.

    Science.gov (United States)

    Ghandourh, Wsam A

    2016-12-01

    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.

  8. Integrating palliative care into the trajectory of cancer care.

    Science.gov (United States)

    Hui, David; Bruera, Eduardo

    2016-03-01

    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, illness understanding, 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 also discuss how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available.

  9. Docetaxel rechallenge after an initial good response in patients with metastatic castration-resistant prostate cancer

    DEFF Research Database (Denmark)

    Oudard, Stéphane; Kramer, Gero; Caffo, Orazio

    2015-01-01

    OBJECTIVE: To evaluate the benefit of docetaxel rechallenge in patients with metastatic castration-resistant prostate cancer (mCRPC) relapsing after an initial good response to first-line docetaxel. PATIENTS AND METHODS: We retrospectively reviewed the records of consecutive patients with mCRPC w...

  10. How can we deliver high-quality cancer care in a healthcare system in crisis?

    Science.gov (United States)

    Mayer, Deborah K

    2014-08-01

    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.

  11. The Surgical Care Improvement Project Antibiotic Guidelines: Should We Expect More Than Good Intentions?

    Science.gov (United States)

    Schonberger, Robert B; Barash, Paul G; Lagasse, Robert S

    2015-08-01

    Since 2006, the Surgical Care Improvement Project (SCIP) has promoted 3 perioperative antibiotic recommendations designed to reduce the incidence of surgical site infections. Despite good evidence for the efficacy of these recommendations, the efforts of SCIP have not measurably improved the rates of surgical site infections. We offer 3 arguments as to why SCIP has fallen short of expectations. We then suggest a reorientation of quality improvement efforts to focus less on reporting, and incentivizing adherence to imperfect metrics, and more on creating local and regional quality collaboratives to educate clinicians about how to improve practice. Ultimately, successful quality improvement projects are behavioral interventions that will only succeed to the degree that they motivate individual clinicians, practicing within a particular context, to do the difficult work of identifying failures and iteratively working toward excellence.

  12. Caring for cancer patients on non-specialist wards.

    LENUS (Irish Health Repository)

    Gill, Finola

    2012-02-01

    As cancer is the leading cause of death worldwide, every nurse will be required to care for patients with the condition at some point in his\\/her career. However, non-specialized oncology nurses are often ill-prepared to nurse patients suffering from cancer. This literature review aims to provide an overview of current trends and developments in cancer care nursing in an attempt to identify the range of previous research pertaining to caring for patients with cancer on non-specialist wards. The review finds that non-specialized cancer nurses report a lack of education and training with regard to cancer care and cancer treatments, which acts as a barrier to providing quality nursing care. Emotional and communication issues with patients and their families can also cause non-specialist nurses significant distress. International research has shown that specialist oncology nurses make a considerable difference to physical and psychosocial patient care. It is therefore paramount that non-speciality nurses\\' educational needs are met to develop clinical competence and to provide supportive holistic care for both patients and their families.

  13. Palliative nursing care for children and adolescents with cancer

    Directory of Open Access Journals (Sweden)

    Gilmer MJ

    2012-06-01

    Full Text Available Terrah L Foster,1,2 Cynthia J Bell,1 Carey F McDonald,2 Joy S Harris,3 Mary Jo Gilmer,1,21Vanderbilt University School of Nursing, Nashville, 2Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, 3Vanderbilt University, Nashville, TN, USAAbstract: Pediatric palliative care aims to enhance life and decrease suffering of children and adolescents living with life-threatening conditions and their loved ones. Oncology nurses are instrumental in providing palliative care to pediatric oncology populations. This paper describes pediatric palliative care and provides an overview of literature related to the physical, psychological, social, and spiritual domains of palliative nursing care for children and adolescents with cancer. Nurses can provide optimal palliative care by accounting for children's understanding of death, encouraging early initiation of palliative care services, and improving utilization of pediatric palliative care in cancer settings. Specific roles of registered nurses and advanced practice nurses in pediatric palliative care will be addressed. Recommendations for future research are made to further advance the science of pediatric palliative care and decrease suffering for children and teens with cancer.Keywords: pediatric palliative care, pediatric cancer, oncology, child, suffering

  14. Racial and Ethnic Differences in Beliefs About Lung Cancer Care

    Science.gov (United States)

    Jonnalagadda, Sirisha; Lin, Jenny J.; Nelson, Judith E.; Powell, Charles A.; Salazar-Schicchi, John; Berman, Andrew R.; Keller, Steven M.; Smith, Cardinale B.; Lurslurchachai, Linda; Halm, Ethan A.; Leventhal, Howard

    2012-01-01

    Background: Disparities in lung cancer treatment and palliative care are well documented. However, the mechanisms underlying these disparities are not fully understood. In this study, we evaluated racial and ethnic differences in beliefs and attitudes about lung cancer treatment and palliative care among patients receiving a new diagnosis of lung cancer. Methods: Patients were recruited from four medical centers in New York City and surveyed about their beliefs regarding lung cancer care, including disease-directed treatments, palliative and end-of-life care, and fatalistic and spiritual beliefs. We used univariate and multiple regression analyses to compare the distribution of beliefs among minority (black and Hispanic) and nonminority patients. Results: Of the 335 patients, 21% were black, 20% were Hispanic, and 59% were nonminority. Beliefs about chemotherapy and radiotherapy were similar across the three groups (P > .05), whereas black patients were more likely to believe that surgery might cause lung cancer to spread (P = .008). Fatalistic beliefs potentially affecting cancer treatment were more common among both minority groups (P ≤ .02). No significant differences were found in attitudes toward clinician communication about cancer prognosis (P > .05). However, both blacks and Hispanics were more likely to have misconceptions about advance directives and hospice care (P ≤ .02). Conclusions: Similarities and differences in beliefs about disease-directed treatment were observed between minority and nonminority patients with lung cancer. Minority patients hold more fatalistic views about the disease and misperceptions about advance care planning and hospice care. Further research is needed to assess the impact of these beliefs on decisions about lung cancer care and patient outcomes. PMID:22700777

  15. Palliative care in castrate-resistant prostate cancer.

    Science.gov (United States)

    Rabow, Michael W; Lee, Michael Xiang

    2012-11-01

    Significant symptoms and suffering related to castrate-resistant prostate cancer (CRPC) are associated with the disease and its treatment. Increasingly, with advances in treatment efficacy, men can live with symptoms for long periods. Interdisciplinary palliative care teams (including physicians, nurses, social workers, chaplains, pharmacists, psychologists, physical therapists, and nutritionists) focused on symptom management and patients' goals of care can collaborate with prostate cancer surgeons, oncologists, and radiation oncologists to provide the best care for men at all stages of treatment, including end of life. This article reviews the benefits of palliative care in helping patients with CRPC manage symptoms and distress.

  16. The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality.

    Science.gov (United States)

    Fennell, Mary L; Das, Irene Prabhu; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew

    2010-01-01

    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.

  17. Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians.

    Science.gov (United States)

    Klabunde, C N; Haggstrom, D; Kahn, K L; Gray, S W; Kim, B; Liu, B; Eisenstein, J; Keating, N L

    2017-01-10

    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.

  18. Corruption in health-care systems and its effect on cancer care in Africa.

    Science.gov (United States)

    Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan

    2015-08-01

    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.

  19. Impact of Chronic Conditions on the Cost of Cancer Care...

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in Impact of Chronic Conditions on the Cost of Cancer Care for Medicaid Beneficiaries, published in Volume 2, Issue 4 of the Medicare...

  20. [Palliative care to adolescents with cancer: a literature review].

    Science.gov (United States)

    Remedi, Patrícia Pereira; Mello, Débora Faleiros de; Menossi, Maria José; Lima, Regina Aparecida Garcia de

    2009-01-01

    Providing care to adolescents with cancer in the process of death and dying has been a great challenge for health professionals. This challenge is marked by a high emotional burden and specificities of this stage of human development. The purpose of the present study was to review the scientific literature regarding palliative care to adolescents with cancer. This study is a literature review, which data collection was performed using Lilacs, Medline, and PsycInfo, in addition to non-systematic databases. An analysis of the manuscripts revealed three themes: adolescence and its different definitions; the particularities of adolescents with cancer; and palliative care to adolescents with cancer. The study showed there is a scarcity of evidenced-based research defining the panorama of symptoms affecting the quality of life during palliative care and an absence of specific programs in the stage of fast changes that, alone, demand for adaptive efforts.

  1. The nursing contribution to nutritional care in cancer cachexia.

    Science.gov (United States)

    Hopkinson, Jane B

    2015-11-01

    Cancer cachexia is a complex syndrome. Its defining feature is involuntary weight loss, which arises, in part, because of muscle atrophy and is accompanied by functional decline. International expert consensus recommends that nutritional support and counselling is a component of multimodal therapy for cancer cachexia, as poor nutritional intake can contribute to progression of the syndrome. The present paper focuses on what is presently known about the nursing contribution to nutritional care in cancer cachexia. There is potential for nurses to play an important role. However, obstacles to this include lack of a robust evidence base to support their nutritional care practices and unmet need for education about nutrition in cancer. The nursing role's boundaries and the outcomes of nurse-delivered nutritional care in cancer cachexia are both uncertain and should be investigated.

  2. Recovery-oriented care in a secure mental health setting: "striving for a good life".

    Science.gov (United States)

    McKenna, Brian; Furness, Trentham; Dhital, Deepa; Park, Malcolm; Connally, Fiona

    2014-01-01

    Recovery-oriented care acknowledges the unique journey of the consumer to regain control of his or her life in order to live a good life. Recovery has become a dominant policy-directed model of mental health service delivery. Even services that have traditionally been institutional and custodial have been challenged to embrace a recovery-oriented model. The aim of this qualitative study was to provide a description of service delivery in a secure in-patient mental health service, which has developed a self-professed recovery-oriented model of service delivery. An in-depth case study of the secure in-patient service using an exploratory research design was undertaken to meet the aim of this study. Qualitative data was gathered from interviews with consumers and staff (n = 15) and a focus group with carers (n = 5). Data were analyzed using a content analysis approach. Ethical approval for the study was obtained. The stakeholders readily described the secure service within recovery domains. They described a common vision; ways to promote hope and autonomy; examples of collaborative partnership which enhanced the goal of community integration; a focus on strength-based, holistic care; and the management of risk by taking calculated risks. Discrepancies in the perceptions of stakeholders were determined. This case study research provides a demonstrable example of recovery-in-action in one secure mental health service in Australia. It is intended to assist mental health services and clinicians seeking guidance in developing strategies for building and maintaining partnerships with consumers and carers in order for secure services to become truly recovery-oriented.

  3. Chinese Herbal Medicine for Symptom Management in Cancer Palliative Care

    OpenAIRE

    2016-01-01

    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 comb...

  4. Multiple Criteria Decision Analysis for Health Care Decision Making--Emerging Good Practices: Report 2 of the ISPOR MCDA Emerging Good Practices Task Force.

    Science.gov (United States)

    Marsh, Kevin; IJzerman, Maarten; Thokala, Praveen; Baltussen, Rob; Boysen, Meindert; Kaló, Zoltán; Lönngren, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Devlin, Nancy

    2016-01-01

    Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making. A set of techniques, known under the collective heading, multiple criteria decision analysis (MCDA), are useful for this purpose. In 2014, ISPOR established an Emerging Good Practices Task Force. The task force's first report defined MCDA, provided examples of its use in health care, described the key steps, and provided an overview of the principal methods of MCDA. This second task force report provides emerging good-practice guidance on the implementation of MCDA to support health care decisions. The report includes: a checklist to support the design, implementation and review of an MCDA; guidance to support the implementation of the checklist; the order in which the steps should be implemented; illustrates how to incorporate budget constraints into an MCDA; provides an overview of the skills and resources, including available software, required to implement MCDA; and future research directions.

  5. NCCN Task Force Report: Bone Health In Cancer Care.

    Science.gov (United States)

    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

    2013-08-01

    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.

  6. Developing a service model that integrates palliative care throughout cancer care: the time is now.

    Science.gov (United States)

    Partridge, Ann H; Seah, Davinia S E; King, Tari; Leighl, Natasha B; Hauke, Ralph; Wollins, Dana S; Von Roenn, Jamie Hayden

    2014-10-10

    Palliative care is a fundamental component of cancer care. As part of the 2011 to 2012 Leadership Development Program (LDP) of the American Society of Clinical Oncology (ASCO), a group of participants was charged with advising ASCO on how to develop a service model integrating palliative care throughout the continuum of cancer care. This article presents the findings of the LDP group. The group focused on the process of palliative care delivery in the oncology setting. We identified key elements for models of palliative care in various settings to be potentially equitable, sustainable, feasible, and acceptable, and here we describe a dynamic model for the integrated, simultaneous implementation of palliative care into oncology practice. We also discuss critical considerations to better integrate palliative care into oncology, including raising consciousness and educating both providers and the public about the importance of palliative care; coordinating palliative care efforts through strengthening affiliations and/or developing new partnerships; prospectively evaluating the impact of palliative care on patient and provider satisfaction, quality improvement, and cost savings; and ensuring sustainability through adequate reimbursement and incentives, including linkage of performance data to quality indicators, and coordination with training efforts and maintenance of certification requirements for providers. In light of these findings, we believe the confluence of increasing importance of incorporation of palliative care education in oncology education, emphasis on value-based care, growing use of technology, and potential cost savings makes developing and incorporating palliative care into current service models a meaningful goal.

  7. Gene expression signature in organized and growth arrested mammaryacini predicts good outcome in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fournier, Marcia V.; Martin, Katherine J.; Kenny, Paraic A.; Xhaja, Kris; Bosch, Irene; Yaswen, Paul; Bissell, Mina J.

    2006-02-08

    To understand how non-malignant human mammary epithelial cells (HMEC) transit from a disorganized proliferating to an organized growth arrested state, and to relate this process to the changes that occur in breast cancer, we studied gene expression changes in non-malignant HMEC grown in three-dimensional cultures, and in a previously published panel of microarray data for 295 breast cancer samples. We hypothesized that the gene expression pattern of organized and growth arrested mammary acini would share similarities with breast tumors with good prognoses. Using Affymetrix HG-U133A microarrays, we analyzed the expression of 22,283 gene transcripts in two HMEC cell lines, 184 (finite life span) and HMT3522 S1 (immortal non-malignant), on successive days post-seeding in a laminin-rich extracellular matrix assay. Both HMECs underwent growth arrest in G0/G1 and differentiated into polarized acini between days 5 and 7. We identified gene expression changes with the same temporal pattern in both lines. We show that genes that are significantly lower in the organized, growth arrested HMEC than in their proliferating counterparts can be used to classify breast cancer patients into poor and good prognosis groups with high accuracy. This study represents a novel unsupervised approach to identifying breast cancer markers that may be of use clinically.

  8. Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management.

    Science.gov (United States)

    Lawn, Sharon; Delany, Toni; Sweet, Linda; Battersby, Malcolm; Skinner, Timothy

    2015-01-01

    Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations.

  9. Integration of palliative medicine into comprehensive cancer care.

    Science.gov (United States)

    Lagman, Ruth; Walsh, Declan

    2005-04-01

    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.

  10. Supportive and Palliative Care Research | Division of Cancer Prevention

    Science.gov (United States)

    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.

  11. Palliative and hospice care in gynecologic cancer: a review.

    Science.gov (United States)

    Lopez-Acevedo, Micael; Lowery, William J; Lowery, Ashlei W; Lee, Paula S; Havrilesky, Laura J

    2013-10-01

    Despite the increasing availability of palliative care, oncology providers often misunderstand and underutilize these resources. The goals of palliative care are relief of suffering and provision of the best possible quality of life for both the patient and her family, regardless of where she is in the natural history of her disease. Lack of understanding and awareness of the services provided by palliative care physicians underlie barriers to referral. Oncologic providers spend a significant amount of time palliating the symptoms of cancer and its treatment; involvement of specialty palliative care providers can assist in managing the complex patient. Patients with gynecologic malignancies remain an ideal population for palliative care intervention. This review of the literature explores the current state of palliative care in the treatment of gynecologic cancers and its implications for the quality and cost of this treatment.

  12. [Efficacy of oral cavity care in preventing stomatitis (mucositis) in cancer chemotherapy].

    Science.gov (United States)

    Koshino, Miki; Sakai, Chie; Ogura, Takafumi; Kawasaki, Akiko; Fukuzato, Fumiko; Miyazaki, Yasuhiro

    2009-03-01

    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.

  13. Cooperation among cancer cells as public goods games on Voronoi networks.

    Science.gov (United States)

    Archetti, Marco

    2016-05-07

    Cancer cells produce growth factors that diffuse and sustain tumour proliferation, a form of cooperation that can be studied using mathematical models of public goods in the framework of evolutionary game theory. Cell populations, however, form heterogeneous networks that cannot be described by regular lattices or scale-free networks, the types of graphs generally used in the study of cooperation. To describe the dynamics of growth factor production in populations of cancer cells, I study public goods games on Voronoi networks, using a range of non-linear benefits that account for the known properties of growth factors, and different types of diffusion gradients. The results are surprisingly similar to those obtained on regular graphs and different from results on scale-free networks, revealing that network heterogeneity per se does not promote cooperation when public goods diffuse beyond one-step neighbours. The exact shape of the diffusion gradient is not crucial, however, whereas the type of non-linear benefit is an essential determinant of the dynamics. Public goods games on Voronoi networks can shed light on intra-tumour heterogeneity, the evolution of resistance to therapies that target growth factors, and new types of cell therapy.

  14. Palliative Care in Iran: Moving Toward the Development of Palliative Care for Cancer.

    Science.gov (United States)

    Rassouli, Maryam; Sajjadi, Moosa

    2016-04-01

    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.

  15. Economic valuation of informal care: lessons from the application of the opportunity costs and proxy good methods.

    Science.gov (United States)

    van den Berg, Bernard; Brouwer, Werner; van Exel, Job; Koopmanschap, Marc; van den Bos, Geertrudis A M; Rutten, Frans

    2006-02-01

    This paper reports the results of the application of the opportunity costs and proxy good methods to determine a monetary value of informal care. We developed a survey in which we asked informal caregivers in The Netherlands to indicate the different types of time forgone (paid work, unpaid work and leisure) in order to be able to provide care. Moreover, we asked informal caregivers how much time they spent on a list of 16 informal care tasks during the week before the interview. Data were obtained from surveys in two different populations: informal caregivers and their care recipients with stroke and with rheumatoid arthritis (RA). A total of 218 care recipients with stroke and their primary informal caregivers completed a survey as well as 147 caregivers and their care recipients with RA. The measurement of care according to both methods is more problematic compared to the valuation. This is especially the case for the opportunity costs method and for the housework part in the proxy good method. More precise guidelines are necessary for the consistent application of both methods in order to ensure comparability of results and of economic evaluations of health care.

  16. Multidisciplinary care and management selection in prostate cancer.

    Science.gov (United States)

    Aizer, Ayal A; Paly, Jonathan J; Efstathiou, Jason A

    2013-07-01

    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.

  17. The potential consequences for cancer care and cancer research of Brexit

    Science.gov (United States)

    Selby, Peter; Lawler, Mark; Baird, Richard; Banks, Ian; Johnston, Patrick; Nurse, Paul

    2017-01-01

    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

  18. The potential consequences for cancer care and cancer research of Brexit.

    Science.gov (United States)

    Selby, Peter; Lawler, Mark; Baird, Richard; Banks, Ian; Johnston, Patrick; Nurse, Paul

    2017-01-01

    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.

  19. The Integrated Study on Agritainment and the Industrial Economy of Keeping Good Health and Caring for the Senior

    Institute of Scientific and Technical Information of China (English)

    Yijun; MA

    2013-01-01

    Based on the development prospect of the industry of keeping in good health and caring for the senior and practical exploration on the Lishui Citys construction of "Health Blessed Land" in Yangtze River Delta, the position, function and facing problems of agritainment in the system of industrial economy of keeping in good health and caring for the senior in Lishui City. From the view of the industry integration, this paper puts forward the new strategies of developing agritainment in terms of design concepts at the top level, guarantee conditions in the government, layout strategies stressing on resources, target assessment focusing on nourishing of life, the basic promoting connotation.

  20. Five Policy Levers To Meet The Value Challenge In Cancer Care.

    Science.gov (United States)

    Callahan, Ryan; Darzi, Ara

    2015-09-01

    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.

  1. Financial Burden of Cancer Care | Cancer Trends Progress Report

    Science.gov (United States)

    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.

  2. [Update on current care guidelines: ovarian cancer].

    Science.gov (United States)

    Leminen, Arto; Auranen, Annika; Bützow, Ralf; Hietanen, Sakari; Komulainen, Marja; Kuoppala, Tapio; Mäenpää, Johanna; Puistola, Ulla; Vuento, Maarit; Vuorela, Piia; Yliskoski, Merja

    2012-01-01

    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.

  3. Good practice in health care for migrants: views and experiences of care professionals in 16 European countries.

    NARCIS (Netherlands)

    Priebe, S.; Sandhu, S.; Dias, S.; Gaddini, A.; Greacen, T.; Ioannidis, E.; Kluge, U.; Krasnik, A.; Lamkaddem, M.; Lorant, V.; Puigpinósi Riera, R.; Sarvary, A.; Soares, J.J.F.; Stankunas, M.; Straßmayr, C.; Wahlbeck, K.; Welbel, M.; Bogic, M.

    2011-01-01

    Background: Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals ex

  4. Canine cell line, IPC-366, as a good model for the study of inflammatory breast cancer.

    Science.gov (United States)

    Caceres, S; Peña, L; Lacerda, L; Illera, M J; de Andres, P J; Larson, R A; Gao, H; Debeb, B G; Woodward, W A; Reuben, J M; Illera, J C

    2016-05-05

    Inflammatory breast cancer (IBC) is an aggressive type of cancer with poor survival in women. Inflammatory mammary cancer (IMC) in dogs is very similar to human IBC and it has been proposed as a good surrogate model for study the human disease. The aim was to determine if IPC-366 shared characteristics with the IBC cell line SUM149. The comparison was conducted in terms of ability to grow (adherent and nonadherent conditions), stem cell markers expression using flow cytometry, protein production using western blot and tumorigenic capacity. Our results revealed that both are capable of forming long-term mammospheres with a grape-like morphology. Adherent and nonadherent cultures exhibited fast growth in vivo. Stem cell markers expressions showed that IPC-366 and SUM149 in adherent and nonadherent conditions has mesenchymal-like characteristics, E-cadherin and N-cadherin, was higher in adherent than in nonadherent cultures. Therefore, this study determines that both cell lines are similar and IPC-366 is a good model for the human and canine disease.

  5. Ensuring quality cancer care: a follow-up review of the Institute of Medicine's 10 recommendations for improving the quality of cancer care in America.

    Science.gov (United States)

    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

    2012-05-15

    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.

  6. Self-assessment in cancer patients referred to palliative care

    DEFF Research Database (Denmark)

    Strömgren, Annette S; Goldschmidt, Dorthe; Groenvold, Mogens

    2002-01-01

    BACKGROUND: Research in palliative care is considered difficult due to the poor health of patients. However, patient-provided data are essential for a thorough description of patient symptomatology and for the evaluation of care. METHODS: The authors examined the feasibility of a questionnaire......-based study using the European Organization for Research and Treatment of Cancer quality-of-life instrument EORTC QLQ-C30, the Edmonton Symptom Assessment System (ESAS), and the Hospital Anxiety and Depression Scale (HADS) in cancer patients who were receiving palliative care. This report describes...... the symptomatology of participating patients and examines differences in symptomatology between patients in three palliative care functions: inpatient, outpatient, and palliative home care. RESULTS: Of 267 eligible patients who were referred to a department of palliative medicine, initial self...

  7. What Should You Ask Your Health Care Team About Thyroid Cancer?

    Science.gov (United States)

    ... Should You Ask Your Health Care Team About Thyroid Cancer? As you deal with thyroid cancer and the ... ask are: When you’re told you have thyroid cancer What kind of thyroid cancer do I have? ...

  8. Primary care for young adult cancer survivors: an international perspective

    DEFF Research Database (Denmark)

    Hølge-Hazelton, Bibi; Blake-Gumbs, Lyla; Miedema, Baujke

    2010-01-01

    and usually not the first thing that comes into the FP's mind. Youth is sometimes mistakenly regarded as a protective factor. Across the countries, almost all YACs are treated in tertiary health care facilities with specialists providing the majority of care. Health care services are covered by the universal...... health insurance in Denmark, The Netherlands, and Canada but not in the US. Once the YAC has completed acute treatment and follow-up care, they often return to the care of the FPs who may potentially be expected to deal with and take action upon any possible medical, mental health, and psychosocial...... issues the YA cancer patient may present with. The role of the FP in follow-up care seems to be very limited. CONCLUSIONS: YACs in the western world seem to have comparable medical and psychosocial problems. However, the nature of health insurance is such that it impacts differently on the care...

  9. "When doing good is just the start to being good": a possible tool to improve the organizational effectiveness of non-profit health care organizations.

    Science.gov (United States)

    Mueller, Jens

    2007-01-01

    Health care is an area where many non-profit organizations do good work, relieving governments and for-profit providers of workload. They contribute often specific knowledge and competence or provide better access to patients through their cultural and ethnic affiliations. Non-profit organizations, NPOs, are often dependent on one or more significant donors, sometimes governments, sometimes for-profit health providers and mostly private/corporate donors with an interest in specific medical areas, such as Alzheimers, or in unique communities, such as the Laotian neighborhoods in Southern California. In the media, high profile scandals involving financial irresponsibility have caused shock waves around the world. Concerns among some donors over the lack of a transparent performance measurement of non-profit entities have increased with the greater call for transparency and good governance in the corporate world. Not all the scandals have been in the commercial sector; some Not for Profit Organizations (NPOs) have been identified as having less than credible governance structures (Thomson, 2003). The watchdog organization SustainAbility reported that accountability and transparency are issues on which several NPOs are found wanting (Anon., 2003) and the New York Times reports that until recently NPOs were thought to be exempt from traditional oversight; their do-good nature and the commitment of their participants were thought to be sufficient to produce positive results (Christensen, 2004).

  10. Illness Perception, Knowledge and Self-Care about Cervical Cancer

    Directory of Open Access Journals (Sweden)

    Elisa Kern de Castro

    2015-09-01

    Full Text Available Prevention plays a central role in early detection of cervical cancer. Common Sense Model proposes that the nature and organization of illness representations can guide actions related to health and how self-care is exercised. The aim of this study was to describe and compare illness perception, knowledge and self-care in women with and without cancer precursor lesions. Participants were 92 women (aged 18-59 from primary care unity divided into two groups: women with and without premalignant lesion. Measures for illness perception, knowledge and self-care were used. There was no statistically significant difference (t test e chi-square test between groups in the variables analyzed. Despite the risk for cervical cancer, women with precursor lesions do not adjust their illness perceptions, knowledge and self-care to the situation. These data show the need to warn women against the cervical cancer risks, because their distorted perceptions and lack of knowledge about the disease may hamper the screening and control of cervical cancer.

  11. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Eva Helena; Kjaergaard, Hanne; Johansen, Christoffer

    2013-01-01

    BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety, an...... and the psychosocial burden on the family does not increase. Pediatr Blood Cancer © 2013 Wiley Periodicals, Inc.......BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety......, and cost. A controlled trial was conducted to assess children's health-related quality of life (HRQOL) using the parent-reported and self-reported PedsQL Generic Core Scale and PedsQL Cancer Module, and the psychosocial impact on the family by PedsQL Family Impact Module comprising a subsample of 28...

  12. Models of helping and coping in cancer care.

    Science.gov (United States)

    Northouse, L L; Wortman, C B

    1990-02-01

    This paper provides a theoretical analysis of four models of helping and coping as they relate to cancer care. The four conceptual models focus on the issue of whether or not patients should be viewed as responsible for the cause or the treatment of their cancer. The moral model, characterized by the holistic health movement, holds patients responsible for both causing and resolving health problems. The compensatory model, exemplified by cancer education programs, attributes low responsibility to patients for causing health problems but high responsibility for resolving them. The medical model views patients as neither responsible for causing nor for resolving health problems. The enlightenment model, typified by the healing movement, holds people responsible for causing their health problems, but not for resolving them. An attempt is made to examine existing programs in cancer care in light of these models. The present analysis addresses the following questions. Why is each of these models appealing? Why are they sometimes embraced by patients or health care providers? What are the benefits and disadvantages of using each of these models with cancer patients? What happens when the health care provider and patient hold different models regarding the patient's responsibility or participation in the cause of the disease or its treatment? Further research is needed to determine the conditions under which a particular model results in better health outcomes for patients, and to assess how factors such as extent of disease or type of cancer influence the patient's choice of a model.

  13. Panitumumab: the evidence of its therapeutic potential in metastatic colorectal cancer care

    Science.gov (United States)

    Martinelli, Erika; Morgillo, Floriana; Troiani, Teresa; Tortora, Giampaolo; Ciardiello, Fortunato

    2007-01-01

    Introduction: Colorectal cancer is the fourth most common malignant disease. Of newly diagnosed patients, 40% have metastatic disease at diagnosis, and approximately 25% of patients with localized disease at diagnosis will ultimately develop metastatic disease. The benefits of systemic chemotherapy in the treatment of metastatic colorectal cancer over best supportive care have been established. Panitumumab (ABX-EGF) is the first fully human monoclonal antibody developed for use in colorectal cancer that targets the extracellular domains of epidermal growth factor receptor. Aims: The goal of this article is to review the published evidence for the use of panitumumab in the treatment of metastatic colorectal cancer to define its therapeutic potential. Evidence review: The major evidence of panitumumab activity in colorectal cancer has appeared in meeting report abstracts. One phase II study in monotherapy, one in combination with chemotherapy, and one phase III study have included only patients with metastatic colorectal cancer. Clinical potential: To date, in phase II clinical studies panitumumab has demonstrated antitumor activity in advanced, refractory colorectal cancer. As monotherapy it resulted in a 10% response rate with 38% of patients having stable disease, and a 36% response rate with 46% stable disease when combined with chemotherapy. A phase III study indicates a clinically significant advantage of panitumumab as third-line monotherapy over best supportive care. Panitumumab appears to have a good tolerability profile, with no maximum tolerated dose yet defined. PMID:21221177

  14. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

    Science.gov (United States)

    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

    2016-01-01

    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.

  15. Low expression of a few genes indicates good prognosis in estrogen receptor positive breast cancer

    Directory of Open Access Journals (Sweden)

    Buechler Steven

    2009-07-01

    Full Text Available Abstract Background Many breast cancer patients remain free of distant metastasis even without adjuvant chemotherapy. While standard histopathological tests fail to identify these good prognosis patients with adequate precision, analyses of gene expression patterns in primary tumors have resulted in more successful diagnostic tests. These tests use continuous measurements of the mRNA concentrations of numerous genes to determine a risk of metastasis in lymph node negative breast cancer patients with other clinical traits. Methods A survival model is constructed from genes that are both connected with relapse and have expression patterns that define distinct subtypes, suggestive of different cellular states. This in silico study uses publicly available microarray databases generated with Affymetrix GeneChip technology. The genes in our model, as represented by array probes, have distinctive distributions in a patient cohort, consisting of a large normal component of low expression values; and a long right tail of high expression values. The cutoff between low and high expression of a probe is determined from the distribution using the theory of mixture models. The good prognosis group in our model consists of the samples in the low expression component of multiple genes. Results Here, we define a novel test for risk of metastasis in estrogen receptor positive (ER+ breast cancer patients, using four probes that determine distinct subtypes. The good prognosis group in this test, denoted AP4-, consists of the samples with low expression of each of the four probes. Two probes target MKI67, antigen identified by monoclonal antibody Ki-67, one targets CDC6, cell division cycle 6 homolog (S. cerevisiae, and a fourth targets SPAG5, sperm associated antigen 5. The long-term metastasis-free survival probability for samples in AP4- is sufficiently high to render chemotherapy of questionable benefit. Conclusion A breast cancer subtype defined by low

  16. Advanced and rapidly progressing head and neck cancer: good palliation following intralesional bleomycin.

    LENUS (Irish Health Repository)

    Quintyne, Keith Ian

    2011-09-01

    The authors herein report the case of a 61-year-old man undergoing adjuvant therapy for locally advanced laryngeal cancer, who developed parastomal recurrence in his radiation field around his tracheotomy site, while he was undergoing radiation therapy, and compromised the secure placement of his tracheotomy tube and maintenance of his upper airway. MRI restaging and biopsy confirmed recurrence and progressive disease in his mediastinum. He underwent local therapy with intralesional bleomycin with good palliation, and ability to maintain the patency of his upper airway.

  17. Symptom interpretation and health care seeking in ovarian cancer

    DEFF Research Database (Denmark)

    Seibaek, Lene; Petersen, Lone K; Blaakær, Jan

    2011-01-01

    with ovarian cancer. These results were combined with findings from semi-structured qualitative research interviews on women's bodily experiences with symptom development. RESULTS: A number of 663 Danish women with ovarian cancer attended 27 different kinds of primary health care providers in a total of 14......BACKGROUND: Ovarian cancer is the leading cause of death among women suffering from gynaecological malignancies in the Western world. Worldwide, approximately 200,000 women are diagnosed with the disease each year. This article deals with the health care seeking and symptom interpretation process...... among Danish women, who have a very high mortality rate. METHODS: The health seeking and symptom interpretation process was analysed via combining study methods. The material consisted of registry data dealing with the use of public health care and hospital services of Danish women, newly diagnosed...

  18. PRIMARY PALLIATIVE CARE? - Treating terminally ill cancer patients in the primary care sector

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Jensen, Anders Bonde; Olesen, Frede;

    sectors.METHOD. A number of focus group interviews were conducted with three types of subgroups: 1) Bereaved relatives, 2) GPs and 3) Various health-care-professionals, namely community nurses, hospital physicians and GPs. The interviews were transcribed and analysed according to a phenomenological......BACKGROUND. Palliative care for cancer patients is an important part of a GP's work. Although every GP is frequently involved in care for terminally ill cancer patients, only little is known about how these palliative efforts are perceived by the patients and their families, a knowledge...... approach.RESULTS. The analyses revealed several key areas, e.g.: 1) How to take, give and maintain professional responsibility for palliative home care. 2) A need for transparent communication both among primary care professionals and among professionals across the primary/secondary interface. 3...

  19. Education in cancer prevention for primary care clinicians.

    Science.gov (United States)

    Love, R R; Stone, H L; Hughes, B

    1986-01-01

    In response to increased public interest in cancer prevention and rapidly escalating health care costs, the National Cancer Institute supported the development of cancer prevention courses for health professionals. A multidisciplinary group of physicians, behavioral scientists, and educators developed, field-tested, revised, and evaluated a 12-module, 24-classroom-hour clinical preventive oncology course for primary care physicians. A rationale for education in cancer prevention is presented, the new clinical discipline of preventive oncology is defined, and contributory disciplines are identified. A curriculum based upon detailed learning objectives is described, short-term evaluation data are presented, and a methodology for incorporating a didactic course into a residency program is suggested. The positive reception given to this course by residents warrants optimism concerning application of a biopsychosocial or self-regulative model rather than the traditional biomedical one to clinical medicine and its teaching.

  20. The supportive care needs of men with prostate cancer (2000).

    Science.gov (United States)

    Steginga, S K; Occhipinti, S; Dunn, J; Gardiner, R A; Heathcote, P; Yaxley, J

    2001-01-01

    The diagnosis and subsequent treatment of prostate cancer is followed by a range of significant disease specific and iatrogenic sequelae. However, the supportive care needs of men with prostate cancer are not well described in the literature. The present study assesses the supportive care needs of men with prostate cancer who are members of prostate cancer self-help groups in Queensland, Australia. In all, 206 men aged between 48 and 85 years (mean=68) completed the Supportive Care Needs Survey (SCNS) (62% response). The SCNS is a validated measure assessing perceived need in the domains of psychological needs, health system and information needs, physical and daily living needs, patient care and support, and sexuality. Items assessing need for access to services and resources were also included. One third of the sample reported a moderate to high need for help for multiple items in the sexuality, psychological and health system and information domains. Younger men reported greater need in the sexuality domain; living in major urban centres was predictive of greater psychological need; being closer to the time of diagnosis was related to greater need for help in the physical and daily living domain; having prostate cancer that is not in remission, having received radiation therapy, and lower levels of education were predictive of greater need for help in patient care and support. Of the total sample, 55% of men had used alternative cancer treatments in the past 12 months, with younger and more educated men more likely to use alternative therapies. Interventions in sexuality, psychological concerns and informational support are priorities for men with prostate cancer.

  1. Health care experiences among women diagnosed with gestational breast cancer.

    Science.gov (United States)

    Hammarberg, K; Sullivan, E; Javid, N; Duncombe, G; Halliday, L; Boyle, F; Saunders, C; Ives, A; Dickinson, J E; Fisher, J

    2017-03-24

    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.

  2. Smarter palliative care for cancer: Use of smartphone applications

    Directory of Open Access Journals (Sweden)

    Nisha Rani Jamwal

    2016-01-01

    Full Text Available 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.

  3. Is the early percutaneous spine total care to treat the polytrauma patient a good way?

    Institute of Scientific and Technical Information of China (English)

    Gabriele Falzarano; Antonio Medici; Giuseppe Pica; Predrag Grubor; Milan Grubor; Francesco Vitaliano Muzi; Mirza Biscevic; Arianna Falzarano; Luigi Meccariello

    2015-01-01

    The"ideal"timing and modality of fracture fixation for unstable thoracolumbar spine fractures in multiply injured patients remains controversial. The concept of"damage control orthopedics"is expressed. We presented a case report of a 27 years' old male who sustained a multilevel spine fractures associated a floating knee (Fraser’s Type A), ulna fracture and carpal scaphoid fracture in July 2014 after car accident (very high energy trauma). All these fractures were treated in early total care. We reported a case control to discuss about the early spinal total care associated at orthopedic total care in patients with multiple trauma.

  4. Is the early percutaneous spine total care to treat the polytrauma patient a good way?

    Directory of Open Access Journals (Sweden)

    Gabriele Falzarano

    2015-03-01

    Full Text Available The “ideal“ timing and modality of fracture fixation for unstable thoracolumbar spine fractures in multiply injured patients remains controversial. The concept of “damage control orthopedics” is expressed. We presented a case report of a 27 years' old male who sustained a multilevel spine fractures associated a floating knee (Fraser's Type A, ulna fracture and carpal scaphoid fracture in July 2014 after car accident (very high energy trauma. All these fractures were treated in early total care. We reported a case control to discuss about the early spinal total care associated at orthopedic total care in patients with multiple trauma.

  5. Breast Cancer Survivorship Care: Targeting a Colorectal Cancer Education Intervention

    Directory of Open Access Journals (Sweden)

    Sherri G. Homan

    2015-08-01

    Full Text Available 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.

  6. Breast Cancer Screening in a Low Income Managed Care Population

    Science.gov (United States)

    1998-10-01

    the morbidity and mortality of breast cancer among the population of low income women who have incomes less than 200% of the national poverty level...34Journal for Health Care for the Poor and Underserved" (see appendix). Entitled "Difficulty in Reaching Low Income Women for Screening Mammography...useful insights for future program planning and research design. Keywords: screening mammography, low income , managed care and barriers Poverty is

  7. Pharmacopuncture for cancer care: a systematic review.

    Science.gov (United States)

    Cheon, Soyeon; Zhang, Xiuyu; Lee, In-Seon; Cho, Seung-Hun; Chae, Younbyoung; Lee, Hyangsook

    2014-01-01

    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.

  8. Pharmacopuncture for Cancer Care: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Soyeon Cheon

    2014-01-01

    Full Text Available 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.

  9. Diabetes: Good Diabetes Management and Regular Foot Care Help Prevent Severe Foot Sores

    Science.gov (United States)

    ... diabetes care is probably why the rates of lower limb amputations have gone down by more than 50 ... and teach you how to use an artificial (prosthetic) limb, wheelchair or other devices to improve your ...

  10. Translating basic research in cancer patient care

    Directory of Open Access Journals (Sweden)

    Marcello Maugeri-Saccà

    2011-01-01

    Full Text Available With the advent of molecular targeted therapies and the development of high-throughput biotechnologies, it has become evident that progress in cancer research is largely due to the creation of multidisciplinary teams able to plan clinical trials supported by appropriate molecular hypotheses. These efforts have culminated in the identification and validation of biomarkers predictive of response, as well as in the generation of more accurate prognostic tools. The identification of cancer stem cells has provided further insights into mechanisms of cancer, and many studies have tried to translate this biological notion into prognostic and predictive information. In this regard, new agents targeting key stemness-related pathways have entered the clinical development, and preliminary data suggested an encouraging antitumor activity.

  11. The micropolitics of elder care in Memento Mori, Diary of a Good Neighbor, and A Taste for Death.

    Science.gov (United States)

    England, S E; Ganzer, C

    1994-01-01

    Using three novels--Muriel Spark's Memento Mori, Doris Lessing's Diary of a Good Neighbor, and P. D. James' A Taste for Death--we examine themes relating to the social construction of caregiving. In our reading of the stories we found numerous instances of the political in the personal, and of how care can be shaped by inequalities of class and gender, by organizational practices and attitudes rooted in cultural assumptions, and by the social idealization of care provided by relatives and friends.

  12. Early stage cervical cancer : quality of cancer care and quality of life

    NARCIS (Netherlands)

    Pieterse, Quirine Dionne

    2007-01-01

    To improve quality of cancer care treatment-related information is needed. This could be acquired by registries. Since January 1984, the Leiden University Medical Center (LUMC) collects prospectively more than 200 relevant clinical and pathological parameters of women with cervical cancer treated in

  13. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Eva Helena; Kjaergaard, H; Schmiegelow, K

    2012-01-01

    . Our study highlights the importance of providing hospital-based home care with consideration for the family members' need for the sense of security achieved by home care by experienced paediatric oncology nurses and regular contact with the doctor. In future studies, interviews with children......The study aims to describe the experiences of a hospital-based home care programme in the families of children with cancer. Fourteen parents, representing 10 families, were interviewed about their experiences of a hospital-based home care programme during a 4-month period in 2009 at a university...... hospital in Denmark. Five children participated in all or part of the interview. The interviews were transcribed verbatim and analysed using qualitative content analysis. The findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment...

  14. Cancer patients, emergencies service and provision of palliative care

    Directory of Open Access Journals (Sweden)

    Bruno Miranda

    2016-06-01

    Full Text Available SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011 with a minimum length of hospital stay of two hours. Student’s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%. 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%, breast (13.6% and prostate (10.5%; 70.7% were in advanced stages (IV, 47.1%; 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.

  15. Health Assets in Nursing Documentation of Cancer Care.

    OpenAIRE

    Rotegård, Ann Kristin; Fagermoen, May Solveig; Ruland, Cornelia M.

    2012-01-01

    Patients’ experiences, knowledge and preferences, as well as more person-centered care need to be implemented in clinical support systems and are central values and outcomes of eHealth. Health assets represent such information. The concept of health assets was explored and described based on analysis of nursing documentation in cancer patients’ records.

  16. Follow-Up Care for Older Women With Breast Cancer

    Science.gov (United States)

    1998-08-01

    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

  17. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

    Science.gov (United States)

    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

    2016-02-20

    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

  18. Cancer screening: Should cancer screening be essential component of primary health care in developing countries?

    Directory of Open Access Journals (Sweden)

    Saurabh Bobdey

    2015-01-01

    Conclusions: Our study highlights the availability and success of visual screening tools in early detection and mortality reduction of major neoplasia in resource-poor health care settings and recommends implementation of oral and cervical cancer screening as part of assured primary health care package in developing countries.

  19. Good practice in social care: the views of people with severe and complex needs and those who support them.

    Science.gov (United States)

    Gridley, Kate; Brooks, Jenni; Glendinning, Caroline

    2014-11-01

    This paper reports findings drawn from a study of good practice in English social care for adults with disability and older people with severe and complex needs. People with severe and complex needs are a relatively small proportion of adult social care service users, but they are growing in numbers and have resource-intensive needs. The study involved qualitative research with adults with disability and older people with severe and complex needs, family carers and members of specialist organisations (n = 67), focusing on the features of social care services they considered to be good practice. Data were collected between August 2010 and June 2011. The approach to data collection was flexible, to accommodate participants' communication needs and preferences, including face-to-face and telephone interviews, Talking Mats(©) sessions and a focus group. Data were managed using Framework and analysed thematically. Features of good practice were considered at three levels: (i) everyday support; (ii) service organisation; and (iii) commissioning. Findings relating to the first two of these are presented here. Participants emphasised the importance of person-centred ways of working at all levels. Personalisation, as currently implemented in English social care, aims to shift power from professionals to service users through the allocation of personal budgets. This approach focuses very much on the role of the individual in directing his/her own support arrangements. However, participants in this study also stressed the importance of ongoing professional support, for example, from a specialist key worker or case manager to co-ordinate diverse services and ensure good practice at an organisational level. The paper argues that, despite the recent move to shift power from professionals to service users, people with the most complex needs still value support from professionals and appropriate organisational support. Without these, they risk being excluded from the benefits

  20. Do Internal Medicine Residents Know Enough About Skilled Nursing Facilities To Orchestrate a Good Care Transition?

    Science.gov (United States)

    Ward, Katherine T.; Eslami, Michelle S.; Garcia, Maristela B.; McCreath, Heather E.

    2015-01-01

    BACKGROUND Although many older adults require skilled nursing facility (SNF) care after acute hospitalization, it is unclear whether Internal Medicine (IM) residents have sufficient knowledge of the care that can be provided at this site. METHODS We developed a 10-item multiple choice pre-test that assessed knowledge of the definition of a SNF, SNF staffing requirements, and SNF services provided on-site. The test was administered to trainees on the first day of a mandatory SNF rotation that occurred during their first, second or third year of training. RESULTS 67 IM residents (41 PGY-1, 11 PGY-2, and 15 PGY-3) were assessed with the test. The mean number of questions answered correctly was 4.9, with a standard deviation of 1.6. Regardless of their level of training, residents had a poor baseline knowledge of SNF care (mean scores 4.2 for PGY-1, 5.3 for PGY-2, and 6.3 for PGY-3 (p<0.0001). Performance on some questions improved with increased level of training but others did not. CONCLUSIONS Medical residents have insufficient knowledge about the type of care that can be provided at a SNF and efforts to improve this knowledge are needed to assure proper triage of patients and safe transitions to the SNF. PMID:25282630

  1. "Is 28% good or bad?" Evaluability and preference reversals in health care decisions.

    Science.gov (United States)

    Zikmund-Fisher, Brian J; Fagerlin, Angela; Ubel, Peter A

    2004-01-01

    Choices of health care providers can become inconsistent when people lack sufficient context to assess the value of available information. In a series of surveys, general population samples were randomized to read descriptions of either 2 possible health care providers or a single provider. Some information about providers was easy to consider (e.g., travel time), but some was difficult to interpret without additional context (e.g., success rates). Ratings of the described health care providers varied significantly by whether options were evaluated independently or concurrently. For example, one fertility clinic (33% success rate, 15 min away) was rated higher than a 2nd (40% success rate, 45 min away) when each clinic was considered separately (7.1 v. 6.2, P = 0.046), but preferences reversed in joint evaluation (5.9 v. 6.7, P = 0.051). The results suggest that clinicians and developers of patient information materials alike should consider information evaluability when deciding how to present health care options to patients.

  2. Cervical cancer screening in primary health care setting in Sudan

    DEFF Research Database (Denmark)

    Ibrahim, Ahmed; Aro, Arja R.; Rasch, Vibeke;

    2012-01-01

    OBJECTIVE: To determine the feasibility of visual inspection with the use of acetic acid (VIA) as a screening method for cervical cancer, an alternative to the Pap smear used in primary health care setting in Sudan, and to compare sensitivity, specificity, positive and negative predictive values....../119 (73.9%) were positive for cervical intraepithelial neoplasia. VIA had higher sensitivity than Pap smear (74.2% versus 72.9%; P = 0.05) respectively. Out of 88 confirmed positive cases, 22 (25.0%) cases were invasive cervical cancer in stage 1, of which 19 versus three were detected by VIA and Pap...... of this study showed that VIA has higher sensitivity and lower specificity compared to Pap smear, but a combination of both tests has greater sensitivity and specificity than each test independently. It indicates that VIA is useful for screening of cervical cancer in the primary health care setting in Sudan...

  3. Play as a care strategy for children with cancer

    Directory of Open Access Journals (Sweden)

    Kálya Yasmine Nunes de Lima

    Full Text Available OBJECTIVE: To understand the influence of play in the care process as perceived by children with cancer. METHOD: A descriptive, exploratory and qualitative study conducted in a children's cancer unit in Natal, Rio Grande do Norte, Brazil. Data were collected between October 2013 and January 2014 by means of photographic records and semi-structured interviews with eight children, and content analysis with emphasis on two categories: Auxiliary instruments during play; and The influence of play in the process of care. RESULTS: Recreational activities involve watching television, using computers, games and toys, drawing, the playroom and the clown, which provide fun, feelings of joy, distraction and interaction with other people. CONCLUSION: There are several activities at the hospital that are considered play-related and, for the children, they all benefit their care process.

  4. Cancer Care Initiative: Creation of a Comprehensive Cancer Center at Naval Medical Center Dan Diego

    Science.gov (United States)

    2008-06-24

    clinic had Cancer Care Initiative 6 a dedicated satellite pharmacy staffed by a part-time pharmacist who prepared chemotherapy solutions...patient education information; 80% want clinical research trials; and 79% want end-of-life palliative care to be included as part of a CCC. Physicians...prevention, early detection, staging evaluation, initial and subsequent treatment, long-term follow-up, palliative and hospice care , and supportive

  5. The Edinburgh Malawi Cancer Partnership: helping to establish multidisciplinary cancer care in Blantyre, Malawi.

    Science.gov (United States)

    Brown, E; Gorman, D; Knowles, G; Taylor, F; Jere, Y; Bates, J; Masamba, L

    2016-03-01

    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.

  6. The effect of multidisciplinary team care on cancer management.

    Science.gov (United States)

    Abdulrahman, Ganiy Opeyemi

    2011-01-01

    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.

  7. Frontiers of cancer care in Asia-Pacific region: cancer care in Australia

    OpenAIRE

    Koh, ES; Do, VT; Barton, MB

    2008-01-01

    Cancer has a significant impact on the Australian community. One in three men and one in four women will develop cancer by the age of 75. The estimated annual health expenditure due to cancer in 2000-1 in Australia was $2.7 billion, representing 5.5% of the country’s total healthcare expenditure. An historical overview of the national cancer control strategies in Australia is provided. In males, the five most common cancers in order of decreasing incidence are: prostate cancer, colorectal can...

  8. Palliative care in advanced cancer patients in a tertiary care hospital in Uttarakhand

    Directory of Open Access Journals (Sweden)

    Manisha Bisht

    2008-01-01

    Full Text Available Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. The data obtained from the patients included symptoms reported by the patients, currently prescribed treatments and the site of cancer. Results: The average number of symptoms reported per patient was 5.33 ± 0.67 (mean ± SE. The most common symptoms were pain, weakness/fatigue, anorexia, insomnia, nausea/vomiting, dyspnea, constipation and cough. Polypharmacy was frequent. Patients consumed approximately 8.7 ± 0.38 (mean ± SE drugs on average during the 2-month period of follow-up. Conclusion: The result gives insight into the varied symptomatology of patients with advanced cancer. Polypharmacy was quite common in patients with advanced cancer, predisposing them to complicated drug interactions and adverse drug reactions.

  9. Free-standing cancer centers: rationale for improving cancer care delivery.

    Science.gov (United States)

    Lokich, J J; Silvers, S; Brereton, H; Byfield, J; Bick, R

    1989-10-01

    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.

  10. Cancer patients with oral mucositis: challenges for nursing care

    Directory of Open Access Journals (Sweden)

    Sarah Nilkece Mesquita Araújo

    2015-04-01

    Full Text Available 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.

  11. Complementary medicine in palliative care and cancer symptom management.

    Science.gov (United States)

    Mansky, Patrick J; Wallerstedt, Dawn B

    2006-01-01

    Complementary and alternative medicine (CAM) use among cancer patients varies according to geographical area, gender, and disease diagnosis. The prevalence of CAM use among cancer patients in the United States has been estimated to be between 7% and 54%. Most cancer patients use CAM with the hope of boosting the immune system, relieving pain, and controlling side effects related to disease or treatment. Only a minority of patients include CAM in the treatment plan with curative intent. This review article focuses on practices belonging to the CAM domains of mind-body medicine, CAM botanicals, manipulative practices, and energy medicine, because they are widely used as complementary approaches to palliative cancer care and cancer symptom management. In the area of cancer symptom management, auricular acupuncture, therapeutic touch, and hypnosis may help to manage cancer pain. Music therapy, massage, and hypnosis may have an effect on anxiety, and both acupuncture and massage may have a therapeutic role in cancer fatigue. Acupuncture and selected botanicals may reduce chemotherapy-induced nausea and emesis, and hypnosis and guided imagery may be beneficial in anticipatory nausea and vomiting. Transcendental meditation and the mindfulness-based stress reduction can play a role in the management of depressed mood and anxiety. Black cohosh and phytoestrogen-rich foods may reduce vasomotor symptoms in postmenopausal women. Most CAM approaches to the treatment of cancer are safe when used by a CAM practitioner experienced in the treatment of cancer patients. The potential for many commonly used botanical to interact with prescription drugs continues to be a concern. Botanicals should be used with caution by cancer patients and only under the guidance of an oncologist knowledgeable in their use.

  12. [Hyperoxia in Anesthesia and Intensive Care Medicine - too much of a good thing?].

    Science.gov (United States)

    Berger, Marc Moritz; Macholz, Franziska; Schmidt, Peter; Huhn, Ragnar

    2016-06-01

    For decades the administration of oxygen has been a corner stone in the treatment of various medical emergencies, e.g. acute myocardial infarction. Several arguments support the perioperative use of high oxygen concentrations (>80%) for the prevention of surgical site infections. However, effects of oxygen include an increase in systemic vascular resistance, a reduction in heart rate and stroke volume and thus an impairment of the microcirculation, e.g. in the coronary and cerebral vasculature. Adequately powered, prospective, randomized, blinded outcome studies on the effects of hyperoxia in anesthesia and intensive care medicine are scarce. Recent data suggest that hyperoxia may be more harmful than beneficial and may increase morbidity and mortality in surgical and intensive care patients. Also, the current guidelines from the European Resuscitation Council from 2015 address the potentially harmful effects of high oxygen concentrations in various emergency settings. The aim of this article is to give an overview about the physiological and clinical effects of hyperoxia with a focus on its use in perioperative and intensive care medicine.

  13. Cancer Phenotype Diagnosis and Drug Efficacy within Japanese Health Care

    Directory of Open Access Journals (Sweden)

    Toshihide Nishimura

    2012-01-01

    Full Text Available An overview on targeted personalized medicine is given describing the developments in Japan of lung cancer patients. These new targeted therapies with novel personalized medicine drugs require new implementations, in order to follow and monitor drug efficacy and outcome. Examples from IRESSA (Gefitinib and TARCEVA (Erlotinib treatments used in medication of lung cancer patients are presented. Lung cancer is one of the most common causes of cancer mortality in the world. The importance of both the quantification of disease progression, where diagnostic-related biomarkers are being implemented, in addition to the actual measurement of disease-specific mechanisms relating to pathway signalling activation of disease-progressive protein targets is summarised. An outline is also presented, describing changes and adaptations in Japan, meeting the rising costs and challenges. Today, urgent implementation of programs to address these needs has led to a rebuilding of the entire approach of medical evaluation and clinical care.

  14. The Patient Protection and Affordable Care Act: the impact on urologic cancer care.

    Science.gov (United States)

    Keegan, Kirk A; Penson, David F

    2013-10-01

    In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the USA. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urologic cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined.

  15. Improving Goals of Care Discussion in Advanced Cancer Patients

    Science.gov (United States)

    2016-12-20

    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

  16. Panitumumab: the evidence of its therapeutic potential in metastatic colorectal cancer care

    Directory of Open Access Journals (Sweden)

    Erika Martinelli

    2007-11-01

    Full Text Available Erika Martinelli1, Floriana Morgillo1, Teresa Troiani1, Giampaolo Tortora2, Fortunato Ciardiello11Cattedra di Oncologia Medica, Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale “F. Magrassi e A. Lanzara”, Seconda Università degli Studi di Napoli, Napoli, Italy; 2Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinina, Università di Napoli Federico II, Napoli, ItalyIntroduction: Colorectal cancer is the fourth most common malignant disease. Of newly diagnosed patients, 40% have metastatic disease at diagnosis, and approximately 25% of patients with localized disease at diagnosis will ultimately develop metastatic disease. The benefits of systemic chemotherapy in the treatment of metastatic colorectal cancer over best supportive care have been established. Panitumumab (ABX-EGF is the first fully human monoclonal antibody developed for use in colorectal cancer that targets the extracellular domains of epidermal growth factor receptor.Aims: The goal of this article is to review the published evidence for the use of panitumumab in the treatment of metastatic colorectal cancer to define its therapeutic potential.Evidence review: The major evidence of panitumumab activity in colorectal cancer has appeared in meeting report abstracts. One phase II study in monotherapy, one in combination with chemotherapy, and one phase III study have included only patients with metastatic colorectal cancer.Clinical potential: To date, in phase II clinical studies panitumumab has demonstrated antitumor activity in advanced, refractory colorectal cancer. As monotherapy it resulted in a 10% response rate with 38% of patients having stable disease, and a 36% response rate with 46% stable disease when combined with chemotherapy. A phase III study indicates a clinically significant advantage of panitumumab as third-line monotherapy over best supportive care. Panitumumab appears to have a good tolerability profile, with no maximum tolerated

  17. Evaluation of the impact of interdisciplinarity in cancer care

    Directory of Open Access Journals (Sweden)

    Touati Nassera

    2011-06-01

    Full Text Available Abstract Background Teamwork is a key component of the health care renewal strategy emphasized in Quebec, elsewhere in Canada and in other countries to enhance the quality of oncology services. While this innovation would appear beneficial in theory, empirical evidences of its impact are limited. Current efforts in Quebec to encourage the development of local interdisciplinary teams in all hospitals offer a unique opportunity to assess the anticipated benefits. These teams working in hospital outpatient clinics are responsible for treatment, follow-up and patient support. The study objective is to assess the impact of interdisciplinarity on cancer patients and health professionals. Methods/Design This is a quasi-experimental study with three comparison groups distinguished by intensity of interdisciplinarity: strong, moderate and weak. The study will use a random sample of 12 local teams in Quebec, stratified by intensity of interdisciplinarity. The instrument to measure the intensity of the interdisciplinarity, developed in collaboration with experts, encompasses five dimensions referring to aspects of team structure and process. Self-administered questionnaires will be used to measure the impact of interdisciplinarity on patients (health care utilization, continuity of care and cancer services responsiveness and on professionals (professional well-being, assessment of teamwork and perception of teamwork climate. Approximately 100 health professionals working on the selected teams and 2000 patients will be recruited. Statistical analyses will include descriptive statistics and comparative analysis of the impact observed according to the strata of interdisciplinarity. Fixed and random multivariate statistical models (multilevel analyses will also be used. Discussion This study will pinpoint to what extent interdisciplinarity is linked to quality of care and meets the complex and varied needs of cancer patients. It will ascertain to what extent

  18. Medical care utilization and costs on end-of-life cancer patients: The role of hospice care.

    Science.gov (United States)

    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

    2016-11-01

    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 hospice care group had significantly less medical utilization and expenses in the last 90, 30, and 14 days of life (all P 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.

  19. Appropriateness of cardiovascular care in elderly adult cancer survivors.

    Science.gov (United States)

    Cheung, Winson Y; Levin, Raisa; Setoguchi, Soko

    2013-01-01

    Research suggests that the quality of non-cancer-related care among cancer survivors (CS) is suboptimal. Secondary disease prevention is an important component of survivorship care that has not been previously evaluated. Our aims were (1) to assess the utilization of and adherence to medications and treatments for the secondary prevention of myocardial infarction (MI) in CS versus non-cancer patients (NCP) and (2) to compare temporal trends in cardiovascular care between these two patient cohorts. Linking data from Medicare, pharmacy assistance programs, and cancer registries, we calculated the percentage of individuals receiving preventive medications (statins, β-blockers, angiotensin-converting enzyme inhibitors) and revascularization interventions (angioplasty, stent, bypass surgery) within 90 days after acute MI in CS and propensity score-matched NCP. We assessed trends over time and determined predictors of appropriate preventive care using modified Poisson regression. We identified 1,119 CS and 7,886 NCP. Compared to NCP, more survivors received statins (38 vs. 31 %) and β-blockers (67 vs. 59 %), but fewer underwent bypass surgery (1.5 vs. 2.8 %) after MI. From 1997 to 2004, both survivors and NCP were increasingly prescribed medications to prevent future coronary events. Over the same time period, receipt of bypass surgery was significantly lower among survivors. Co-morbidities, such as depression and lung disease, and demographic factors, such as advanced age and female, were associated with underuse of preventive care among survivors when compared to NCP. Use of preventive medications and procedures has generally improved, but uptake of bypass surgery among CS still lags behind NCP.

  20. Magnitude and Leading Sites of Cancer in A Tertiary Cancer Care Hospital of Western Maharashtra

    Directory of Open Access Journals (Sweden)

    Kapil H Agrawal, S.S. Rajderkar

    2011-01-01

    Full Text Available Context: It is observed that cancers are increasingly seen in both genders and all the age groups due to a complex interaction of various risk factors. To implement the Public health intervention measures it is essential to have the baseline data regarding frequency, distribution of cancers in the population. Aims: To study the magnitude of cancers by obtaining a baseline data regarding the frequency, distribution, leading cancer sites among the patients in a tertiary cancer care hospital of Western Maharashtra. Study settings: Shri Siddhivinayak Ganapati Cancer Hospital, Miraj Study Design: Hospital based, Cross sectional study involving retrospective information of patients from 1st March 2005 to 28th February 2006. Methods and Material: Retrospective, questionnaire study of patients from 1st March 2005 to 28th February 2006. Out of the total 2168 new patients registered, 1891 patients were detected to be malignant and included in the study. Results: 63.5 % Males and 67% Females in the age group 35-64 years had cancer. The sex ratio percent was 1.01%. Top five Cancer in males in our study were Oral Cavity, Oesophagus, Lung, Larynx and NHL. Top five Cancer in females in our study were Cervix, Breast, Ovary, Oral Cavity and Oesophagus. 27% were TRCs (Tobacco Related Cancers in males while 9.6% were TRCs in females. 34% cancers were in easily accessible parts of body. Conclusions: The Tobacco Related Cancers represent the most preventable form of cancer in our society. It was 27% in males and 9.6% in females in our study. Additionally 34% cancers were in easily accessible parts of body. It highlights the possibility of easy and early detection of cancers in the population thus decreasing the cancer burden in the community.

  1. Screening and prevention of breast cancer in primary care.

    Science.gov (United States)

    Tice, Jeffrey A; Kerlikowske, Karla

    2009-09-01

    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.

  2. Improving Cancer Care Through Nursing Research.

    Science.gov (United States)

    Mayer, Deborah K

    2015-09-01

    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)
.

  3. Integrating cannabis into clinical cancer care.

    Science.gov (United States)

    Abrams, D I

    2016-03-01

    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.

  4. Current good manufacturing practice production of an oncolytic recombinant vesicular stomatitis viral vector for cancer treatment.

    Science.gov (United States)

    Ausubel, L J; Meseck, M; Derecho, I; Lopez, P; Knoblauch, C; McMahon, R; Anderson, J; Dunphy, N; Quezada, V; Khan, R; Huang, P; Dang, W; Luo, M; Hsu, D; Woo, S L C; Couture, L

    2011-04-01

    Vesicular stomatitis virus (VSV) is an oncolytic virus currently being investigated as a promising tool to treat cancer because of its ability to selectively replicate in cancer cells. To enhance the oncolytic property of the nonpathologic laboratory strain of VSV, we generated a recombinant vector [rVSV(MΔ51)-M3] expressing murine gammaherpesvirus M3, a secreted viral chemokine-binding protein that binds to a broad range of mammalian chemokines with high affinity. As previously reported, when rVSV(MΔ51)-M3 was used in an orthotopic model of hepatocellular carcinoma (HCC) in rats, it suppressed inflammatory cell migration to the virus-infected tumor site, which allowed for enhanced intratumoral virus replication leading to increased tumor necrosis and substantially prolonged survival. These encouraging results led to the development of this vector for clinical translation in patients with HCC. However, a scalable current Good Manufacturing Practice (cGMP)-compliant manufacturing process has not been described for this vector. To produce the quantities of high-titer virus required for clinical trials, a process that is amenable to GMP manufacturing and scale-up was developed. We describe here a large-scale (50-liter) vector production process capable of achieving crude titers on the order of 10(9) plaque-forming units (PFU)/ml under cGMP. This process was used to generate a master virus seed stock and a clinical lot of the clinical trial agent under cGMP with an infectious viral titer of approximately 2 × 10(10) PFU/ml (total yield, 1 × 10(13) PFU). The lot has passed all U.S. Food and Drug Administration-mandated release testing and will be used in a phase 1 clinical translational trial in patients with advanced HCC.

  5. [Manual for the design of non-drug trials in primary care, taking account of Good Clinical Practice (GCP) criteria].

    Science.gov (United States)

    Joos, Stefanie; Bleidorn, Jutta; Haasenritter, Jörg; Hummers-Pradier, Eva; Peters-Klimm, Frank; Gágyor, Ildikó

    2013-01-01

    In recent years studies not falling under the German Pharmaceutical Law ("non-drug trials") have also been increasingly expected to be conducted according to Good Clinical Practice (GCP) in order to ensure that uniform standards are maintained for data quality and patient safety. However, simple transfer of the GCP criteria is not always possible and often not useful. Given the fact that research questions regarding non-drug interventions are common in primary care (e.g., general practice), the "Network for Clinical Studies in General Practice" has developed a manual for planning and conducting non-drug trials. This manual is based on the GCP guideline, taking account of the conditions and circumstances in primary care settings. Both structure and relevant content of the manual are presented in the article. (As supplied by the authors).

  6. Good quality of oral anticoagulation treatment in general practice using international normalised ratio point of care testing

    DEFF Research Database (Denmark)

    Løkkegaard, Thomas; Pedersen, Tina Heidi; Lind, Bent;

    2015-01-01

    INTRODUCTION: Oral anticoagulation treatment (OACT)with warfarin is common in general practice. Increasingly,international normalised ratio (INR) point of care testing(POCT) is being used to manage patients. The aim of thisstudy was to describe and analyse the quality of OACT withwarfarin...... was notsignificant (4.2 percentage points (pp); 95% confidenceinterval (CI): –0.8-9.2). Short sampling intervals, e.g. 10-20days (–11 pp, 95% CI: –16-–6)) and lack of diagnostic coding(–11.8 pp; 95% CI: –19.9-–3.7) were correlated with a lowTTR. CONCLUSION: In our study most of the general practices usingINR POCT...... in the management of patients in warfarintreatment provided good quality of care. Sampling intervaland diagnostic coding were significantly correlated withtreatment quality. FUNDING: The study received financial support from theSarah Krabbe Foundation, the General Practitioners’ Educationand Development Foundation...

  7. Cancer patients' use of family practice and secondary care

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Kjeldgaard, Anette Hvenegaard; Olesen, Frede

    Aims: We know that in Denmark some 90% of citizens have contact with family practice (FP) during a year and around 40% has contact with secondary care.  This demands efforts to create integrated and shared care. The aim of this study is to document the pattern of contacts with FP among patients...... population b) about 33,000 patients diagnosed with cancer in 2007, and c) about 220,000 patients living with a previous diagnosis of cancer.        Results: Data for the total population is known. The total number of contacts with FP in daytime is about 38.4 million, with out of hours service about 2...

  8. Radiology as the Point of Cancer Patient and Care Team Engagement: Applying the 4R Model at a Patient's Breast Cancer Care Initiation.

    Science.gov (United States)

    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

    2016-12-01

    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

  9. Qigong in Cancer Care: Theory, Evidence-Base, and Practice

    Directory of Open Access Journals (Sweden)

    Penelope Klein

    2017-01-01

    Full Text Available Background: The purpose of this discussion is to explore the theory, evidence base, and practice of Qigong for individuals with cancer. Questions addressed are: What is qigong? How does it work? What evidence exists supporting its practice in integrative oncology? What barriers to wide-spread programming access exist? Methods: Sources for this discussion include a review of scholarly texts, the Internet, PubMed, field observations, and expert opinion. Results: Qigong is a gentle, mind/body exercise integral within Chinese medicine. Theoretical foundations include Chinese medicine energy theory, psychoneuroimmunology, the relaxation response, the meditation effect, and epigenetics. Research supports positive effects on quality of life (QOL, fatigue, immune function and cortisol levels, and cognition for individuals with cancer. There is indirect, scientific evidence suggesting that qigong practice may positively influence cancer prevention and survival. No one Qigong exercise regimen has been established as superior. Effective protocols do have common elements: slow mindful exercise, easy to learn, breath regulation, meditation, emphasis on relaxation, and energy cultivation including mental intent and self-massage. Conclusions: Regular practice of Qigong exercise therapy has the potential to improve cancer-related QOL and is indirectly linked to cancer prevention and survival. Wide-spread access to quality Qigong in cancer care programming may be challenged by the availability of existing programming and work force capacity.

  10. Helsinn: 20 years in primary cancer supportive care.

    Science.gov (United States)

    Cantoreggi, Sergio

    2016-11-01

    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.

  11. Inoperable esophageal cancer and outcome of palliative care

    Institute of Scientific and Technical Information of China (English)

    Sima Besharat; Ali Jabbari; Shahryar Semnani; Abbasali Keshtkar; Jeran Marjani

    2008-01-01

    AIM: To determine the outcome of esophageal cancer patients referred for palliative care, in Gorgan and Gonbad gastrointestinal clinics, northeast of Iran.METHODS: This cross-sectional study was done on inoperable esophageal cancer cases referred to gastrointestinal clinics in Gorgan and Gonbad city (2005-2006). Demographic data were collected during the procedure and cases were followed up every one month. Improvement proportion was calculated with 95% confidence interval, to determine the rate of improvement. Survival analysis and Kaplan-Meier methods were used to estimate the duration of palliative care effectiveness.RESULTS: We recruited 39 cases into the study. Squamous cell carcinoma was the most prevalent (92.3%). The middle third of the esophagus was involved predominantly (51.3%). Dilation was the most preferred method (89.7%) and stenting was done in 4 cases. Decreasing dysphagia score was not related to palliation method or pathology type of carcinoma. Age of the patients was significantly related to the improvement of dysphagia score. Mean survival time was 137.6d and median was 103d.CONCLUSION: Results of this study showed a low survival rate after palliative care in esophageal cancer cases despite dysphagia scores' improvement after dilating or stenting.

  12. Fitness for work in health care workers from the prospective of ethics, science and good practices.

    Science.gov (United States)

    Alessio, L; Arici, Cecilia; Franco, G

    2012-01-01

    Fitness for work (FFW) is the final task of both risk assessment and health surveillance, aimed at protecting workers' health and working capacity. There are numerous specific concerns regarding health care workers. In particular: i) the frequent difficulty in determining at pre-employment/pre-placement examinations the specific task that the individual worker will perform; ii) the prevalence of female workers and the contemporary presence of numerous occupational risk factors that are a potential cause of harmful effects on women's reproductive health; iii) the progressive aging of the staff especially nurses; iv) the risk to third parties, with particular reference to the issues of biological risk and substance abuse, also in relation to shift work, fatigue and occupational stress; v) the increasing number of immigrant workers among support staff In such cases the occupational physician, respecting both ethical principles and regulations and with an appropriate balance between scientific evidence and the precautionary principle, should express a FFW judgment that allows both the adaptation of work to the worker and vice versa, as recommended by the World Health Organization (WHO) and the International Commission on Occupational Health (ICOH). Proper FFW judgment also permits the expected benefits to be achieved, not only for the workers but also for employers, companies and society.

  13. An evaluation of nursing care in cancer patients.

    Science.gov (United States)

    Karadeniz, G; Yanikkerem, E; Altiparmak, S; Sevil, U; Ertem, G; Esen, A

    2004-01-01

    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 patients reported that nursing management was unsatisfactory. Some demographic factors such as cultural and social status affected patients' expectations.

  14. Professionalism in global, personalized cancer care: restoring authenticity and integrity.

    Science.gov (United States)

    Surbone, Antonella

    2013-01-01

    Personalized medicine is revolutionizing cancer care and creating new expectations among oncologists and patients. At present the benefit is still marginal, however, and must be understood as incremental. In addition, cultural and resource disparities limit the sustainability of new cancer therapies on a global scale. Adequate instruments are needed to enable our exercise of sound and honest judgment in distinguishing breakthrough treatments from those that yield only marginal or doubtful improvements, and to develop strategies for formulation and correct application of balanced guidelines for sustainable cancer care. Professionalism requires that the acquisition of knowledge and skills go hand in hand with moral education in the intellectual virtues of humility, perseverance, adaptability, communicativeness, and commitment to resist self-deception or conflicts of interest. Hidden curricula undermine the moral values of medicine: these must be understood and uncovered. We should possess a special body of knowledge, skills, and values that allow us to change our practices when appropriate and to be stewards of society's limited resources through proper communication with our patients and families. In the era of personalized oncology and global issues of sustainability, professional authenticity and integrity in cancer clinical practice are key to bridging the gaps between true and false expectations of patients and the public.

  15. US Primary Care Physicians’ Prostate Cancer Screening Practices

    Directory of Open Access Journals (Sweden)

    Sun Hee Rim

    2014-12-01

    Full Text Available Background: Limited information exists on primary care physicians’ (PCPs use of the prostate-specific antigen (PSA test by patient risk category. We describe PCP responses to hypothetical patient scenario (PS involving PSA testing among high-risk asymptomatic men. Methods: Data were from the 2007 to 2008 National Survey of Primary Care Physicians’ Practices Regarding Prostate Cancer Screening. PS#1: healthy 55-year-old white male with no family history of prostate cancer; PS#2: healthy 45-year-old African American male with no family history of prostate cancer; and PS#3: healthy 50-year-old male with a family history of prostate cancer. Data were analyzed in SAS/SUDAAN. Results: Most PCPs indicated that they generally discuss the possible benefits/risks of PSA testing with the patient and then recommend the test (PS#1-PS#3 range, 53.4%-68.7%; P < .001; only about 1% reported discussing and then recommending against the test. For PS#3, compared to PS#1 and #2, PCPs were more likely to discuss and recommend the test or attempt to persuade the patient who initially declines the test. For PS#3, all clinicians generally would order/discuss the PSA test and not rely on the patient to ask. Conclusion: Clinicians treat family history as an important reason to recommend, persuade, and initiate PSA testing.

  16. The pathways of care for women diagnosed with breast cancer

    Directory of Open Access Journals (Sweden)

    Aline Machado Feijó

    2016-01-01

    Full Text Available Objective: To describe the pathways of care experienced by women with breast cancer receiving radiotherapy. Methodology: It is a descriptive, exploratory and qualitative study, conducted among women in the Radiotherapy Clinic of a Federal University in the South of Brazil. The participants were six women affected by breast cancer who were receiving radiotherapy. Data were collected through semi-structured interviews from March 2006 to December 2007. Results:The data were analyzed according to the operationalization of thematic analysis, emerging two categories: The plots of the pathways of care, and Overcoming the cancer diagnosis. Conclusions: It was perceived that pathways experienced by women affected by breast cancer involve both barriers and facilitators regarding access to health services, their relationship with professionals, and their ability to overcome. It is also considered important to have knowledge about the diagnosis of the disease in order to be an active person in this process. It is important to have well prepared health professionals and services, in order to accept women in ill situations, since support and guidance are essential to their recovery.

  17. Cancer care coordination: building a platform for the development of care coordinator roles and ongoing evaluation.

    Science.gov (United States)

    Freijser, Louise; Naccarella, Lucio; McKenzie, Rosemary; Krishnasamy, Meinir

    2015-01-01

    Continuity of care is integral to the quality and safety of care provided to people with cancer and their carers. Further evidence is required to examine the contribution Nurse Cancer Care Coordinator (NCCC) roles make in improving the continuity. The aim of the present study was to clarify the assumptions underpinning the NCCC roles and provide a basis for ongoing evaluation. The project comprised a literature review and a qualitative study to develop program logic. The participants who were purposively sampled included policy makers, practitioners, patient advocates, and researchers. Both the literature and participant reports found that NCCC roles are diverse and responsive to contextual influences to coordinate care at the individual (patient), organisational, and systems levels. The application of the program logic for the development of NCCC roles was explored. The conceptualisation of NCCC roles was also examined in relation to Boundary Spanning and Relational Coordination theory. Further research is required to examine how NCCCs contribute to improving equity, safety, quality and coordination of care. The project has implications for research, policy and practice, and makes explicit existing assumptions to provide a platform for further development and evaluation of these roles.

  18. Caring for a child with cancer: impact on mother's health.

    Science.gov (United States)

    Rafii, Forugh; Oskouie, Fatemeh; Shoghi, Mahnaz

    2014-01-01

    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.

  19. Health care restructuring and family physician care for those who died of cancer

    Directory of Open Access Journals (Sweden)

    Johnston Grace

    2005-01-01

    Full Text Available Abstract Background During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992 to 30% (1998. These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP visits to advanced cancer patients in Nova Scotia (NS during the years of health care restructuring. Methods Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics, the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000. Subjects: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212. Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department, time of day (regular hours, after hours, total length of inpatient hospital stay and number of hospital admissions during the last six months of life. Results In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED, 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP

  20. Palliative Care Improves Survival, Quality of Life in Advanced Lung Cancer | Division of Cancer Prevention

    Science.gov (United States)

    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. |

  1. Integrative cancer care in a US academic cancer centre: The Memorial Sloan-Kettering Experience.

    Science.gov (United States)

    Deng, G

    2008-08-01

    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.

  2. Integrative Cancer Care in a US Academic Cancer Centre: The Memorial Sloan–Kettering Experience

    Science.gov (United States)

    Deng, G.

    2008-01-01

    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

  3. Symptom interpretation and health care seeking in ovarian cancer

    Directory of Open Access Journals (Sweden)

    Blaakaer Jan

    2011-06-01

    Full Text Available Abstract Background Ovarian cancer is the leading cause of death among women suffering from gynaecological malignancies in the Western world. Worldwide, approximately 200,000 women are diagnosed with the disease each year. This article deals with the health care seeking and symptom interpretation process among Danish women, who have a very high mortality rate. Methods The health seeking and symptom interpretation process was analysed via combining study methods. The material consisted of registry data dealing with the use of public health care and hospital services of Danish women, newly diagnosed with ovarian cancer. These results were combined with findings from semi-structured qualitative research interviews on women's bodily experiences with symptom development. Results A number of 663 Danish women with ovarian cancer attended 27 different kinds of primary health care providers in a total of 14,009 visits during 2007. The women also had 6,214 contacts with various hospitals, and obtained 562 different diagnoses. From the main theme "Women's experiences with the onset of symptoms" three sub-themes were identified: "Bodily sensations", "From bodily sensation to symptom", and "Health seeking and treatment start". In all cases the General Practitioner represented the first contact to public health care, acting as gate-keeper to specialist and hospital referral. The women were major users of public health care throughout the diagnostic process and subsequent treatment. All women held personal knowledge concerning the onset of their symptoms. The early symptoms of ovarian cancer might be uncharacteristic and non-disease-specific when interpreted as personal experiences, but they had similarities when analysed together. Conclusions Diagnostic delay in ovarian cancer seems far from being exclusively a medical problem, as the delay proved to be influenced by organisational, cultural, and social factors, too. Initiatives facilitating the diagnostic

  4. [Essentials for transition of palliative care patients to palliative home care and for management of their cancer pain].

    Science.gov (United States)

    Koshikawa, Takafumi; Shimoyama, Naohito

    2006-05-01

    Multi-disciplinary team work among visiting doctors, nurses, care managers and pharmacists located close to the patient's home is essential for smooth transition of a palliative care patient from hospital care to palliative home care and should be set up prior to the patient's discharge from the hospital. Palliative home care physicians should have knowledge of the fundamental support by the government to spare excessive cost to the patients. As for cancer pain management, opioid-centered analgesic therapies have lead to better quality home care for patients. In Japan, although oxycodone SRs and fentanyl patches are available besides morphine, there is no rescue opioid other than morphine. On the other hand, some cancer pain refractory to opioids such as neuropathic cancer pain should be carefully treated by adjuvant analgesics in conjunction with non-pharmacological treatments.

  5. Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study

    DEFF Research Database (Denmark)

    Devillé, Walter; Greacen, Tim; Bogic, Marija;

    2011-01-01

    and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. Methods: A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four...... to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider...

  6. Cancer patient-centered home care: a new model for health care in oncology

    Directory of Open Access Journals (Sweden)

    Tralongo P

    2011-09-01

    Full Text Available Paolo Tralongo1, Francesco Ferraù2, Nicolò Borsellino3, Francesco Verderame4, Michele Caruso5, Dario Giuffrida6, Alfredo Butera7, Vittorio Gebbia81Medical Oncology Unit, Azienda Sanitaria Provinciale, Siracusa; 2Medical Oncology Unit, Ospedale San Vincenzo, Taormina; 3Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo; 4Medical Oncology Unit, Ospedale Giovanni Paolo II, Sciacca; 5Medical Oncology Unit, Istituto Humanitas, Catania; 6Medical Oncology Unit, Istituto Oncologico del Mediterraneo, Catania; 7Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento; 8Medical Oncology Unit, Dipartimento Oncologico, La Maddalena, Università degli Studi, Palermo, ItalyAbstract: Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients' needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients' needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.Keywords: cancer, home care

  7. Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901

    Science.gov (United States)

    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.

    2015-01-01

    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

  8. [Is "mental health" part of the common good? The sociopolitical framework of psychiatric ethics and the responsibility of health-care elites].

    Science.gov (United States)

    Bohlken, Eike

    2014-07-01

    Psychiatric work can only be that ethical as the framework of a health-care system allows. Thus, the responsibility of the health-care elites to establish a sociopolitical framework that suits psychiatric ethics is discussed on the basis of a theory of the common good and of a philosophical and normative elite theory. "Mental health" is demonstrated to be part of a basic sphere of the common good which cannot be denied to any member of a society. The final section discusses which specific duties can be derived for health-care elites on the ground of the aforementioned conception of "mental health" as a part of the common good.

  9. Promoting Patient and Caregiver Engagement to Care in Cancer

    Directory of Open Access Journals (Sweden)

    Emanuela Saita

    2016-10-01

    Full Text Available 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.

  10. Virtual reality for the palliative care of cancer.

    Science.gov (United States)

    Oyama, H

    1997-01-01

    We have been developing a VR system to provide patients with emotional support and to encourage them to assume an active life against cancer, since patients with an active lifestyle survive longer than those with a passive lifestyle. A possible explanation for this latter fact is that psychological stimulation may also activate the endocrine system and the immune system. Both systems may be able to rapidly repair tissue damaged by cancer and change the characteristics of the cancer itself. Although microelectrical analysis and molecular and genetic analyses are rapidly solving the riddles of the relationship between the brain and thought, we think that our VR research for palliative medicine may also play an important role in this area with regard to the development of new tools for treatment and support. This notion is based on the hypothesis that the brain can reorganize itself to compensate for irrationality or inappropriateness through pharmacological adaptation and/or anatomical regeneration of synapses. Another reason why VR research in palliative medicine is useful is that VR techniques represent not only an enhanced human-machine interface, but also an enhanced human communication technology. VR technology may also be used to help patients accept their disease. The mental state of a patient in the terminal stage of cancer changes step by step from denial of cancer, hope for a new treatment for cancer, suspicion of medical treatment, uneasiness regarding their future life, irritation, depression, and acceptance or despair. We plan to develop a new type of counseling system in medical cyberspace to provide mental care. It can also be used for group therapy or humor therapy to reduce loneliness. In summary, we conclude that VR technology can be applied to palliative medicine (1) to support communication between the patient and others, (2) to provide psychological support to treat neurosis and help to stabilize the patient's mental state, and (3) to actually

  11. Will patients benefit from regionalization of gynecologic cancer care?

    Directory of Open Access Journals (Sweden)

    Kathleen F Brookfield

    Full Text Available OBJECTIVE: Patient chances for cure and palliation for a variety of malignancies may be greatly affected by the care provided by a treating hospital. We sought to determine the effect of volume and teaching status on patient outcomes for five gynecologic malignancies: endometrial, cervical, ovarian and vulvar carcinoma and uterine sarcoma. METHODS: The Florida Cancer Data System dataset was queried for all patients undergoing treatment for gynecologic cancers from 1990-2000. RESULTS: Overall, 48,981 patients with gynecologic malignancies were identified. Endometrial tumors were the most common, representing 43.2% of the entire cohort, followed by ovarian cancer (30.9%, cervical cancer (20.8%, vulvar cancer (4.6%, and uterine sarcoma (0.5%. By univariate analysis, although patients treated at high volume centers (HVC were significantly younger, they benefited from an improved short-term (30-day and/or 90-day survival for cervical, ovarian and endometrial cancers. Multivariate analysis (MVA, however, failed to demonstrate significant survival benefit for gynecologic cancer patients treated at teaching facilities (TF or HVC. Significant prognostic factors at presentation by MVA were age over 65 (HR = 2.6, p<0.01, African-American race (HR = 1.36, p<0.01, and advanced stage (regional HR = 2.08, p<0.01; advanced HR = 3.82, p<0.01, respectively. Surgery and use of chemotherapy were each significantly associated with improved survival. CONCLUSION: No difference in patient survival was observed for any gynecologic malignancy based upon treating hospital teaching or volume status. Although instances of improved outcomes may occur, overall further regionalization would not appear to significantly improve patient survival.

  12. Quality improvement by implementing an integrated oncological care pathway for breast cancer patients

    NARCIS (Netherlands)

    van Hoeve, J.; de Munck, L.; Otter, Renee; de Vries, J.; Siesling, S.

    2014-01-01

    Background and aim: In cancer care, more and more systemized approaches such as care pathways are used to reduce variation, reduce waiting- and throughput times and to improve quality of care. The aim of this study was to determine whether the implementation of a multidisciplinary breast cancer path

  13. Quality improvement by implementing an integrated oncological care pathway for breast cancer patients

    NARCIS (Netherlands)

    Hoeve, van J.; Munck, de L.; Otter, R.; Vries, de J.; Siesling, S.

    2014-01-01

    Background and aim In cancer care, more and more systemized approaches such as care pathways are used to reduce variation, reduce waiting- and throughput times and to improve quality of care. The aim of this study was to determine whether the implementation of a multidisciplinary breast cancer pathw

  14. The role of a community palliative care specialist nurse team in caring for people with metastatic breast cancer.

    Science.gov (United States)

    Leadbeater, Maria

    2013-02-01

    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.

  15. Integrating Palliative Care in Pediatric Oncology: An Evolving Paradigm for Comprehensive Cancer Care

    Science.gov (United States)

    Levine, Deena R.; Johnson, Liza-Marie; Snyder, Angela; Wiser, Robert K.; Gibson, Deborah; Kane, Javier R.; Baker, Justin N.

    2017-01-01

    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

  16. [Good practice in occupational health services: prophylactic care and occupational activation of people with disabilities due to respiratory diseases].

    Science.gov (United States)

    Wiszniewska, Marta; Tymoszuk, Diana; Lipińska-Ojrzanowska, Agnieszka; Wagrowska-Koski, Ewa; Walusiak-Skorupa, Jolanta

    2013-01-01

    Respiratory diseases are a cause of long-term sickness absence, and even of partial or complete inability to work. This paper presents the first in Poland description of principles of good practice in occupational health service provided for people with respiratory diseases. The issues concerning the certification of the ability to work in this group of patients are discussed. The key-principles of preventive care of workers with obstructive and interstitial lung diseases with particular attention paid to the control of major risk factors are also presented. The importance of possible contraindications for job performance by workers affected by these diseases, as well as the responsibilities of occupational health physicians were highlighted. M

  17. Estimation of Hospital Costs for Colorectal Cancer Care for Nova Scotia

    Directory of Open Access Journals (Sweden)

    Brian D O'Brien

    2001-01-01

    Full Text Available BACKGROUND: Colorectal cancer (CRC is the second most common invasive cancer in Canada. Estimates of the costs of care allow estimation of the cost effectiveness of screening for premalignant and early disease.

  18. Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care.

    Science.gov (United States)

    Feucht, Ute D; Meyer, Anell; Thomas, Winifred N; Forsyth, Brian W C; Kruger, Mariana

    2016-01-01

    HIV-infected children require early initiation of antiretroviral therapy (ART) to ensure good outcomes. The aim was to investigate missed opportunities in childhood HIV diagnosis leading to delayed ART initiation. Baseline data were reviewed of all children aged HIV services in Gauteng, South Africa. Of the 250 children, one-quarter (24.5%) was of school-going age, 34.5% in the preschool group, 18% between 6 and 12 months old and 23% below 6 months of age (median age = 1.5 years [interquartile range 0.5-4.8]). Most children (82%) presented with advanced/severe HIV disease, particularly those aged 6-12 months (95%). Malnutrition was prominent and referrals were mostly from hospital inpatient services (61%). A structured caregiver interview was conducted in a subgroup, with detailed review of medical records and HIV results. The majority (≥89%) of the 65 interviewed caregivers reported good access to routine healthcare, except for postnatal care (26%). Maternal HIV-testing was mostly done during the second and third pregnancy trimesters (69%). Maternal non-disclosure of HIV status was common (63%) and 83% of mothers reported a lack of psychosocial support. Routine infant HIV-testing was not done in 66%, and inadequate reporting on patient-held records (Road-to-Health Cards/Booklets) occurred frequently (74%). Children with symptomatic HIV disease were not investigated at primary healthcare in 53%, and in 68% of families the siblings were not tested. One-third of children (35%) had a previous HIV diagnosis, with 77% of caregivers aware of these prior results, while 50% acknowledged failing to attend ART services despite referral. In conclusion, a clear strategy on paediatric HIV case finding, especially at primary healthcare, is vital. Multiple barriers need to be overcome in the HIV care pathway to reach high uptake of services, of which especially maternal reasons for not attending paediatric ART services need further exploration.

  19. Building A Health Care Data Warehouse for Cancer Diseases

    Directory of Open Access Journals (Sweden)

    Osama E.Sheta

    2012-11-01

    Full Text Available This paper presents architecture for health care data warehouse specific to cancer diseases which could be used by executive managers, doctors, physicians and other health professionals to support the healthcare process. The data today existing in multi sources with different formats makes it necessary to have some techniques for data integration. Executive managers need access to Information so that decision makers can react in real time to changing needs. Information is one of the most factors to an organization success that executive managers or physicians would need to base their decisions on, during decisionmaking. A health care data warehouse is therefore necessary to integrate the different data sources into a central data repository and analysis this data.

  20. A comparative study of the palliative care needs of heart failure and cancer patients.

    LENUS (Irish Health Repository)

    O'Leary, Norma

    2012-02-01

    AIMS: Studies suggest that patients with advanced heart failure (HF) have unmet palliative care (PC) needs. However, many of these studies have been retrospective or based on patients receiving poorly coordinated ad hoc care. We aimed to demonstrate whether the PC needs of patients with advanced HF receiving specialist multidisciplinary coordinated care are similar to cancer patients deemed to have specialist PC needs; thereby justifying the extension of specialist PC services to HF patients. METHODS AND RESULTS: This was a cross-sectional comparative cohort study of 50 HF patients and 50 cancer patients, using quantitative and qualitative methods. Both patient cohorts were statistically indistinguishable in terms of symptom burden, emotional wellbeing, and quality-of-life scores. HF patients had good access to community and social support. HF patients particularly valued the close supervision, medication monitoring, ease of access to service, telephone support, and key worker provided at the HF unit. A small subset of patients had unmet PC needs. A palliative transition point is described. CONCLUSION: HF patients should not be excluded from specialist PC services. However, the majority of their needs can be met at a HF unit. Recognition of the palliative transition point may be key to ensuring that end-of-life issues are addressed. The palliative transition point needs further evaluation.

  1. Interpersonal complaints regarding cancer care through a gender lens.

    Science.gov (United States)

    Olsson, Erik Masao

    2016-07-11

    Purpose - The purpose of this paper is to investigate healthcare customer complaints concerning interpersonal matters in cancer care. Design/methodology/approach - Complaints from cancer patients and their relatives (n=116) that dealt with interpersonal matters registered between 2009 and 2011 at four local Patients' Advisory Committees in Western Sweden were sampled and analyzed using qualitative content analysis. Findings - Complaints concerned lack of information and consideration from healthcare providers. Lack of empathy and civility also caused dissatisfaction, the latter particularly for women. Relatives complained that they did not feel included in the care process or were not offered proper support. Most complaints by relatives were filed by a female relative and concerned a male patient. Research limitations/implications - Information about patient demographics other than gender could not be investigated due to database limitations. Hence, factors such as age, country of birth, and geographical residence were not included for analysis. In addition, neither the type nor stage of cancer among the sampled patients was able to be addressed. Practical implications - Patient complaints should not only be viewed as a post-consumption judgment, but also as a service interaction activity. This may require healthcare providers to enhance their interpersonal skills, allowing patients and relatives to provide feedback during service interaction to satisfactorily address dissatisfaction. Visualizing gender disparities may help healthcare providers prevent stereotypical encounters. In addition, the provider should be invited to participate in the customer's value creating network, which may also include knowledge and skills from other sources, such as relatives. Originality/value - Value co-creation offers a different view on patient complaints. Incorporating social construction into value co-creation may reveal socially constructed disparities. The paper provides

  2. The diagnostic process of cervical cancer; areas of good practice, and windows of opportunity

    NARCIS (Netherlands)

    Zaal, A.; de Wilde, Marlieke; Duk, M.J.; Graziosi, G.C.M.; van Haaften, Maarten; von Mensdorff-Pouilly, S.; van Diest, Paul J.; Zweemer, RP; Peeters, Petra H.M.; Verheijen, RHM

    2015-01-01

    Objective Despite an extensive screening programme in The Netherlands, some cases of cervical cancer are still diagnosed in late stages of disease. The aim of the present study was to investigate which elements in the diagnostic process of cervical cancer may be improved. Methods This is a retrospec

  3. The WHOQOL-100 has good psychometric properties in breast cancer patients

    NARCIS (Netherlands)

    B.L. den Oudsten; G.L. van Heck; A.F.W. van der Steeg; J.A. Roukema; J. de Vries

    2009-01-01

    OBJECTIVE: This prospective follow-up study examines the psychometric properties of the World Health Organization Quality of Life assessment instrument (WHOQOL-100) for assessing quality of life in women suspected of having breast cancer and disease-free breast cancer survivors. STUDY DESIGN AND SET

  4. The professional role of breast cancer nurses in multi-disciplinary breast cancer care teams.

    Science.gov (United States)

    Amir, Z; Scully, J; Borrill, C

    2004-12-01

    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.

  5. Healing environments in cancer treatment and care. Relations of space and practice in hematological cancer treatment

    DEFF Research Database (Denmark)

    Høybye, Mette Terp

    2013-01-01

    to incite an experience of homeliness and care. Furthermore, cancer patients continuously challenge the use and limits of space by individual objects and practices of privacy and home. Discussion. Healing environments are complex relations between practices, space and care, where recognition...... to the need for fl exible spaces in hospitals that recognize the dynamics of healing, by providing individualized care, relating to the particular and changing needs of patients supporting their potential and their challenged condition with the best care possible....... these concepts, the study demonstrates how the hospital environment is a fl ow of relations between space and practice that changes and challenges a structural idea of design and healing. Patients ’ sense of healing changes with the experience of progression in treatment and the capacity of the hospital space...

  6. Quality of Cancer Care Among Foreign-Born and US-Born Patients With Lung or Colorectal Cancer

    DEFF Research Database (Denmark)

    Nielsen, Signe Smith; He, Yulei; Ayanian, John Z.

    2010-01-01

      BACKGROUND: Disparities in care have been documented for foreign-born cancer patients in the United States. However, few data are available regarding patients with lung and colorectal cancer. In the current study, the authors assessed whether patient-reported quality and receipt of recommended...... and radiotherapy for stage II/III rectal cancer (AOR, 0.35; 95% CI, 0.12-0.99). Rates of other treatments did not differ significantly by nativity. CONCLUSIONS: Foreign-born cancer patients reported lower quality of care and were less likely to receive some cancer therapies than patients born in the Unites States...

  7. Alliance Against Cancer, the network of Italian cancer centers bridging research and care.

    Science.gov (United States)

    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

    2015-11-14

    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.

  8. Attributes of patient-centered primary care associated with the public perception of good healthcare quality in Brazil, Colombia, Mexico and El Salvador.

    Science.gov (United States)

    Doubova, Svetlana V; Guanais, Frederico C; Pérez-Cuevas, Ricardo; Canning, David; Macinko, James; Reich, Michael R

    2016-09-01

    This study evaluated primary care attributes of patient-centered care associated with the public perception of good quality in Brazil, Colombia, Mexico and El Salvador. We conducted a secondary data analysis of a Latin American survey on public perceptions and experiences with healthcare systems. The primary care attributes examined were access, coordination, provider-patient communication, provision of health-related information and emotional support. A double-weighted multiple Poisson regression with robust variance model was performed. The study included between 1500 and 1503 adults in each country. The results identified four significant gaps in the provision of primary care: not all respondents had a regular place of care or a regular primary care doctor (Brazil 35.7%, Colombia 28.4%, Mexico 22% and El Salvador 45.4%). The communication with the primary care clinic was difficult (Brazil 44.2%, Colombia 41.3%, Mexico 45.1% and El Salvador 56.7%). There was a lack of coordination of care (Brazil 78.4%, Colombia 52.3%, Mexico 48% and El Salvador 55.9%). Also, there was a lack of information about healthy diet (Brazil 21.7%, Colombia 32.9%, Mexico 16.9% and El Salvador 20.8%). The public's perception of good quality was variable (Brazil 67%, Colombia 71.1%, Mexico 79.6% and El Salvador 79.5%). The primary care attributes associated with the perception of good quality were a primary care provider 'who knows relevant information about a patient's medical history', 'solves most of the health problems', 'spends enough time with the patient', 'coordinates healthcare' and a 'primary care clinic that is easy to communicate with'. In conclusion, the public has a positive perception of the quality of primary care, although it has unfulfilled expectations; further efforts are necessary to improve the provision of patient-centered primary care services in these four Latin American countries.

  9. Good practice in mental health care for socially marginalised groups in Europe: a qualitative study of expert views in 14 countries

    Directory of Open Access Journals (Sweden)

    Priebe Stefan

    2012-03-01

    Full Text Available Abstract Background Socially marginalised groups tend to have higher rates of mental disorders than the general population and can be difficult to engage in health care. Providing mental health care for these groups represents a particular challenge, and evidence on good practice is required. This study explored the experiences and views of experts in 14 European countries regarding mental health care for six socially marginalised groups: long-term unemployed; street sex workers; homeless; refugees/asylum seekers; irregular migrants and members of the travelling communities. Methods Two highly deprived areas were selected in the capital cities of 14 countries, and experts were interviewed for each of the six marginalised groups. Semi-structured interviews with case vignettes were conducted to explore experiences of good practice and analysed using thematic analysis. Results In a total of 154 interviews, four components of good practice were identified across all six groups: a establishing outreach programmes to identify and engage with individuals with mental disorders; b facilitating access to services that provide different aspects of health care, including mental health care, and thus reducing the need for further referrals; c strengthening the collaboration and co-ordination between different services; and d disseminating information on services both to marginalised groups and to practitioners in the area. Conclusions Experts across Europe hold similar views on what constitutes good practice in mental health care for marginalised groups. Care may be improved through better service organisation, coordination and information.

  10. Observation as Good as Surgery for Some Men with Prostate Cancer

    Science.gov (United States)

    Many men diagnosed with early-stage prostate cancer could forego radical prostatectomy and live as long as men who have immediate surgery, according to long-awaited results from a clinical trial published July 19, 2012, in NEJM.

  11. What are the current barriers to effective cancer care coordination? A qualitative study

    Directory of Open Access Journals (Sweden)

    Solomon Michael J

    2010-05-01

    Full Text Available Abstract Background National cancer policies identify the improvement of care coordination as a priority to improve the delivery of health services for people with cancer. Identification of the current barriers to effective cancer care coordination is needed to drive service improvement. Methods A qualitative study was undertaken in which semi-structured individual interviews and focus groups were conducted with those best placed to identify issues; patients who had been treated for a range of cancers and their carers as well as health professionals involved in providing cancer care. Data collection continued until saturation of concepts was reached. A grounded theory influenced approach was used to explore the participants' experiences and views of cancer care coordination. Results Overall, 20 patients, four carers and 29 health professionals participated. Barriers to cancer care coordination related to six aspects of care namely, recognising health professional roles and responsibilities, implementing comprehensive multidisciplinary team meetings, transitioning of care: falling through the cracks, inadequate communication between specialist and primary care, inequitable access to health services and managing scarce resources. Conclusions This study has identified a number of barriers to coordination of cancer care. Development and evaluation of interventions based on these findings is now required.

  12. The War on Cancer: Cold Spring Harbor Laboratory Is Fighting the Good Fight.

    Science.gov (United States)

    Mertz, Leslie

    2017-01-01

    Located on the north shore of Long Island in New York, Cold Spring Harbor Laboratory (Figure 1) started out with a marine biology emphasis at the end of the 19th century, but it soon established itself as a prominent cancer research facility. That strong emphasis on cancer work continues today as this private, not-for-profit research institution enters its 127th year (Figure 2).

  13. Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer

    Science.gov (United States)

    Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney M.; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A.

    2015-01-01

    Abstract Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care. PMID:26186553

  14. Spiritual concerns in Hindu cancer patients undergoing palliative care: A qualitative study

    Directory of Open Access Journals (Sweden)

    Srinagesh Simha

    2013-01-01

    Full Text Available Aims: Spiritual concerns are being identified as important components of palliative care. The aim of this study was to explore the nature of spiritual concerns in cancer patients undergoing palliative care in a hospice in India. Materials and Methods: The methodology used was a qualitative method: Interpretive phenomenological analysis. A semi-structured interview guide was used to collect data, based on Indian and western literature reports. Certain aspects like karma and pooja, relevant to Hindus, were included. Theme saturation was achieved on interviewing 10 participants. Results: The seven most common spiritual concerns reported were benefit of pooja, faith in God, concern about the future, concept of rebirth, acceptance of one′s situation, belief in karma, and the question "Why me?" No participant expressed four of the concerns studied: Loneliness, need of seeking forgiveness from others, not being remembered later, and religious struggle. Conclusions: This study confirms that there are spiritual concerns reported by patients receiving palliative care. The qualitative descriptions give a good idea about these experiences, and how patients deal with them. The study indicates the need for adequate attention to spiritual aspects during palliative care.

  15. Survivorship care for older adults with cancer: U13 conference report.

    Science.gov (United States)

    Guerard, Emily J; Nightingale, Ginah; Bellizzi, Keith; Burhenn, Peggy; Rosko, Ashley; Artz, Andrew S; Korc-Grodzicki, Beatriz; Canin, Beverly; Dale, William; Ferrell, Betty

    2016-07-01

    Older adult cancer survivors currently account for almost 60% of all cancer survivors. The number of older cancer survivors will continue to increase as the population ages and as patients' live longer after a cancer diagnosis. As part of cancer center accreditation, the American College of Surgeons Commission on Cancer® (CoC) has placed great importance on survivorship care planning. While the CoC has set standards for general survivorship care, there is sparse evidence on how to best care for older adult cancer survivors. Concern exists among the medical community that survivorship care plans could increase paperwork without improving outcomes. Given the diverse and unique needs of older adult cancer survivors, the inter-professional team provides a structure and process for survivorship care built around the particular needs of older adults. The Cancer and Aging Research Group (CARG), in partnership with the NIA/NCI, held a U13 conference in May 2015 in part to discuss survivorship care for older adults with cancer. This report discusses four themes that emerged from one section of the conference: (1) survivorship care is a process that continually evolves to meet the needs of older adults; (2) older adult cancer survivors have unique needs and care plans should be tailored to meet these needs; (3) the inter-professional team is ideally suited to structure survivorship care of older adults; (4) patient advocacy must be encouraged throughout the cancer care continuum. As evidence based survivorship practices develop, the unique needs of older adults need to be given substantial attention.

  16. Quality of life among immigrant Latina breast cancer survivors: realities of culture and enhancing cancer care.

    Science.gov (United States)

    Lopez-Class, Maria; Perret-Gentil, Monique; Kreling, Barbara; Caicedo, Larisa; Mandelblatt, Jeanne; Graves, Kristi D

    2011-12-01

    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.

  17. American Society of Clinical Oncology guidance statement: the cost of cancer care.

    Science.gov (United States)

    Meropol, Neal J; Schrag, Deborah; Smith, Thomas J; Mulvey, Therese M; Langdon, Robert M; Blum, Diane; Ubel, Peter A; Schnipper, Lowell E

    2009-08-10

    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

  18. Illness perceptions in relation to experiences of contemporary cancer care settings among colorectal cancer survivors and their partners.

    Science.gov (United States)

    Johansson, Ann-Caroline; Axelsson, Malin; Berndtsson, Ina; Brink, Eva

    2014-01-01

    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

  19. Financial Burden of Cancer Care - Life After Cancer Summary Table | Cancer Trends Progress Report

    Science.gov (United States)

    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.

  20. Integration of Early Specialist Palliative Care in Cancer Care and Patient Related Outcomes: A Critical Review of Evidence

    Science.gov (United States)

    Salins, Naveen; Ramanjulu, Raghavendra; Patra, Lipika; Deodhar, Jayita; Muckaden, Mary Ann

    2016-01-01

    Introduction: World Health Organization and American Society of Clinical Oncology recommend early integration of specialist palliative care in patients with cancer. This paper focuses on critical review of evidence on integration of early specialist palliative care in cancer care and patient-related outcomes. Methods: The question for the literature search was – Does integration of early specialist palliative care in cancer care influences patient-related outcomes? 31 articles related to literature search review question were included in this paper. Results: Ten patient-related outcomes of early specialist palliative care in adult cancer care was studied. Studies by Temel et al. (2012), Bakitas et al. (2009), Zimmermann et al. (2014), Rugno et al. (2014), Lowery et al. (2013) and Walker et al. (2014) showed early specialist palliative care improves health-related quality of life (HRQOL). Studies by Pirl et al. (2012), Lowery et al. (2013), and Walker et al. (2014) showed early specialist palliative care improved mood depression and anxiety. Studies by Zimmermann et al. and Rugno et al. (2014) showed symptom control benefit of early specialist palliative care. Studies by Temel (2010), Bakitas (2015) and Rugno et al. (2014) showed survival improvement with early specialist palliative care. All these studies were carried in ambulatory palliative care setting. No survival benefit of palliative care intervention was seen in inpatient palliative care setting. The studies by Geer et al. (2012), Rugno et al. (2014), and Lowery et al. (2013) showed that early palliative care intervention positively influences treatment decision making. All the studies showed that palliative care intervention group received less intravenous chemotherapy in last few weeks of life. Studies by Yoong et al. and Temel et al. (2011) shows early specialist palliative care improves advanced care planning. Studies by Temel et al. (2010), Greer et al. (2012), McNamara et al. (2013), Hui et al. (2014

  1. Challenges in Prevention and Care Delivery for Women with Cervical Cancer in Sub-Saharan Africa

    OpenAIRE

    Randall, Thomas C.; Ghebre, Rahel

    2016-01-01

    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-Sahar...

  2. 77 FR 58338 - Trade Regulation Rule on Care Labeling of Textile Wearing Apparel and Certain Piece Goods

    Science.gov (United States)

    2012-09-20

    ..., such as a barcode, QR code, or an RFID chip.\\118\\ It explained that the code would include a... for Care Instructions on Textile Products,'' or ISO 3758:2005(E), ``Textiles--Care labelling code... Care Instructions on Textile Products,'' and ISO 3758:2005(E), ``Textiles--Care labelling code...

  3. The national database of hospital-based cancer registries: a nationwide infrastructure to support evidence-based cancer care and cancer control policy in Japan.

    Science.gov (United States)

    Higashi, Takahiro; Nakamura, Fumiaki; Shibata, Akiko; Emori, Yoshiko; Nishimoto, Hiroshi

    2014-01-01

    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.

  4. Immunity, inflammation, and cancer: an eternal fight between good and evil.

    Science.gov (United States)

    Shalapour, Shabnam; Karin, Michael

    2015-09-01

    Cancer development and its response to therapy are strongly influenced by innate and adaptive immunity, which either promote or attenuate tumorigenesis and can have opposing effects on therapeutic outcome. Chronic inflammation promotes tumor development, progression, and metastatic dissemination, as well as treatment resistance. However, cancer development and malignant progression are also associated with accumulation of genetic alterations and loss of normal regulatory processes, which cause expression of tumor-specific antigens and tumor-associated antigens (TAAs) that can activate antitumor immune responses. Although signals that trigger acute inflammatory reactions often stimulate dendritic cell maturation and antigen presentation, chronic inflammation can be immunosuppressive. This antagonism between inflammation and immunity also affects the outcome of cancer treatment and needs to be considered when designing new therapeutic approaches.

  5. Supportive nursing care around breast cancer surgery : An evaluation of the 1997 status in The Netherlands

    NARCIS (Netherlands)

    Thijs-Boer, FM; de Kruif, ATC; van de Wiel, HBM

    1999-01-01

    This study aimed to assess nurses' involvement in the supportive care of patients with recently diagnosed breast cancer in Dutch hospitals. A questionnaire used to evaluate various aspects of nursing care for breast cancer patients was sent to the surgical nursing teams in all 120 Dutch hospitals th

  6. Two decades of external peer review of cancer care in general hospitals; the Dutch experience

    NARCIS (Netherlands)

    Kilsdonk, M.J.; Siesling, S.; Otter, R.; Harten, van W.H.

    2015-01-01

    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 we

  7. The need for hospital care of patients with clinically localized prostate cancer managed by noncurative intent

    DEFF Research Database (Denmark)

    Brasso, Klaus; Friis, S; Juel, K;

    2000-01-01

    We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy.......We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy....

  8. A nurse practitioner-led urgent care center: meeting the needs of the patient with cancer.

    Science.gov (United States)

    Ruegg, Tracy A

    2013-08-01

    Providing comprehensive care for patients with cancer is complex with regard to severe treatment-related side effects. Hundreds of thousands of patients with cancer visit the emergency department (ED) each year, and more than half report multiple visits. In the United States, few of the National Cancer Institute-designated cancer centers have an ED specifically for patients with cancer. EDs often are an overcrowded and expensive way in which to care for the urgent needs of patients with cancer. In addition, a looming shortage exists for both primary care providers and oncologists who can address symptom issues. As the Affordable Care Act is implemented, more patients will enter the healthcare system, placing a demand on providers that the current supply cannot meet. A report from the Institute of Medicine advocates that nurse practitioners (NPs) are more than competent to provide for the unique urgent care needs of patients with cancer. The aim of this article is to describe an NP-led urgent care center for patients with cancer and how that care center provides access to vital, expeditious, and cost-effective care.

  9. Living in the face of death: Studies on palliative care in upper GI cancer patients

    NARCIS (Netherlands)

    M.J. Uitdehaag (Madeleen)

    2012-01-01

    textabstractThis thesis explores palliative care provided to patients with advanced upper gastrointestinal (GI) cancer. The 5-year survival rates for these cancer sites range between 4 and 17%, which implies that many of these patients require palliative care. Considering the fact that there is no u

  10. Factors contributing to late breast cancer presentation for health care amongst women in Kumasi, Ghana

    Directory of Open Access Journals (Sweden)

    Comfort Asoogo

    2015-02-01

    Full Text Available Background: Delay in presenting breast cancer for health care is dangerous because it can increase the mortality rate amongst affected women. Delaying health care and treatment makes it difficult to manage advanced breast cancer successfully. Understanding the factors that contribute to delays in presentation for health care can save lives.Objectives: The purpose of the study was to describe the factors which contribute to the latepresentation of Ghanaian women with breast cancer for health care at a tertiary hospital in Kumasi, Ghana.Method: A descriptive qualitative research design was utilised to answer the research question: ‘What factors contribute to presenting with late breast cancer for health care amongst Ghanaian women who were treated for breast cancer at a tertiary hospital in Kumasi, Ghana?’ A sample of 30 women diagnosed with breast cancer and presented with Stage II and Stage III participated in the study. Semi-structured interviews and field notes were conducted for data collection. Content data analysis was used in line with the research question.Findings: Five themes were discovered as findings. These were: lack of knowledge about breast cancer; fear of cancer treatment and its outcomes; poverty; traditional and spiritual beliefs and treatments and caring for others.Conclusions: We recommend the development of breast cancer awareness programmes and health education at primary health care level.

  11. TRP channels in prostate cancer: the good,the bad and the ugly?

    Institute of Scientific and Technical Information of China (English)

    Dimitra Gkikal; Natalia Prevarskaya

    2011-01-01

    @@ During the last decade,transient receptor potential (TRP) channels emerge as key proteins in central mechanisms of the carcinogenesis such as cell proliferation,apoptosis and migration.Initial studies showed that expression profile of some TRP channels,notably TRP melastatin 8 (TRPM8),TRP vanilloid 6 (TRPV6),TRP canonical (TRPC6) and TRPV2,is changing during the development and the progression of prostate cancer towards the hormone-refractory stages.The link between the change in expression levels and the functional role of these channels in prostate cancer is step by step being elucidated.These recent advances are here described and discussed.

  12. [Certified prostate cancer centers and second opinion centers for testicular cancer: successful models of uro-oncology cancer care].

    Science.gov (United States)

    Gschwend, J E; Albers, P; Schrader, M

    2011-08-01

    Establishment of organ site-specific cancer centers by the German Cancer Society (GCS) is part of the basic politically driven reform of oncology care in Germany. Since 2007 an increasing number of prostate cancer centers have been guided toward certification by the OnkoZert GmbH of the GCS. Currently 68 centers are certified and together with ongoing certification proceedings will amount to 81 prostate cancer centers, which cover about one fourth of cases of primary prostate cancer. Urology is of particular importance in the management of these centers. For the most part, urologists belonging to a clinical unit are the initiators of the certification process, thus ensuring that uro-oncology is firmly entrenched in the specialty with involvement of outpatient service providers. Fears that authority will be lost are unfounded as long as responsibility for this task is taken seriously and active use is made of the possibilities for creativity. A similarly important function is fulfilled by the testicular cancer centers that offer second opinion services, which were initiated by urology conjointly with German Cancer Aid to pursue the goal of quality assurance for this tumor entity and therefore likewise secure the position of this tumor in the realm of urologists. By applying such strategic approaches, urologists will succeed in sustainably safeguarding their future importance in a very competitive environment and in counteracting the encroachments of other specialties by exhibiting clear orientation.

  13. Defining the role of University of Kentucky HealthCare in its medical market--how strategic planning creates the intersection of good public policy and good business practices.

    Science.gov (United States)

    Karpf, Michael; Lofgren, Richard; Bricker, Timothy; Claypool, Joseph O; Zembrodt, Jim; Perman, Jay; Higdon, Courtney M

    2009-02-01

    In response both to national pressures to reduce costs and improve health care access and outcomes and to local pressures to become a top-20 public research university, the University of Kentucky moved toward an integrated clinical enterprise, UK HealthCare, to create a common vision, shared goals, and an effective decision-making process. The leadership formed the vision and then embarked on a comprehensive and coordinated planning process that addressed financial, clinical, academic, and operational issues. The authors describe in depth the strategic planning process and specifically the definition of UK HealthCare's role in its medical marketplace. They began a rigorous process to assess and develop goals for the clinical programs and followed the progress of these programs through meetings driven by data and attended by the organization's senior leadership. They describe their approach to working with rural and community hospitals throughout central, eastern, and southern Kentucky to support the health care infrastructure of the state. They review the early successes of their strategic approach and describe the lessons they learned. The clinical successes have led to academic gains. The experience of UK HealthCare suggests that good business practices and good public policy are synergistic.

  14. Treatment Summaries and Follow-Up Care Instructions for Cancer Survivors: Improving Survivor Self-Efficacy and Health Care Utilization

    Science.gov (United States)

    Kvale, Elizabeth A.; Rocque, Gabrielle B.; Demark-Wahnefried, Wendy; Martin, Michelle Y.; Jackson, Bradford E.; Meneses, Karen; Partridge, Edward E.; Pisu, Maria

    2016-01-01

    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

  15. Health assets in nursing documentation of cancer care.

    Science.gov (United States)

    Rotegård, Ann Kristin; Fagermoen, May Solveig; Ruland, Cornelia M

    2012-01-01

    Patients' experiences, knowledge and preferences, as well as more person-centered care need to be implemented in clinical support systems and are central values and outcomes of eHealth. Health assets represent such information. The concept of health assets was explored and described based on analysis of nursing documentation in cancer patients' records. A convenience sample from 100 records, available from a larger study, resulted in 43 records that met the inclusion criteria. These were analyzed using content analysis methods. A mean of 3.2 health assets was documented in these records, and 61% of the descriptions of assets quoted patients. Assets were found most often in the admission notes (49%), but no information was found that described or indicated an intended use or follow up in the nursing documentation.

  16. The Emergency Care of Patients With Cancer: Setting the Research Agenda.

    Science.gov (United States)

    Brown, Jeremy; Grudzen, Corita; Kyriacou, Demetrios N; Obermeyer, Ziad; Quest, Tammie; Rivera, Donna; Stone, Susan; Wright, Jason; Shelburne, Nonniekaye

    2016-12-01

    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.

  17. Palliative cancer care ethics: Principles and challenges in the Indian setting

    Directory of Open Access Journals (Sweden)

    Tejaswi Mudigonda

    2010-01-01

    Full Text Available Palliative cancer treatment is a system of care that seeks to relieve suffering in patients with progressive cancer. Given the intractable symptoms with which certain malignancies manifest, palliative care offers a practical approach towards improving the patient′s quality of life. However, there are an array of ethical issues associated with this treatment strategy such as particular methods of pain relief, a reliable assessment of suffering, autonomy, and multi-specialist care. While these principles are important to increase and improve the network of palliative care, the resource-poor Indian environments present numerous barriers for these principles to be practically applied. As the infrastructure of comprehensive cancer centers develop, paralleled with an increase in training of palliative care professionals, significant improvements need to be made in order to elevate the status of palliative cancer care in India.

  18. The accuracy and completeness for receipt of colorectal cancer care using Veterans Health Administration administrative data

    OpenAIRE

    Sherer, Eric A.; Fisher, Deborah A; Barnd, Jeffrey; Jackson, George L.; Provenzale, Dawn; Haggstrom, David A.

    2016-01-01

    Background The National Comprehensive Cancer Network and the American Society of Clinical Oncology have established guidelines for the treatment and surveillance of colorectal cancer (CRC), respectively. Considering these guidelines, an accurate and efficient method is needed to measure receipt of care. Methods The accuracy and completeness of Veterans Health Administration (VA) administrative data were assessed by comparing them with data manually abstracted during the Colorectal Cancer Care...

  19. Identifying priority actions for improving patient satisfaction with outpatient cancer care.

    Science.gov (United States)

    Gesell, Sabina B; Gregory, Nancy

    2004-01-01

    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.

  20. Development and validation of a simple questionnaire for the identification of hereditary breast cancer in primary care

    Directory of Open Access Journals (Sweden)

    Palmero Edenir I

    2009-08-01

    Full Text Available Abstract Background Breast cancer is a significant public health problem worldwide and the development of tools to identify individuals at-risk for hereditary breast cancer syndromes, where specific interventions can be proposed to reduce risk, has become increasingly relevant. A previous study in Southern Brazil has shown that a family history suggestive of these syndromes may be prevalent at the primary care level. Development of a simple and sensitive instrument, easily applicable in primary care units, would be particularly helpful in underserved communities in which identification and referral of high-risk individuals is difficult. Methods A simple 7-question instrument about family history of breast, ovarian and colorectal cancer, FHS-7, was developed to screen for individuals with an increased risk for hereditary breast cancer syndromes. FHS-7 was applied to 9218 women during routine visits to primary care units in Southern Brazil. Two consecutive samples of 885 women and 910 women who answered positively to at least one question and negatively to all questions were included, respectively. The sensitivity, specificity and positive and negative predictive values were determined. Results Of the 885 women reporting a positive family history, 211 (23.8%; CI95%: 21.5–26.2 had a pedigree suggestive of a hereditary breast and/or breast and colorectal cancer syndrome. Using as cut point one positive answer, the sensitivity and specificity of the instrument were 87.6% and 56.4%, respectively. Concordance between answers in two different applications was given by a intra-class correlation (ICC of 0.84 for at least one positive answer. Temporal stability of the instrument was adequate (ICC = 0.65. Conclusion A simple instrument for the identification of the most common hereditary breast cancer syndrome phenotypes, showing good specificity and temporal stability was developed and could be used as a screening tool in primary care to refer at

  1. Long-term follow-up study and long-term care of childhood cancer survivors

    Directory of Open Access Journals (Sweden)

    Hyeon Jin Park

    2010-04-01

    Full Text Available The number of long-term survivors is increasing in the western countries due to remarkable improvements in the treatment of childhood cancer. The long-term complications of childhood cancer survivors in these countries were brought to light by the childhood cancer survivor studies. In Korea, the 5-year survival rate of childhood cancer patients is approaching 70%; therefore, it is extremely important to undertake similar long-term follow-up studies and comprehensive long-term care for our population. On the basis of the experiences of childhood cancer survivorship care of the western countries and the current Korean status of childhood cancer survivors, long-term follow-up study and long-term care systems need to be established in Korea in the near future. This system might contribute to the improvement of the quality of life of childhood cancer survivors through effective intervention strategies.

  2. Breast cancer in limited-resource countries: health care systems and public policy.

    Science.gov (United States)

    Anderson, Benjamin O; Yip, Cheng-Har; Ramsey, Scott D; Bengoa, Rafael; Braun, Susan; Fitch, Margaret; Groot, Martijn; Sancho-Garnier, Helene; Tsu, Vivien D

    2006-01-01

    As the largest cancer killer of women around the globe, breast cancer adversely impacts countries at all levels of economic development. Despite major advances in the early detection, diagnosis, and treatment of breast cancer, health care ministries face multitiered challenges to create and support health care programs that can improve breast cancer outcomes. In addition to the financial and organizational problems inherent in any health care system, breast health programs are hindered by a lack of recognition of cancer as a public health priority, trained health care personnel shortages and migration, public and health care provider educational deficits, and social barriers that impede patient entry into early detection and cancer treatment programs. No perfect health care system exists, even in the wealthiest countries. Based on inevitable economic and practical constraints, all health care systems are compelled to make trade-offs among four factors: access to care, scope of service, quality of care, and cost containment. Given these trade-offs, guidelines can define stratified approaches by which economically realistic incremental improvements can be sequentially implemented within the context of resource constraints to improve breast health care. Disease-specific "vertical" programs warrant "horizontal" integration with existing health care systems in limited-resource countries. The Breast Health Global Initiative (BHGI) Health Care Systems and Public Policy Panel defined a stratified framework outlining recommended breast health care interventions for each of four incremental levels of resources (basic, limited, enhanced, and maximal). Reallocation of existing resources and integration of a breast health care program with existing programs and infrastructure can potentially improve outcomes in a cost-sensitive manner. This adaptable framework can be used as a tool by policymakers for program planning and research design to make best use of available resources

  3. Challenges in Prevention and Care Delivery for Women with Cervical Cancer in Sub-Saharan Africa.

    Science.gov (United States)

    Randall, Thomas C; Ghebre, Rahel

    2016-01-01

    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.

  4. Changes in symptoms and pain intensity of cancer patients after enrollment in palliative care at home

    OpenAIRE

    Dumitrescu, Luminita; van den Heuvel-Olaroiu, Marinela; van den Heuvel, Wim J. A.

    2007-01-01

    This study describes the activities and interventions carried out by an at-home palliative care team treating cancer patients who died within two years of being enrolled in a palliative care program. It analyzes which changes in symptoms and pain occurred and which sociodemographic and medical characteristics were related to these changes. The analysis is based on 102 cancer patients. Data were collected through systematic registration during the palliative care process. At enrollment, patien...

  5. Perceived factors affecting distress among women taking part in surgical continuity of care for breast cancer

    DEFF Research Database (Denmark)

    Jørgensen, Lone; Laursen, Birgitte Schantz

    2016-01-01

    REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to identify, appraise and synthesize the evidence on perceived factors affecting distress among women taking part in surgical continuity of care for breast cancer to provide evidence for improving support and care.The specific...... review question is: What are the perceived factors that contribute to an increase or a reduction in distress among women taking part in surgical continuity of care for breast cancer?...

  6. Patient-centered care in lung cancer: exploring the next milestones

    OpenAIRE

    2015-01-01

    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 ch...

  7. 2014 President's plenary international psycho-oncology society: moving toward cancer care for the whole patient.

    Science.gov (United States)

    Bultz, Barry D; Travado, Luzia; Jacobsen, Paul B; Turner, Jane; Borras, Josep M; Ullrich, Andreas W H

    2015-12-01

    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.

  8. Colorectal cancer screening practices of primary care providers: results of a national survey in Malaysia.

    Science.gov (United States)

    Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim

    2014-01-01

    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.

  9. Predictors of colorectal cancer screening in diverse primary care practices

    Directory of Open Access Journals (Sweden)

    Tabbarah Melissa

    2006-09-01

    Full Text Available Abstract Background To explain why rates of colorectal cancer (CRC screening including fecal occult blood testing (FOBT, flexible sigmoidoscopy (FS, colonoscopy (CS, and barium enema (BE, are low, this study assessed determinants of CRC screening from medical records. Methods Data were abstracted from patients aged ≥64 years selected from each clinician from 30 diverse primary care practices (n = 981. Measurements included the rates of annual FOBT, ever receiving FOBT, ever receiving FS/CS/BE under a combination variable, endoscopy/barium enema (EBE. Results Over five years, 8% had received annual FOBT, 53% had ever received FOBT and 22% had ever received EBE. Annual FOBT was negatively associated with female gender, odds ratio (OR = .23; 95% confidence interval = .12–.44 and positively associated with routinely receiving influenza vaccine, OR = 2.55 (1.45–4.47; and more office visits: 3 to Conclusion Overall CRC screening rates were low, but were related to the number of primary care office visits. FOBT was related to immunization status, suggesting the possible benefit of linking these preventive services.

  10. Ethical, Socioeconomic, and Cultural Considerations in Gynecologic Cancer Care in Developing Countries

    Directory of Open Access Journals (Sweden)

    Uzochukwu Uzoma Aniebue

    2014-01-01

    Full Text Available Gynaecologic cancers contribute significantly to the cancer burden in developing countries, resulting in higher mortality and morbidity rates among women in these nations. This situation is further compounded by the occurrence of wars, famine, poverty and natural disasters, and infectious diseases like hepatitis B and HIV/AIDS. In addition, merge resources and manpower lack in these countries further compound this very delicate situation. Often times, socioeconomic, cultural, and ethical factors such as truth-telling, choice of place of care, place of death, treatment choices, medication use, and terminal sedation can interfere in patient management. Availability and use of oral morphine for pain relief, spiritual care and availability of palliative care services, the individuals’ autonomy, and family and community participation in care, end of life issues, and preservation of fertility are also big issues that determine the course of care. This review discusses these pertinent factors, discusses how they affect cancer care in women, and proffers ideas for healthcare workers and policy makers on implementation of sustainable models for cancer care in developing countries. Addressing socioeconomic, cultural, and ethical issues affecting gynaecologic cancer care will aid in ensuring development of viable models of cancer care in resource-limited countries.

  11. The Good Pain Management (GPM) Ward Program in China and its impact on Chinese cancer patients:the SYSUCC experience

    Institute of Scientific and Technical Information of China (English)

    Yun-Peng Yang; Yu-Xiang Ma; Yan Huang; Yuan-Yuan Zhao; Fei Xu; Ying Tian; Ben-Yan Zou; Rui-Zhen Gao; Li Zhang

    2014-01-01

    To improve cancer pain management, the Medical Oncology Department of Sun Yat-sen University Cancer Center (SYSUCC) launched the Good Pain Management (GPM) Ward Program, which has been recognized by the Chinese Ministry of Health and promoted throughout the nation. This retrospective case-control study was designed to evaluate the effectiveness of the program. Patients diagnosed with malignant solid tumors with bone metastasis were eligible. Patients who were admitted 6 months before the initiation of the GPM program were used as the control group, and patients admitted 6 months after the initiation of the program were used as the GPM group. The pain-reporting rate and pain management index (PMI) were calculated. The pain levels before and after pain management were compared. A total of 475 patients (244 in the control group and 231 in the GPM group) were analyzed. The pain-reporting rate of the GPM group was significantly higher than that of the control group (62.8% vs. 37.7%,P< 0.001). The PMI of the GPM group was significantly higher than that of the control group (0.083 vs. -0.261,P< 0.001). Therefore, the GPM Ward Program improved the pain management of cancer patients and provided experience for improving cancer pain management in the future.

  12. Anticipating the effect of the Patient Protection and Affordable Care Act for patients with urologic cancer.

    Science.gov (United States)

    Ellimoottil, Chandy; Miller, David C

    2014-02-01

    The Affordable Care Act seeks to overhaul the US health care system by providing insurance for more Americans, improving the quality of health care delivery, and reducing health care expenditures. Although the law's intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the Affordable Care Act, including the proposed insurance expansion, payment and delivery system reforms (e.g., bundled payments and Accountable Care Organizations), and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may affect patients with urologic cancers.

  13. Cross-sectoral cancer care: views from patients and health care professionals regarding a personal electronic health record.

    Science.gov (United States)

    Baudendistel, I; Winkler, E C; Kamradt, M; Brophy, S; Längst, G; Eckrich, F; Heinze, O; Bergh, B; Szecsenyi, J; Ose, D

    2017-03-01

    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.

  14. Being prepared: essential to self-care and quality of life for the person with cancer.

    Science.gov (United States)

    Knobf, M Tish

    2013-06-01

    Being adequately prepared for an experience such as cancer empowers patients, lowers distress, improves coping, supports self-management, promotes recovery, and improves quality of life. However, patients with cancer report unmet informational and support needs across the cancer trajectory. The purpose of this article is to describe the relationship of information preparation and patient outcomes, identify information and support needs across the cancer trajectory, and describe the role of oncology nurses in the delivery of high-quality patient-centered cancer care. The middle range theory of "Carrying On" was used to identify information and support needs during different phases of the cancer trajectory from treatment to survivorship. The authors concluded that nurses should engage the patient in a relational exchange of information; provide concrete, understandable information across specific times in the cancer experience; and use creative approaches to minimize barriers in meeting patient needs to achieve high-quality patient-centered cancer care.

  15. Preventing Overdiagnosis and Overtreatment: Just the Next Step in the Evolution of Breast Cancer Care.

    Science.gov (United States)

    Mukhtar, Rita A; Wong, Jasmine M; Esserman, Laura J

    2015-06-01

    The problem of overdiagnosis and overtreatment has been highlighted in breast cancer and many other cancer types, most notably prostate cancer. Addressing this problem presents an opportunity to continue the evolution of breast cancer care. Advances in technology, such as molecular subtyping, have increased the understanding of breast cancer biology and the range of associated behavior, and have provided tools that allow greater personalization of treatment. This article identifies 3 areas of breast cancer care where opportunity currently exists to refine management strategies and help decrease overtreatment and overdiagnosis: the use of adjuvant-external beam radiation in invasive breast cancer, the application of aggressive treatment for all ductal carcinoma in situ, and the authors' approach to breast cancer screening. Personalizing treatment based on patient and tumor characteristics holds promise for minimizing harms and maximizing benefits. This approach will allow continual improvement and ultimately result in providing the right treatment for each patient.

  16. "Good idea but not feasible" – the views of decision makers and stakeholders towards strategies for better palliative care in Germany: a representative survey

    Directory of Open Access Journals (Sweden)

    Schneider Nils

    2009-07-01

    Full Text Available Abstract Background Statements on potential measures to improve palliative care in Germany predominantly reflect the points of view of experts from specialized palliative care organizations. By contrast, relatively little is known about the views of representatives of organizations and institutions that do not explicitly specialize in palliative care, but are involved to a relevant extent in the decision-making and policy-making processes. Therefore, for the first time in Germany, we carried out a representative study of the attitudes of a broad range of different stakeholders acting at the national or state level of the health care system. Methods 442 organizations and institutions were included and grouped as follows: patient organizations, nursing organizations, medical associations, specialized palliative care organizations, political institutions, health insurance funds and others. Using a standardized questionnaire, the participants were asked to rate their agreement with the World Health Organization's definition of palliative care (five-point scale: 1 = completely agree, 5 = completely disagree and to evaluate 18 pre-selected improvement measures with regard to their general meaningfulness and the feasibility of their introduction into the German health care system (two-point scale: 1 = good, 2 = poor. Results The response rate was 67%. Overall, the acceptance of the aims of palliative care in the WHO definition was strong. However, the level of agreement among health insurance funds' representatives was significantly less than that among representatives of the palliative care organizations. All the improvement measures selected for evaluation were rated significantly higher in respect of their meaningfulness than of their feasibility in Germany. In detail, the meaningfulness of 16 measures was evaluated positively (70–100% participants chose the answer "good"; for six of these measures feasibility was evaluated negatively (0–30

  17. Adherence to Survivorship Care Guidelines in Health Care Providers for Non-Small Cell Lung Cancer and Colorectal Cancer Survivor Care

    Science.gov (United States)

    2016-03-01

    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

  18. Identification of the predictors of cognitive impairment in patients with cancer in palliative care

    DEFF Research Database (Denmark)

    Kurita, Geana Paula; Benthien, Kirstine Skov; Sjøgren, Per;

    2017-01-01

    care. METHODS: Prospective longitudinal investigation derived from the European Palliative Care Cancer Symptom study (2011-2013) including patients with cancer in palliative care, ≥18 years, and with at least one assessment post-inclusion. For cognitive assessment, a 4-item version of the Mini Mental......) showed that those with low KPS (OR = 1.6, 95% CI 1.0-2.5) most often developed cognitive impairment, while patients with breast cancer (OR = 0.4, 95% CI 0.2-0.7) had lower odds for impairment. CONCLUSIONS: During palliative care, a substantial number of patients remained cognitively impaired or developed......PURPOSE: Studies with neuropsychological assessments in patients with cancer are sparse, and the evidence is very limited regarding their status of cognitive function over time. This study aimed at assessing the prevalence and predictors of cognitive impairment in patients with cancer in palliative...

  19. Is There a Role for Homeopathy in Cancer Care? Questions and Challenges.

    Science.gov (United States)

    Frenkel, Moshe

    2015-09-01

    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.

  20. Syzygium aromaticum extracts as good source of betulinic acid and potential anti-breast cancer

    Directory of Open Access Journals (Sweden)

    Abdalrahim F. A. Aisha

    2012-04-01

    Full Text Available Syzygium aromaticum (L. Merr. & L.M. Perry, Myrtaceae, is an evergreen tree with anticarcinogenic, antimutagenic, aphrodisiac, antimicrobial, antioxidant and antiinflammatory properties. This study aims to investigate the anti-breast cancer effect of extracts from leaves, stem and bark of S. aromaticum and to develop a method for preparation of betulinic acid fraction from the leaves. Betulinic acid, ursolic acid and oleanolic acid contents of the extracts were determined by HPLC. A betulinic acid fraction was prepared by simple crystallization of leaves extract and was characterized by HPLC and mass analysis. Anti-breast cancer effects were studied on MCF-7 and MDA-MB-231 cells. The extracts were found to contain high levels of betulinic acid particularly the leaves extract which contained 17% wt/wt. The betulinic acid fraction contains 75% betulinic acid. Cytotoxicity testing reveals high and selective cytotoxic effect of the stem extract on MCF-7 cells with IC50 33±1.6 µg/mL. Cytotoxic effect of the stem extract was due to activation of apoptotic machinery of cell death. Combination studies of stem extract with tamoxifen reveals antagonistic effect at high concentration of tamoxifen and enhancement effect at low concentration. The selective cytotoxicity of the stem extract of S. aromaticum on MCF-7 is not due to betulinic acid but due to other constituents yet to be discovered.

  1. Non-invasive, serum DNA pregnancy testing leading to incidental discovery of cancer: a good thing?

    Science.gov (United States)

    Prasad, Vinay

    2015-11-01

    Cell-free DNA for perinatal screening is a growing industry. Non-invasive prenatal testing (NIPT) is based on the premise that foetal DNA is able to cross the placental barrier and enter the mother's circulation, where it can be examined for chromosomal abnormalities, such as trisomy 13, 18 or 21. Such tests are expected to be widely used by pregnant women, with the annual market expected to surpass $1 billion. Recently, a number of case reports have emerged in the haematology-oncology literature. The routine use of NIPT has led to the discovery of maternal neoplasms. Most writers have concluded that this is yet another benefit of the test; however, a closer examination of the cases reveals that this incidental detection may not improve patient outcomes. In some cases, early detection provides lead time bias, but does not change the ultimate clinical outcome, and in other cases, detection constitutes earlier knowledge of a cancer whose natural history cannot be altered. Here, we explore in detail cases where cancer was incidentally discovered among women undergoing routine non-invasive pregnancy testing, and investigate whether or not these women were benefitted by the discovery.

  2. Patient-centered care in lung cancer: exploring the next milestones.

    Science.gov (United States)

    Ben-Arye, Eran; Samuels, Noah

    2015-10-01

    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.

  3. Awareness, Interest, and Preferences of Primary Care Providers in Using Point-of-Care Cancer Screening Technology.

    Directory of Open Access Journals (Sweden)

    Chloe S Kim

    Full Text Available 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

  4. Awareness, Interest, and Preferences of Primary Care Providers in Using Point-of-Care Cancer Screening Technology.

    Science.gov (United States)

    Kim, Chloe S; Vanture, Sarah; Cho, Margaret; Klapperich, Catherine M; Wang, Catharine; Huang, Franklin W

    2016-01-01

    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.

  5. Compliance with the commission on cancer quality of breast cancer care measures: self-evaluation advised.

    Science.gov (United States)

    Lodrigues, William; Dumas, Judy; Rao, Madhu; Lilley, Lisa; Rao, Roshni

    2011-01-01

    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.

  6. Integrating complementary and alternative medicine into cancer care: Canadian oncology nurses′ perspectives

    Directory of Open Access Journals (Sweden)

    Tracy L Truant

    2015-01-01

    Full Text Available The integration of complementary and alternative medicine (CAM and conventional cancer care in Canada is in its nascent stages. While most patients use CAM during their cancer experience, the majority does not receive adequate support from their oncology health care professionals (HCPs to integrate CAM safely and effectively into their treatment and care. A variety of factors influence this lack of integration in Canada, such as health care professional(HCP education and attitudes about CAM; variable licensure, credentialing of CAM practitioners, and reimbursement issues across the country; an emerging CAM evidence base; and models of cancer care that privilege diseased-focused care at the expense of whole person care. Oncology nurses are optimally aligned to be leaders in the integration of CAM into cancer care in Canada. Beyond the respect afforded to oncology nurses by patients and family members that support them in broaching the topic of CAM, policies, and position statements exist that allow oncology nurses to include CAM as part of their scope. Oncology nurses have also taken on leadership roles in clinical innovation, research, education, and advocacy that are integral to the safe and informed integration of evidence-based CAM therapies into cancer care settings in Canada.

  7. Being cared by a family member: the existential feelings of cancer patients

    OpenAIRE

    Julia Wakiuchi; Anna Maria de Oliveira Salimena; Catarina Aparecida Sales

    2015-01-01

    The present article aimed to understand the daily life of cancer patients under palliative care while experiencing home care provided by family members. This was a Heideggerian phenomenological study with 20 patients being treated at the primary health care service of Northeast Paraná, Brazil, between November 2012 and February 2013. Data collection was based on the following research guiding question: What has been your experience of being cared for by your family? Phenomenological analysis ...

  8. Evaluating sexual nursing care intervention for reducing sexual dysfunction in Indonesian cervical cancer survivors

    Directory of Open Access Journals (Sweden)

    Yati Afiyanti

    2016-01-01

    Full Text Available 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.

  9. Oncologists’ Perspectives on Concurrent Palliative Care in an NCI-designated Comprehensive Cancer Center

    Science.gov (United States)

    Bakitas, Marie; Lyons, Kathleen Doyle; Hegel, Mark T.; Ahles, Tim

    2013-01-01

    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

  10. Multiple Criteria Decision Analysis for Health Care Decision Making--An Introduction: Report 1 of the ISPOR MCDA Emerging Good Practices Task Force.

    Science.gov (United States)

    Thokala, Praveen; Devlin, Nancy; Marsh, Kevin; Baltussen, Rob; Boysen, Meindert; Kalo, Zoltan; Longrenn, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Ijzerman, Maarten

    2016-01-01

    Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting, objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making and a set of techniques, known under the collective heading multiple criteria decision analysis (MCDA), are useful for this purpose. MCDA methods are widely used in other sectors, and recently there has been an increase in health care applications. In 2014, ISPOR established an MCDA Emerging Good Practices Task Force. It was charged with establishing a common definition for MCDA in health care decision making and developing good practice guidelines for conducting MCDA to aid health care decision making. This initial ISPOR MCDA task force report provides an introduction to MCDA - it defines MCDA; provides examples of its use in different kinds of decision making in health care (including benefit risk analysis, health technology assessment, resource allocation, portfolio decision analysis, shared patient clinician decision making and prioritizing patients' access to services); provides an overview of the principal methods of MCDA; and describes the key steps involved. Upon reviewing this report, readers should have a solid overview of MCDA methods and their potential for supporting health care decision making.

  11. Caring for caregivers and patients: Research and clinical priorities for informal cancer caregiving.

    Science.gov (United States)

    Kent, Erin E; Rowland, Julia H; Northouse, Laurel; Litzelman, Kristin; Chou, Wen-Ying Sylvia; Shelburne, Nonniekaye; Timura, Catherine; O'Mara, Ann; Huss, Karen

    2016-07-01

    Informal/family caregivers are a fundamental source of care for cancer patients in the United States, yet the population of caregivers and their tasks, psychosocial needs, and health outcomes are not well understood. Changes in the nature of cancer care and its delivery, along with the growing population of survivors and their caregivers, warrant increased attention to the roles and demands of caregiving. This article reviews current evidence presented at a 2-day meeting examining the state of the science of informal cancer caregiving that was convened by the National Cancer Institute and the National Institute of Nursing Research. The meeting sought to define who is an informal cancer caregiver, summarize the state of the science in informal cancer caregiving, and describe both the kinds of interventions developed to address caregiving challenges and the various outcomes used to evaluate their impact. This article offers recommendations for moving science forward in 4 areas: 1) improving the estimation of the prevalence and burden of informal cancer caregiving; 2) advancing the development of interventions designed to improve outcomes for cancer patients, caregivers, and patient-caregiver dyads; 3) generating and testing strategies for integrating caregivers into formal health care settings; and 4) promoting the use of technology to support informal cancer caregivers. Cancer 2016;122:1987-95. © 2016 American Cancer Society.

  12. Oncology nurses′ recognition of long-term cancer survivorship care in Japan

    Directory of Open Access Journals (Sweden)

    Asako Miura

    2015-01-01

    Full Text Available Objective: This study aims to assess the knowledge of definition of cancer survivors among Japanese oncology nurses and their roles in long-term cancer survivorship care. Methods: A structured self-administered and self-report questionnaire created by the study investigators was given to members of the Japanese Society of Cancer Nursing. The subjects were 81 female oncology nurses. Results: Forty-nine nurses had 11 or more years of nursing experience, while 27 nurses had cancer-related nursing certifications such as, certification in oncology nursing specialist. This study population had rather rich experience in oncology nursing. Sixty-two nurses defined a cancer survivor from the time of diagnosis, while the nurses′ recognition of long-term survivorship care was poor, compared with nursing care at the time of diagnosis, during treatment, and end of life. Conclusions: The nurses were aware of the needs to recognize and address issues faced by long-term cancer survivors and for nursing study, but very few put the effective patient education and interventions into practice. It is because oncology nurses have few chances to see cancer survivors who go out of the hands of healthcare professionals. In increasing the number of long-term survivors, long-term survivorship care is needed in addition to incorporating such education into undergraduate and graduate programs. Further study on the knowledge of long-term cancer survivorship care and nursing practices are required.

  13. Low free to total PSA ratio is not a good discriminator of chronic prostatitis and prostate cancer: An Indian experience

    Directory of Open Access Journals (Sweden)

    V Thakur

    2014-01-01

    Full Text Available Aims: To find out the utility of free to total PSA ratio in discriminating chronic prostatitis and prostate cancer. Setting and design: The patients visited urology clinics at Batra Hospital and Medical Research Center, New Delhi. Background: The use of serum free to total PSA as a diagnostic tool for prostate cancer has led to early detection of prostate cancer; however, the effect of inflammation on f/t PSA ratio restricts its use in early detection of cancer. Materials and Methods: The study was conducted in age related 101 patients which include 27 carcinoma patients (group I, 34 BPH patients (group II and 40 chronic prostatitis patients (group III. Serum total PSA (tPSA and free PSA (fPSA were analyzed on Elecsys 2010. These were compared with histological reports of biopsy specimen. Other biochemistry tests were done on Randox Imola. P Value was calculated using one way ANOVA with posthoc Bonferroni analysis. Results: Serum total PSA levels were comparable in group I and III and were higher than group II (P < 0.049. Serum fPSA in group I was not significantly different from group II and III, However, group II has higher levels than group III (P < 0.035. Difference was significant for f/t PSA ratio in group I and II (P < 0.00 and group II and III (P < 0.000.Group I and III were with comparable levels (P < 0.807. Conclusions: f/t PSA ratio is not a good discriminator for malignancy and chronic prostatitis. This limitation of f/t PSA ratio must be taken into consideration while interpreting the results clinically.

  14. Head and neck cancer in geriatric patients: Analysis of the pattern of care given at a tertiary cancer care center

    Directory of Open Access Journals (Sweden)

    S Thiagarajan

    2015-01-01

    Full Text Available Background And Aim: The percentage of elderly people with head and neck cancers (HNC is on the rise. This makes HNC in this group of patients an important issue for healthcare providers. The present study was planned to analyze the patterns of care given to the geriatric patients and to identify the factors influencing the decision making process. Materials And Methods: Data of all the elderly patients (≥65 years registered in the year 2012, with histologically proven HNC (all sites, stages, histopathological types, except lymphoma, sarcoma and cervical metastasis of unknown origin receiving treatment (definitive/palliative were collected. Results: A total of 270 patients were included in this study. The median age was 72 years (range: 65–101, with predominant male population (70%, n = 190. Oral cavity squamous cell carcinoma (SCC was the most common cancer (57%, n = 154. Eastern Co-Operative Oncology Group performance status (PS of 0–2 was seen in 91% of the patients. Co-morbidities were present in 139 (51.5% patients. 50% (n = 134 of the patients received palliative intent treatment, 45% (n = 123 definitive treatment, whereas in 5% (n = 13 the intent was not mentioned. Age, a clinical stage and PS significantly influenced the decision making on the intent of treatment. 208 (77% patients completed their treatment irrespective of the intent. Age was the only factor influencing treatment completion irrespective of the intent. Conclusion: Geriatric HNC patients frequently present with advanced disease, having multiple co-morbidities. Hence, a multidisciplinary team management of these patients is essential, also taking into account of the social and financial support available to these patients.

  15. Mechanisms that Trigger a Good Health-Care Response to Intimate Partner Violence in Spain. Combining Realist Evaluation and Qualitative Comparative Analysis Approaches

    Science.gov (United States)

    Goicolea, Isabel; Vives-Cases, Carmen; Hurtig, Anna-Karin; Marchal, Bruno; Briones-Vozmediano, Erica; Otero-García, Laura; García-Quinto, Marta; San Sebastian, Miguel

    2015-01-01

    Background Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence. Methods A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software. Results The emerging programme theory highlighted the importance of the combination of each team’s self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence. Conclusions Interventions to improve primary health care teams’ response to intimate partner violence should focus on strengthening team’s self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the

  16. End-of-life hospital care for cancer patients: an update.

    Science.gov (United States)

    Dudevich, Alexey; Chen, Allie; Gula, Cheryl; Fagbemi, Josh

    2014-01-01

    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.

  17. Negative {sup 18}F-2-fluorodeoxyglucose PET/CT predicts good cancer specific survival in patients with a suspicion of recurrent ovarian cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hebel, Carolin B.; Behrendt, Florian F.; Heinzel, Alexander; Krohn, Thomas [University Hospital Aachen, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany); Mottaghy, Felix M. [University Hospital Aachen, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany); Maastricht University Medical Center, Department of Nuclear Medicine, P. Debyelaan 25, 6229 HX Maastricht (Netherlands); Bauerschlag, Dirk O. [University Hospital Aachen, Department of Gynecology and Obstetrics, Pauwelsstraße 30, 52074 Aachen (Germany); Verburg, Frederik A., E-mail: fverburg@ukaachen.de [University Hospital Aachen, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany); Maastricht University Medical Center, Department of Nuclear Medicine, P. Debyelaan 25, 6229 HX Maastricht (Netherlands)

    2014-03-15

    Aim: The aim of the present study was to investigate the diagnostic and prognostic value of combined {sup 18}F-2-fluorodeoxyglucose positron emission tomography and contrast enhanced X-ray computed tomography (FDG-PET/CT) in women with a suspicion of recurrent ovarian cancer. Patients and methods: We retrospectively reviewed 48 patients with a suspicion of recurrent ovarian cancer who were referred to our department for combined FDG-PET/CT. Results: Median follow-up was 25 months. 38/48 (79%) patients showed pathological findings on PET/CT. 17/48 (35%) of patients died of ovarian cancer. One FDG-PET/CT was false positive and one was false negative, leading to a sensitivity and positive predictive value of 97% and a specificity and negative predictive value of 90%. 33/48 (69%) underwent a change in therapy following FDG-PET/CT. There was a significantly better survival in FDG-PET/CT negative than in positive patients (p = 0.04). In the FDG-PET/CT negative group no patients had died of ovarian cancer during follow-up. Remarkably, there was no difference in survival between patients who only had peritoneal metastases on FDG-PET/CT and those who also had extraperitoneal metastases (p = 0.71). Conclusion: A negative FDG-PET/CT has a high negative predictive value for the presence of disease and, more importantly, is associated with a very good disease-specific survival rate.

  18. Breast Cancer Diagnosed During Pregnancy: Adapting Recent Advances in Breast Cancer Care for Pregnant Patients.

    Science.gov (United States)

    Loibl, Sibylle; Schmidt, André; Gentilini, Oreste; Kaufman, Bella; Kuhl, Christine; Denkert, Carsten; von Minckwitz, Gunter; Parokonnaya, Anastasia; Stensheim, Hanne; Thomssen, Christoph; van Calsteren, Kristel; Poortmans, Philip; Berveiller, Paul; Markert, Udo R; Amant, Frederic

    2015-11-01

    Breast cancer during pregnancy (BCP), although rare, is becoming more common and treatment should be as similar as possible to that for nonpregnant young patients with breast cancer. A group of specialists convened to review current guidelines and provide guidance on how recent advances in breast cancer diagnosis and treatment can be adapted for pregnant patients. The majority of patients with BCP will be considered for treatment during the pregnancy. Premature delivery should be avoided whenever possible. Most treatments, including sentinel lymph node biopsy, systemic therapy with taxanes, platinum agents, or dose-dense treatment can be safely given during pregnancy, after careful risk/benefit assessment for mother and child. Chemotherapy is contraindicated during the first trimester because of a higher risk of fetal malformations but is feasible in the second and third trimesters. Other treatments such as radiation therapy or anti-human epidermal growth receptor 2 treatment are in general not indicated during pregnancy but might be considered in some instances. Patient data should be collected in a systematic way whenever possible.

  19. Profile of Cancer Cases at a Tertiary Care Level Teaching Hospital in Rural Western Maharashtra, India

    Directory of Open Access Journals (Sweden)

    Jayant D Deshpande , Kailash K Singh , Deepak B Phalke

    2012-01-01

    Full Text Available Background: Cancer is one of the major public health problems worldwide. Prevalence and pattern of cancer is known to vary from region to region. Epidemiological information on cancer including the pattern is an important basis for determining the priorities for cancer control in any population group. Objective: Present work is an attempt to study magnitude, profile and some epidemiological aspects in relation to cancer cases at a tertiary care level teaching hospital in rural area. Method: All records were studied and analyzed. A total of 1106 patients were treated during the period studied. A proforma was used to collect data such as age, sex, place of residence, type of cancers and treatment given. The data collected were entered into MS-Excel sheets and analysis was carried out. The information obtained was tabulated analyzed using the software GraphPad Instat demo version. Results: A total of 1106 cancer patients were treated during the January 2010 to December 2010. Among these, 626(56.60 were females and 480(43.39 were females. In males, the common cancers were oral cavity cancers, lung cancers and GIT cancers. The most common cancers among females were the cervical carcinomas, which constituted 32.10% of the total number of cancers cases followed by cancers of breast. Almost 2/3rd of cases occurred in the age group of 41 to 70 years. Maximum frequency was observed in 51–60 year age group in both sexes. Maximum numbers (74.59% of the cases were from rural area. The main methods of cancer treatment were surgery, chemotherapy and radiotherapy, used alone or in combination. Conclusion: Tobacco and alcohol related cancers predominated in males. In females, cervical cancer predominated over breast cancer. Human behavior is a major determinant in the successful control of cancer. Understanding cancer magnitude, risk and trends will be of help in cancer control.

  20. Nutritional support among cancer patients enrolled in palliative home care services

    OpenAIRE

    2008-01-01

    Nutritional problems are common in palliative cancer care. Little is known about nutritional problems and nutritional support in home care. AIMS: The primary aim of this thesis was to investigate experiences of nutritional problems and home nutritional support, with a special focus on home parenteral nutrition (HPN), from the perspectives of cancer patients and their family members. Further aims were to investigate the prevalence of nutritional risk and use of nutritional su...

  1. Improving the quality of palliative care for ambulatory patients with lung cancer

    DEFF Research Database (Denmark)

    von Plessen, Christian; Aslaksen, Aslak

    2005-01-01

    PROBLEM: Most patients with advanced lung cancer currently receive much of their health care, including chemotherapy, as outpatients. Patients have to deal with the complex and time consuming logistics of ambulatory cancer care. At the same time, members of staff often waste considerable time......; satisfaction among patients. STRATEGIES FOR CHANGE: Rescheduled patients' appointments, automated retrieval of blood test results, systematic reporting in patients' files, design of an information leaflet, and refurnishing of the waiting area at the clinic. EFFECTS OF CHANGE: Interventions resulted...

  2. Multidisciplinary Approach to Breast Cancer: A New Outlook on Nursing Care

    Institute of Scientific and Technical Information of China (English)

    Ilana Kadmon; Frida Barak

    2009-01-01

    The treatment and general care for women diagnosed with breast cancer has made a tremendous change and advance in the last decades. Better methods for early detection and screening of the disease, higher compliance of women to go for screening, an open social and political discourse of women and the health care team and others, are just a few that both enabled and are a result of this change. Nurses have been highly involved in these changes, which resulted in the specialization of nursing in the field of breast cancer. This article will focus on the main four points that influence the nursing specialist care, that is, the tailoring of treatment and the ability to offer women treatment which is more specific to their own cancer; the importance of the multidisciplinary team as providing a State of the Art care; the involvement of women in the decision-making regarding their treatment and the specific developing role of the specialist breast care nurse.

  3. Overall and worst gleason scores are equally good predictors of prostate cancer progression

    Directory of Open Access Journals (Sweden)

    Tuominen Vilppu J

    2011-10-01

    Full Text Available Abstract Background Gleason scoring has experienced several modifications during the past decade. So far, only one study has compared the prognostic abilities of worst (WGS and overall (OGS modified Gleason scores after the ISUP 2005 conference. Prostatic needle biopsies are individually paraffin-embedded in 57% of European pathology laboratories, whereas the rest of laboratories embed multiple (2 - 6 biopsies per one paraffin-block. Differences in the processing method can have a far-reaching effect, because reporting of the Gleason score (GS is different for individually embedded and pooled biopsies, and GS is one of the most important factors when selecting treatment for patients. Methods The study material consisted of needle biopsies from 236 prostate cancer patients that were endocrine-treated in 1999-2003. Biopsies from left side and right side were embedded separately. Haematoxylin-eosin-stained slides were scanned and analyzed on web-based virtual microscopy. Worst and overall Gleason scores were assessed according to the modified Gleason score schema after analyzing each biopsy separately. The compound Gleason scores (CGS were obtained from the original pathology reports. Two different grade groupings were used: GS 6 or less vs. 7 vs. 8 or above; and GS 7(3 + 4 or less vs. 7(4 + 3 and 8 vs. 9-10. The prognostic ability of the three scoring methods to predict biochemical progression was compared with Kaplan-Meier survival analysis and univariate and multivariate Cox regression analyses. Results The median follow-up time of the patients was 64.5 months (range 0-118. The modified GS criteria led to upgrading of the Gleason sums compared to the original CGS from the pathology reports 1999-2003 (mean 7.0 for CGS, 7.5 for OGS, 7.6 for WGS. In 43 cases WGS was > OGS. In a univariate analysis the relative risks were 2.1 (95%-confidence interval 1.8-2.4 for CGS, 2.5 (2.1-2.8 for OGS, and 2.6 (2.2-2.9 for WGS. In a multivariate analysis, OGS was

  4. Realizing good care within a context of cross-cultural diversity: an ethical guideline for healthcare organizations in Flanders, Belgium.

    Science.gov (United States)

    Denier, Yvonne; Gastmans, Chris

    2013-09-01

    In our globalizing world, health care professionals and organizations increasingly experience cross-cultural challenges in care relationships, which give rise to ethical questions regarding "the right thing to do" in such situations. For the time being, the international literature lacks examples of elaborated ethical guidelines for cross-cultural healthcare on the organizational level. As such, the ethical responsibility of healthcare organizations in realizing cross-cultural care remains underexposed. This paper aims to fill this gap by offering a case-study that illustrates the bioethical practice on a large-scale organizational level by presenting the ethical guideline developed in the period 2007-2011 by the Ethics Committee of Zorgnet Vlaanderen, a Christian-inspired umbrella organization for over 500 social profit healthcare organizations in Flanders, Belgium. The guideline offers an ethical framework within which fundamental ethical values are being analyzed within the context of cross-cultural care. The case study concludes with implications for healthcare practice on four different levels: (1) the level of the healthcare organization, (2) staff, (3) care receivers, and (4) the level of care supply. The study combines content-based ethics with process-based benchmarks.

  5. Inequity in access to cancer care: a review of the Canadian literature.

    Science.gov (United States)

    Maddison, André R; Asada, Yukiko; Urquhart, Robin

    2011-03-01

    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.

  6. Nurses′ knowledge and education about oral care of cancer patients undergoing chemotherapy and radiation therapy

    Directory of Open Access Journals (Sweden)

    Radhika R Pai

    2015-01-01

    Setting and design: A cross sectional descriptive survey was conducted among 158 staff nurses working in oncology related areas from 4 different hospitals of Dakshina Kannada district and Udupi district of Karnataka state, India. Statistical Analysis: descriptive and inferential statistics was used by using SPSS 16 version. Results: Majority 81 (51.3% of the staff nurses had poor knowledge of oral care in cancer patients whereas 87 (55.1% reported that knowledge acquired through basic education in oral care is not sufficient. Most of the staff nurses 115 (72.8% did not receive basic education in oral care of cancer patients. There was significant association between knowledge and variables such as designation (.005, years of work experience (.040 and years of experience in cancer wards (.000 at 0.05 levels. Conclusion: Lack of knowledge suggest the need to develop and implement continuing nursing education programs on oral care specifically for patients receiving cancer treatments, for improving knowledge of staff nurses′ in order to render comprehensive care to the patients. This study also recommends the importance of inclusion of cancer patient specific oral care in the curriculum which can enhance competency of the qualified nurses in cancer wards.

  7. Providing palliative care to patients with cancer: Addressing the needs in Kenya

    Directory of Open Access Journals (Sweden)

    Pam Malloy

    2017-01-01

    Full Text Available 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.

  8. Supporting cancer patients with palliative care needs: district nurses' role perceptions.

    Science.gov (United States)

    Griffiths, Jane; Ewing, Gail; Rogers, Margaret; Barclay, Stephen; Martin, Anna; McCabe, Janet; Todd, Chris

    2007-01-01

    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.

  9. Providers' Perspectives of Survivorship Care for Young Adult Survivors of Childhood Cancer.

    Science.gov (United States)

    Berg, Carla; Stratton, Erin; Esiashvili, Natia; Mertens, Ann; Vanderpool, Robin C

    2016-03-01

    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.

  10. Communication in Cancer Care (PDQ®)—Patient Version

    Science.gov (United States)

    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.

  11. Communication in Cancer Care (PDQ®)—Health Professional Version

    Science.gov (United States)

    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.

  12. Deciding intensive care unit-admission for critically ill cancer patients

    Directory of Open Access Journals (Sweden)

    Thiery Guillaume

    2007-01-01

    Full Text Available Over the last 15 years, the management of critically ill cancer patients requiring intensive care unit admission has substantially changed. High mortality rates (75-85% were reported 10-20 years ago in cancer patients requiring life sustaining treatments. Because of these high mortality rates, the high costs, and the moral burden for patients and their families, ICU admission of cancer patients became controversial, or even clearly discouraged by some. As a result, the reluctance of intensivists regarding cancer patients has led to frequent refusal admission in the ICU. However, prognosis of critically ill cancer patients has been improved over the past 10 years leading to an urgent need to reappraise this reluctance. In this review, the authors sought to highlight that critical care management, including mechanical ventilation and other life sustaining therapies, may benefit to cancer patients. In addition, criteria for ICU admission are discussed, with a particular emphasis to potential benefits of early ICU-admission.

  13. Is centralization of ovarian cancer care warranted? A cost-effectiveness analysis

    NARCIS (Netherlands)

    Greving, Jacoba P.; Vernooji, Flora; Heintz, A. Peter M.; van der Graaf, Yolanda; Buskens, Erik

    2009-01-01

    Objective. To evaluate the cost-effectiveness of tertiary referral care for ovarian cancer patients in the Netherlands. Methods. We collected clinical and registry data on 1077 newly diagnosed ovarian cancer patients treated from 1996-2003 in a random sample of Dutch hospitals. Decision modelling wa

  14. Specialized care and survival of ovarian cancer patients in The Netherlands: Nationwide cohort study

    NARCIS (Netherlands)

    F. Vernooij (Flora); A.P.M. Heintz (Peter); P.O. Witteveen (Petronella); M. van der Heiden-Van der Loo (Margriet); J.W.W. Coebergh (Jan Willem); Y. van der Graaf (Yolanda)

    2008-01-01

    textabstractBackground: There is much debate on the necessity of regionalization of ovarian cancer care. We investigated the association between hospital type and survival of patients with ovarian cancer in The Netherlands. Methods: A retrospective, population-based cohort study was performed on all

  15. Modest improvement in 20 years of kidney cancer care in the Netherlands.

    NARCIS (Netherlands)

    Schans, S.A. van de; Aben, K.K.H.; Mulders, P.F.A.; Haanen, J.B.; Herpen, C.M. van; Verhoeven, R.H.; Karim-Kos, H.E.; Oosterwijk, E.; Kiemeney, L.A.L.M.

    2012-01-01

    AIM: For an evaluation of the progress achieved in the field of kidney cancer care in the Netherlands in the last decades, we described trends in incidence, treatment, mortality and relative survival. METHODS: All adult patients newly diagnosed with kidney cancer between 1989 and 2009 (N=32,545) wer

  16. Ethical Issues in the End of Life Care for Cancer Patients in Iran

    Directory of Open Access Journals (Sweden)

    Mina Mobasher

    2013-02-01

    Full Text Available Background: In the recent years, advances in medical technologies for end stage cancer patients’ care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists' viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process.Methods: In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data.Results: During the process of analysis, three main themes emerged about ethical dilemmas in end of life care for advanced cancer patients: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system.Conclusion: Health care and insurance system in Iran face to end of life care challenges; therefore, health care providers and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians’ communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. The findings of this study can help us to provide ethical policies for decision-making in end-of-life care.

  17. The International Cancer Expert Corps: a unique approach for sustainable cancer care in low and lower-middle income countries

    Directory of Open Access Journals (Sweden)

    C Norman eColeman

    2014-11-01

    Full Text Available 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 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 for novel and sustainable solutions to transform

  18. Changes in symptoms and pain intensity of cancer patients after enrollment in palliative care at home

    NARCIS (Netherlands)

    Dumitrescu, Luminita; van den Heuvel-Olaroiu, Marinela; van den Heuvel, Wim J. A.

    2007-01-01

    This study describes the activities and interventions carried out by an at-home palliative care team treating cancer patients who died within two years of being enrolled in a palliative care program. It analyzes which changes in symptoms and pain occurred and which sociodemographic and medical chara

  19. Recovery at the post anaesthetic care unit after breast cancer surgery

    DEFF Research Database (Denmark)

    Gärtner, Rune; Callesen, Torben; Kroman, Niels Thorndahl

    2010-01-01

    Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine...

  20. Marshalling Social Support: A Care-Getting Model for Persons Living with Cancer

    Science.gov (United States)

    Kahana, Eva; Kahana, Boaz; Wykle, May; Kulle, Diana

    2009-01-01

    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…

  1. Filling the Gap for Early-Stage Breast Cancer Follow-Up: An Overview for Primary Care Providers.

    Science.gov (United States)

    Bond-Bero, Stacy

    2016-01-01

    Earlier detection and newer treatments now make breast cancer highly survivable, and breast cancer survivors are the largest female cancer survivor group in the United States. With earlier detection, more women are being diagnosed with early-stage breast cancer and need follow-up care. With the increasing number of breast cancer survivors, there is a projected shortage in the workforce of oncology specialists to care for these women. The American Society of Clinical Oncology recommends that breast cancer follow-up care can be provided by an oncologist or primary care provider, as long as the primary care provider has spoken to the oncologist about appropriate follow-up care. Several studies have shown that primary care providers and oncologists have comparable outcomes for follow-up care of women with early-stage breast cancer. The National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) are considered the gold standard for breast cancer treatment and follow-up. These guidelines are clear and straightforward. Using knowledge of the NCCN Guidelines, primary care providers can fill the gap for follow-up care of women with early-stage breast cancer.

  2. A five-year assessment of the affordable care act: market forces still trump the common good in U.S. Health care.

    Science.gov (United States)

    Geyman, John P

    2015-01-01

    The Affordable Care Act (ACA) was enacted in 2010 as the signature domestic achievement of the Obama presidency. It was intended to contain costs and achieve near-universal access to affordable health care of improved quality. Now, five years later, it is time to assess its track record. This article compares the goals and claims of the ACA with its actual experience in the areas of access, costs, affordability, and quality of care. Based on the evidence, one has to conclude that containment of health care costs is nowhere in sight, that more than 37 million Americans will still be uninsured when the ACA is fully implemented in 2019, that many more millions will be underinsured, and that profiteering will still dominate the culture of U.S. health care. More fundamental reform will be needed. The country still needs to confront the challenge that our for-profit health insurance industry, together with enormous bureaucratic waste and widespread investor ownership throughout our market-based system, are themselves barriers to health care reform. Here we consider the lessons we can take away from the ACA's first five years and lay out the economic, social/political, and moral arguments for replacing it with single-payer national health insurance.

  3. Reporting characteristics of cancer pain: A systematic review and quantitative analysis of research publications in palliative care journals

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available 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.

  4. EURECCA colorectal: multidisciplinary mission statement on better care for patients with colon and rectal cancer in Europe

    NARCIS (Netherlands)

    Velde, C.J. van de; Aristei, C.; Boelens, P.G.; Beets-Tan, R.G.; Blomqvist, L.; Borras, J.M.; Broek, C.B. van den; Brown, G.; Coebergh, J.W.W.; Cutsem, E.V.; Espin, E.; Gore-Booth, J.; Glimelius, B.; Haustermans, K.; Henning, G.; Iversen, L.H.; Krieken, J.H. van; Marijnen, C.A.; Mroczkowski, P.; Nagtegaal, I.; Naredi, P.; Ortiz, H.; Pahlman, L.; Quirke, P.; Rodel, C.; Roth, A.; Rutten, H.J.; Schmoll, H.J.; Smith, J.; Tanis, P.J.; Taylor, C.; Wibe, A.; Gambacorta, M.A.; Meldolesi, E.; Wiggers, T.; Cervantes, A.; Valentini, V.

    2013-01-01

    BACKGROUND: Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at def

  5. EURECCA colorectal : Multidisciplinary Mission statement on better care for patients with colon and rectal cancer in Europe

    NARCIS (Netherlands)

    van de Velde, Cornelis J. H.; Aristei, Cynthia; Boelens, Petra G.; Beets-Tan, Regina G. H.; Blomqvist, Lennart; Borras, Josep M.; van den Broek, Colette B. M.; Brown, Gina; Coebergh, Jan-Willem; Van Cutsem, Eric; Espin, Eloy; Gore-Booth, Jola; Glimelius, Bengt; Haustermans, Karin; Henning, Geoffrey; Iversen, Lene H.; van Krieken, J. Han; Marijnen, Corrie A. M.; Mroczkowski, Pawel; Nagtegaal, Iris; Naredi, Peter; Ortiz, Hector; Pahlman, Lars; Quirke, Philip; Roedel, Claus; Roth, Arnaud; Rutten, Harm J. T.; Schmoll, Hans J.; Smith, Jason; Tanis, Pieter J.; Taylor, Claire; Wibe, Arne; Gambacorta, Maria Antonietta; Meldolesi, Elisa; Wiggers, Theo; Cervantes, Andres; Valentini, Vincenzo

    2013-01-01

    Background: Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at def

  6. The role of acupuncture in cancer supportive care.

    Science.gov (United States)

    Lin, Jaung-Geng; Chen, Yi-Hung

    2012-01-01

    Acupuncture has many beneficial effects during cancer therapy and has proven efficacy in the management of side effects induced by chemotherapy and radiotherapy. In this review, we discussed the benefits of acupuncture on cancer patients. In cancer pain management, acupuncture is effective for head and neck pain, waist pain, abdominal and chest pain. Many studies confirm the excellent efficacy of acupuncture against symptoms of vomiting and nausea, including those induced by chemotherapy and radiotherapy. Head and neck cancer patients receiving radiotherapy may develop xerostomia, which may be relieved by acupuncture. Acupuncture may also cause sedative and hypnotic effects in cancer patients for treating nervousness and insomnia.

  7. Caring for cancer patients in the general dental office

    Energy Technology Data Exchange (ETDEWEB)

    McDermott, I.

    Modern therapeutic modalities and emphasis on early detection have made oral cancer a treatable, and in many cases, a curable disease. The role of the dentist in cancer patient management is two-fold. Early detection of oral lesions during routine dental examination has been shown to be a significant factor in cancer diagnosis. The dentist's other role comes after cancer treatment, specifically therapeutic radiation. Ionizing radiation can have permanent effects on both hard and soft tissues. Prescription and use of fluoride gel in topical applicators can aid in assuring oral health for post-cancer patients.

  8. The effects of hospice-shared care for gastric cancer patients

    Science.gov (United States)

    Huang, Kun-Siang; Wang, Shih-Ho; Chuah, Seng-Kee; Rau, Kun-Ming; Lin, Yu-Hung; Hsieh, Meng-Che; Shih, Li-Hsueh; Chen, Yen-Hao

    2017-01-01

    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%, phospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR) orders (95% vs 37%, phospice care (16% vs 1%, phospice 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

  9. Cancer survivors' rehabilitation needs in a primary health care context

    DEFF Research Database (Denmark)

    Mikkelsen, Thorbjørn; Søndergaard, Jens; Sokolowski, Ineta;

    2009-01-01

    BACKGROUND: Studies of cancer survivors' rehabilitation needs have mostly addressed specific areas of needs, e.g. physical aspects and/or rehabilitation needs in relation to specific cancer types. OBJECTIVE: To assess cancer survivors' perceived need for physical and psychosocial rehabilitation......, whether these needs have been presented to and discussed with their GP. METHODS: A survey among a cohort of cancer survivors approximately 15 months after diagnosis. The questionnaire consisted of an ad hoc questionnaire on rehabilitation needs and the two validated questionnaires, the SF-12...... and the Research and Treatment of Cancer quality of life questionnaire, the QLQ C-30 version 3. RESULTS: Among 534 eligible patients, we received 353 (66.1%) answers. Two-thirds of the cancer survivors had discussed physical rehabilitation needs with their GPs. Many (51%) feared cancer relapse, but they rarely...

  10. A Randomized Controlled Trial of Hospital-based Case Management in Cancer Care

    DEFF Research Database (Denmark)

    Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens

    2012-01-01

    BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital......-based CM on (i) GPs' evaluation of information from the hospital and collaboration with the hospital staff and (ii) patients' contacts with GPs during daytime and out of hours. DESIGN: A randomized controlled trial allocated 280 colorectal cancer patients 1:1 to either a control group or CM intervention...

  11. Delivering Coordinated Cancer Care by Building Transactive Memory in a Team of Teams.

    Science.gov (United States)

    Henry, Elizabeth; Silva, Abigail; Tarlov, Elizabeth; Czerlanis, Cheryl; Bernard, Margie; Chauhan, Cynthia; Schalk, Denise; Stewart, Greg

    2016-11-01

    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.

  12. Moving Toward Improved Teamwork in Cancer Care: The Role of Psychological Safety in Team Communication.

    Science.gov (United States)

    Jain, Anshu K; Fennell, Mary L; Chagpar, Anees B; Connolly, Hannah K; Nembhard, Ingrid M

    2016-11-01

    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.

  13. Health care utilisation and characteristics of long-term breast cancer survivors: nationwide survey in Denmark

    DEFF Research Database (Denmark)

    Peuckmann, V; Ekholm, O; Sjøgren, P;

    2008-01-01

    AIM: To investigate long-term female breast cancer survivors' (BCS') health care utilisation, health, and employment. METHODS: An age-stratified random sample of 2000 female breast cancer survivors (BCS) 5-15 years after primary surgery without recurrence was drawn from the Danish Breast Cancer...... Cooperative Group register. A self-administered questionnaire assessed sociodemography, health care utilisation, employment, and health-related quality of life (HRQOL). Associations with breast cancer treatment were investigated. RESULTS: Response rate was 79%. Significantly more BCS than the general women...... population reported health care utilisation (61% versus. 56%; age-standardised risk ratio (SRR): 1.10; 95% confidence interval (CI) 1.05-1.15), but significantly fewer BCS were disability pensioners (15% versus 19%; SRR: 0.77; 95% CI 0.64-0.93). 'Daily activities limited due to sequelae' were reported by 20...

  14. Improving the quality of cancer care in America through health information technology.

    Science.gov (United States)

    Feeley, Thomas W; Sledge, George W; Levit, Laura; Ganz, Patricia A

    2014-01-01

    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.

  15. Perspectives on preventive health care and barriers to breast cancer screening among Iraqi women refugees.

    Science.gov (United States)

    Saadi, Altaf; Bond, Barbara; Percac-Lima, Sanja

    2012-08-01

    Since the Iraq war began in 2003, over 4 million Iraqis have been displaced. Little is known about preventive cancer care in this population, but stark disparities have been documented. The purpose of this study was to assess the perspectives of Iraqi women refugees on preventive care and perceived barriers to breast cancer screening. Interviews were conducted in Arabic with twenty Iraqi refugee women by a bilingual (English/Arabic) medical student, transcribed, translated and coded according to established qualitative content and thematic analysis procedures. Psychosocial barriers, culturally mediated beliefs, and health consequences of war were identified as major themes, ultimately showing what factors, alone and collectively, have impeded Iraqi refugee women's ability and motivation to obtain breast cancer screening. To improve cancer prevention and decrease disparities in care in this most vulnerable population, culturally appropriate health education and outreach programs, as well as further community-level targeted studies, are needed.

  16. Assessment of cancer care in Indian elderly cancer patients: A single center study

    Science.gov (United States)

    Sarkar, Anindya; Shahi, UP

    2013-01-01

    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

  17. Assessment of cancer care in Indian elderly cancer patients: A single center study

    Directory of Open Access Journals (Sweden)

    Anindya Sarkar

    2013-01-01

    Full Text Available 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.

  18. Multi-agent systems: effective approach for cancer care information management.

    Science.gov (United States)

    Mohammadzadeh, Niloofar; Safdari, Reza; Rahimi, Azin

    2013-01-01

    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.

  19. Care-seeking behavior of Japanese gynecological cancer survivors suffering from adverse effects

    Directory of Open Access Journals (Sweden)

    Oshima Sumiko

    2013-01-01

    Full Text Available Abstract Background Post-treatment follow-up visits for gynecological cancer survivors should provide opportunities for management of adverse physical/psychological effects of therapy and early recurrence detection. However, the adequacy of such visits in Japan is poorly documented. We qualitatively explored care-seeking experiences of Japanese gynecological cancer survivors and deduced factors influencing care-seeking behaviors and treatment access. Methods We conducted 4 semi-structured focus groups comprising altogether 28 Japanese gynecological cancer survivors to collect a variety of participants’ post-treatment care-seeking behaviors through active interaction with participants. Factors influencing access to treatment for adverse effects were analyzed qualitatively. Results Survivors sought care through specialty clinic visits when regular post-treatment gynecological follow-ups were inadequate or when symptoms seemed to be non-treatment related. Information provided by hospital staff during initial treatment influenced patients’ understanding and response to adverse effects. Lack of knowledge and inaccurate symptom interpretation delayed help-seeking, exacerbating symptoms. Gynecologists’ attitudes during follow-ups frequently led survivors to cope with symptoms on their own. Information from mass media, Internet, and support groups helped patients understand symptoms and facilitated care seeking. Conclusions Post-treatment adverse effects are often untreated during follow-up visits. Awareness of possible post-treatment adverse effects is important for gynecological cancer survivors in order to obtain appropriate care if the need arises. Consultation during the follow-up visit is essential for continuity in care.

  20. Breast cancer and depression: issues in clinical care

    Directory of Open Access Journals (Sweden)

    Thingbaijam B. Singh

    2012-11-01

    Full Text Available Many of breast-cancer patients experience distress and most of them experience depression which may lead to amplification of physical symptoms, increased functional impairment, and poor treatment adherence. We did a review on available literature from PubMed about prevalence, distress magnitudes, coping styles, and treatment methods of major depression in women with breast cancer from 1978 to 2010. Diagnosis and treatment of depressive episodes in women with breast cancer is challenging because of overlapping symptoms and co-morbid conditions. Major depression is often under-recognized and undertreated among breast cancer patients. This review highlighted the issues on identifying and managing depression in breast cancer patients in clinical settings. (Med J Indones. 2012;21:240-6Keywords: Breast cancer, coping, depression, distress

  1. Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services.

    Science.gov (United States)

    Silver, Julie K; Raj, Vishwa S; Fu, Jack B; Wisotzky, Eric M; Smith, Sean Robinson; Kirch, Rebecca A

    2015-12-01

    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

  2. 呵护好贫困学生的自尊%Good Care Poor Self-esteem of Students

    Institute of Scientific and Technical Information of China (English)

    韩嵬

    2014-01-01

    Adolescent self-esteem is stronger,especially for the poor students of teenagers,in dealing with this part of the students, teachers must pay attention to repeat special psychological care for poor students. In this paper,the author combining with specific cases, expounds how to care for the poor students self-esteem.%青少年的自尊心比较强,尤其对于青少年中的贫困生而言,在对待这部分学生的时候,教师一定要注意重点照顾贫困生的特殊心理。结合具体的案例,就如何呵护贫困生的自尊展开阐述。

  3. Quality end-of-Life cancer care: An overdue imperative.

    Science.gov (United States)

    Faguet, Guy B

    2016-12-01

    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.

  4. Health care professionals' familiarity with non-pharmacological strategies for managing cancer pain.

    Science.gov (United States)

    Zaza, C; Sellick, S M; Willan, A; Reyno, L; Browman, G P

    1999-01-01

    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.

  5. "PRIMARY PALLIATIVE CARE? - Treating terminally ill cancer patients in the primary care sector"

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Jensen, AB; Olesen, Frede;

    2006-01-01

    4th Research Forum of the European Association for Palliative Care "Collaborate to Catalyse Research", Venice Lido,......4th Research Forum of the European Association for Palliative Care "Collaborate to Catalyse Research", Venice Lido,...

  6. Current and future care of patients with the cancer anorexia-cachexia syndrome.

    Science.gov (United States)

    Del Fabbro, Egidio

    2015-01-01

    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.

  7. [Nursing in palliative care to children and adolescents with cancer: integrative literature review].

    Science.gov (United States)

    da Costa, Thailly Faria; Ceolim, Maria Filomena

    2010-12-01

    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.

  8. The use of playing by the nursing staff on palliative care for children with cancer

    Directory of Open Access Journals (Sweden)

    Vanessa Albuquerque Soares

    Full Text Available This study aimed to describe ways of using play by the nursing staff on palliative care of children with cancer and analyze the facilitators and barriers of the use of playing on this type of care. Qualitative, descriptive research developed on November 2012 with 11 health professionals, in a public hospital of the state of Rio de Janeiro. Semi-structured interviews and thematic analysis of the information were conducted. The use of playing before procedures was highlighted as a facilitator on palliative care. The child's physical condition, one's restriction, resistance of some professionals and the lack of time for developing this activity, made the use of play harder. We concluded that playing enables the child with cancer, in palliative care, a humanized assistance, being fundamental to integrate it on the care for these children.

  9. Effectiveness of an Interdisciplinary Palliative Care Intervention for Family Caregivers in Lung Cancer

    Science.gov (United States)

    Sun, Virginia; Grant, Marcia; Koczywas, Marianna; Freeman, Bonnie; Zachariah, Finly; Fujinami, Rebecca; Del Ferraro, Catherine; Uman, Gwen; Ferrell, Betty

    2015-01-01

    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; pcaregiver 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

  10. Standardizing central venous catheter care by using observations from patients with cancer.

    Science.gov (United States)

    Weingart, Saul N; Hsieh, Candace; Lane, Sharon; Cleary, Angela M

    2014-06-01

    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.

  11. Quality palliative care for cancer and dementia in five European countries: some common challenges

    Science.gov (United States)

    Davies, Nathan; Maio, Laura; van Riet Paap, Jasper; Mariani, Elena; Jaspers, Birgit; Sommerbakk, Ragni; Grammatico, Daniela; Manthorpe, Jill; Ahmedzai, Sam; Vernooij-Dassen, Myrra; Iliffe, Steve

    2013-01-01

    Objectives There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. Method One focus group (n = 7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings. Results The interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints. Conclusion These are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care. PMID:24131061

  12. Providing palliative care for the newly diagnosed cancer patient: concepts and resources.

    Science.gov (United States)

    Gabriel, Michelle

    2008-04-01

    Palliative care has evolved from end-of-life care following exhaustion of curative therapy to care across the cancer-management continuum. Often initiated concurrently with curative care at the time of diagnosis, palliative care ensures both effective symptom management and the best possible quality of life in four key domains-physical, psychological, social, and spiritual. The significant growth and development of palliative care in the United States is evident in that one in four hospitals now has a palliative care program, palliative medicine is now recognized as an official medical subspecialty by the American Board of Medical Specialties, and national programs offer comprehensive continuing education in palliative care for nurses and physicians. The oncology nurse who provides palliative care does so as part of a multidisciplinary team that includes not only physicians but also can involve chaplains, massage therapists, pharmacists, nutritionists, and other specialists. This article provides resources and reviews and highlights pertinent palliative care issues to guide oncology nurses managing newly diagnosed cancer patients.

  13. Follow-up care for breast cancer survivors: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Chopra I

    2014-08-01

    Full Text Available Ishveen Chopra,1 Avijeet Chopra2 1Department of Pharmacy Administration, Duquesne University, Pittsburgh, PA, USA; 2Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, USA Background: Appropriate follow-up care is important for improving health outcomes in breast cancer survivors (BCSs and requires determination of the optimum intensity of clinical examination and surveillance, assessment of models of follow-up care such as primary care-based follow-up, an understanding of the goals of follow-up care, and unique psychosocial aspects of care for these patients. The objective of this systematic review was to identify studies focusing on follow-up care in BCSs from the patient's and physician's perspective or from patterns of care and to integrate primary empirical evidence on the different aspects of follow-up care from these studies. Methods: A comprehensive literature review and evaluation was conducted for all relevant publications in English from January 1, 1990 to December 31, 2013 using electronic databases. Studies were included in the final review if they focused on BCS’s preferences and perceptions, physician's perceptions, patterns of care, and effectiveness of follow-up care. Results: A total of 47 studies assessing the different aspects of follow-up care were included in the review, with a majority of studies (n=13 evaluating the pattern of follow-up care in BCSs, followed by studies focusing on BCS's perceptions (n=9 and preferences (n=9. Most of the studies reported variations in recommended frequency, duration, and intensity of follow-up care as well as frequency of mammogram screening. In addition, variations were noted in patient preferences for type of health care provider (specialist versus non-specialist. Further, BCSs perceived a lack of psychosocial support and information for management of side effects. Conclusion: The studies reviewed, conducted in a range of settings, reflect variations in

  14. Has the new TNM classification for colorectal cancer improved care?

    NARCIS (Netherlands)

    Nagtegaal, I.D.; Quirke, P.; Schmoll, H.J.

    2012-01-01

    In 2009, the Union for International Cancer Control issued the seventh edition of the well-used T (tumor), N (node), and M (metastasis) classification guidelines. There has been a continual refinement of the staging for colorectal cancer since this system for assessing tumor stage was initially adop

  15. CARING (CAncer Risk and INsulin analoGues)

    DEFF Research Database (Denmark)

    Starup-Linde, Jakob; Karlstad, Oystein; Eriksen, Stine Aistrup

    2013-01-01

    BACKGROUND: Patients suffering from diabetes mellitus (DM) may experience an increased risk of cancer; however, it is not certain whether this effect is due to diabetes per se. OBJECTIVE: To examine the association between DM and cancers by a systematic review and meta-analysis according to the P......BACKGROUND: Patients suffering from diabetes mellitus (DM) may experience an increased risk of cancer; however, it is not certain whether this effect is due to diabetes per se. OBJECTIVE: To examine the association between DM and cancers by a systematic review and meta-analysis according......, and possible effect modification of age, gender, with some influence of study characteristics (population source, cancer- and diabetes ascertainment). LIMITATIONS: Publication bias seemed to be present. Only published data were used in the analyses. CONCLUSIONS: The systematic review and meta-analysis confirm...

  16. Advice on Good Grooming.

    Science.gov (United States)

    Tingey, Carol

    1987-01-01

    Suggestions are presented from parents on how to help children with disabilities (with particular focus on Downs Syndrome) learn good grooming habits in such areas as good health, exercise, cleanliness, teeth and hair care, skin care, glasses and other devices, and social behavior. (CB)

  17. Integrative review of the supportive care needs of Arab people affected by cancer

    Directory of Open Access Journals (Sweden)

    Ibrahim Alananzeh

    2016-01-01

    Full Text Available 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.

  18. The benchmark analysis of gastric, colorectal and rectal cancer pathways: toward establishing standardized clinical pathway in the cancer care.

    Science.gov (United States)

    Ryu, Munemasa; Hamano, Masaaki; Nakagawara, Akira; Shinoda, Masayuki; Shimizu, Hideaki; Miura, Takeshi; Yoshida, Isao; Nemoto, Atsushi; Yoshikawa, Aki

    2011-01-01

    Most clinical pathways in treating cancers in Japan are based on individual physician's personal experiences rather than on an empirical analysis of clinical data such as benchmark comparison with other hospitals. Therefore, these pathways are far from being standardized. By comparing detailed clinical data from five cancer centers, we have observed various differences among hospitals. By conducting benchmark analyses, providing detailed feedback to the participating hospitals and by repeating the benchmark a year later, we strive to develop more standardized clinical pathways for the treatment of cancers. The Cancer Quality Initiative was launched in 2007 by five cancer centers. Using diagnosis procedure combination data, the member hospitals benchmarked their pre-operative and post-operative length of stays, the duration of antibiotics administrations and the post-operative fasting duration for gastric, colon and rectal cancers. The benchmark was conducted by disclosing hospital identities and performed using 2007 and 2008 data. In the 2007 benchmark, substantial differences were shown among five hospitals in the treatment of gastric, colon and rectal cancers. After providing the 2007 results to the participating hospitals and organizing several brainstorming discussions, significant improvements were observed in the 2008 data study. The benchmark analysis of clinical data is extremely useful in promoting more standardized care and, thus in improving the quality of cancer treatment in Japan. By repeating the benchmark analyses, we can offer truly clinical evidence-based higher quality standardized cancer treatment to our patients.

  19. Accuracy of unidimensional and volumetric ultrasound measurements in predicting good pathological response to neoadjuvant chemotherapy in breast cancer patients.

    Science.gov (United States)

    Gounaris, I; Provenzano, E; Vallier, A L; Hiller, L; Iddawela, M; Hilborne, S; Taylor, K; Britton, P; Earl, H M; Sinnatamby, R

    2011-06-01

    Pathological complete response (pCR) is an important predictor of long-term survival in patients with breast cancer receiving neoadjuvant chemotherapy (NAC). At present, the accuracy of traditional radiological assessments during treatment in predicting pCR is poor. Unidimensional and 3D volumetric ultrasound measurements prior to, after 4 cycles (mid-treatment), and at the end of 8 cycles (end-treatment) of chemotherapy were available from a subset of 55 patients enrolled in Neo-tAnGo, a National Cancer Research Network (NCRN) UK neoadjuvant chemotherapy breast cancer trial. Proportional changes in longest diameter (LD) and volume as well as absolute residual size thresholds were examined for their ability to predict pCR or pCR plus minimal residual disease (pCR/MRD). Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and likelihood ratios (LRs) were calculated. Receiver-operator characteristic (ROC) curves and logistic regression models were also constructed. At mid-treatment, neither complete radiological response, nor proportional LD or volume changes were found predictive of final pCR. A small residual tumour volume (≤ 1 cm³ vs. > 1 cm³) at mid-treatment, however, was associated with pCR/MRD (P = 0.014). Sensitivity, specificity, PPV, NPV, LR+ and LR- values were 61%, 77%, 61%, 77%, 2.62 and 0.51, respectively. The area under the ROC curve was 0.689 (P = 0.03). Volume ≤ 1 cm³ at mid-treatment was found significant in a logistic regression (OR: 0.194, P = 0.011). At end-treatment, no ultrasound measurements were found predictive of pCR or pCR/MRD. In conclusion, proportional tumour size changes (the basis of the RECIST criteria) were not found predictive of good pathological response, although residual volume ≤ 1 cm³ at mid-treatment was found to be predictive of pCR/MRD. However, multiple volume and LD thresholds were examined and uncorrected P values presented, increasing the possibility of type I errors. Replication in an

  20. Child perceptions of parental care and overprotection in children with cancer and healthy children.

    Science.gov (United States)

    Tillery, Rachel; Long, Alanna; Phipps, Sean

    2014-06-01

    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.

  1. Exploring the barriers to health care and psychosocial challenges in cervical cancer management in Kenya

    Directory of Open Access Journals (Sweden)

    Ngutu M

    2015-08-01

    Full Text Available Mariah Ngutu, Isaac K Nyamongo Institute of Anthropology, Gender and African Studies (IAGAS, University of Nairobi, Nairobi, Kenya Abstract: Cervical cancer is the most frequent cancer among women aged between 15 years and 44 years in Kenya, resulting in an estimated 4,802 women being diagnosed with cervical cancer and 2,451 dying from the disease annually. It is often detected at its advanced invasive stages, resulting in a protracted illness upon diagnosis. This qualitative study looked at the illness trajectories of women living with cervical cancer enrolled for follow-up care at Kenyatta National Hospital cancer treatment center and the Nairobi Hospice, both in Nairobi county, Kenya. Using the qualitative phenomenological approach, data were collected through 18 in-depth interviews with women living with cervical cancer between April and July 2011. In-depth interviews with their caregivers, key informant interviews with health care workers, and participant observation field notes were used to provide additional qualitative data. These data were analyzed based on grounded theory’s inductive approach. Two key themes on which the data analysis was then anchored were identified, namely, psychosocial challenges of cervical cancer and structural barriers to quality health care. Findings indicated a prolonged illness trajectory with psychosocial challenges, fueled by structural barriers that women were faced with after a cervical cancer diagnosis. To address issues relevant to the increasing numbers of women with cervical cancer, research studies need to include larger samples of these women. Also important are studies that allow in-depth understanding of the experiences of women living with cervical cancer. Keywords: qualitative, illness trajectories, women, cervical cancer

  2. Transition from Hospital to Community Care: The Experience of Cancer Patients

    Directory of Open Access Journals (Sweden)

    Hanna Admi

    2015-12-01

    Full Text Available Purpose: This study examines care transition experiences of cancer patients and assesses barriers to effective transitions.Methods: Participants were adult Hebrew, Arabic, or Russian speaking oncology patients and health care providers from hospital and community settings. Qualitative (n=77 and quantitative (n=422 methods such as focus groups, interviews and self-administered questionnaires were used. Qualitative analysis showed that patients faced difficulties navigating a complex and fragmented healthcare system.Results: Mechanisms to overcome barriers included informal routes such as personal relationships, coordinating roles by nurse coordinators and the patients' general practitioners (GPs. The most significant variable was GPs involvement, which affected transition process quality as rated on the CTM (p<0.001. Our findings point to the important interpersonal role of oncology nurses to coordinate and facilitate the care transition process.Conclusion: Interventions targeted towards supporting the care transition process should emphasize ongoing counseling throughout a patient’s care, during and after hospitalization.-----------------------------------------Cite this article as:  Admi H, Muller E, Shadmi E. Transition from Hospital to Community Care: The Experience of Cancer Patients. Int J Cancer Ther Oncol 2015; 3(4:34011.[This abstract was presented at the BIT’s 8th Annual World Cancer Congress, which was held from May 15-17, 2015 in Beijing, China.

  3. Stepped care targeting psychological distress in head and neck and lung cancer patients: a randomized clinical trial

    OpenAIRE

    Krebber Anne-Marie H; Leemans C; de Bree Remco; van Straten Annemieke; Smit Filip; Smit Egbert F; Becker Annemarie; Eeckhout Guus M; Beekman Aartjan TF; Cuijpers Pim; Leeuw Irma M

    2012-01-01

    Abstract Background Psychological distress is common in cancer survivors. Although there is some evidence on effectiveness of psychosocial care in distressed cancer patients, referral rate is low. Lack of adequate screening instruments in oncology settings and insufficient availability of traditional models of psychosocial care are the main barriers. A stepped care approach has the potential to improve the efficiency of psychosocial care. The aim of the study described herein is to evaluate e...

  4. One-Year Experience Managing a Cancer Survivorship Clinic Using a Shared-Care Model for Gastric Cancer Survivors in Korea.

    Science.gov (United States)

    Lee, Ji Eun; Shin, Dong Wook; Lee, Hyejin; Son, Ki Young; Kim, Warrick Junsuk; Suh, Yun-Suhk; Kong, Seong-Ho; Lee, Hyuk Joon; Cho, Belong; Yang, Han-Kwang

    2016-06-01

    Given the rapid growth of the population of cancer survivors, increased attention has been paid to their health problems. Although gastric cancer is one of the most common cancers, empirical evidence of survivorship care is limited. The objectives of this study were to describe the health care status of gastric cancer survivors and to report the experience of using the shared-care model during a one-year experience at the cancer survivorship clinic in Seoul National University Hospital. This is a descriptive, single-center study of 250 long-term gastric cancer survivors who were referred to the survivorship clinic. The status of their health behaviors, comorbid conditions, secondary cancer screenings, and survivorship care status were investigated through questionnaires and examining the medical records. Among the survivors, 7.2% were current smokers, 8.8% were at-risk drinkers, and 32.4% were physically inactive. Among the patients who did not know their bone density status, the majority were in the osteopenic (37.1%) or osteoporotic range (24.1%). Screening among the eligible population within the recommended time intervals were 76.3% for colorectal cancer, but only 13.6% for lung cancer. All of the survivors were provided with counseling and medical management at the survivorship clinic, as appropriate. In conclusion, Long-term gastric cancer survivors have various unmet needs. Shared-care through survivorship clinics can be an effective solution for providing comprehensive care to cancer survivors.

  5. Reimagining care for adolescent and young adult cancer programs: Moving with the times.

    Science.gov (United States)

    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

    2016-04-01

    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.

  6. [Cancer in adolescents and young adults in France: Epidemiology and pathways of care].

    Science.gov (United States)

    Desandes, Emmanuel; Lacour, Brigitte; Clavel, Jacqueline

    2016-12-01

    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.

  7. Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews.

    Science.gov (United States)

    Wu, Xinyin; Chung, Vincent C H; Hui, Edwin P; Ziea, Eric T C; Ng, Bacon F L; Ho, Robin S T; Tsoi, Kelvin K F; Wong, Samuel Y S; Wu, Justin C Y

    2015-01-01

    Acupuncture and related therapies such as moxibustion and transcutaneous electrical nerve stimulation are often used to manage cancer-related symptoms, but their effectiveness and safety are controversial. We conducted this overview to summarise the evidence on acupuncture for palliative care of cancer. Our systematic review synthesised the results from clinical trials of patients with any type of cancer. The methodological quality of the 23 systematic reviews in this overview, assessed using the Methodological Quality of Systematic Reviews Instrument, was found to be satisfactory. There is evidence for the therapeutic effects of acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. There is conflicting evidence regarding the treatment of cancer-related pain, hot flashes and hiccups, and improving patients' quality of life. The available evidence is currently insufficient to support or refute the potential of acupuncture and related therapies in the management of xerostomia, dyspnea and lymphedema and in the improvement of psychological well-being. No serious adverse effects were reported in any study. Because acupuncture appears to be relatively safe, it could be considered as a complementary form of palliative care for cancer, especially for clinical problems for which conventional care options are limited.

  8. The use of biofield therapies in cancer care.

    Science.gov (United States)

    Pierce, Beverly

    2007-04-01

    Biofield therapies form a subcategory of the domain of energy therapies, as defined by the National Center for Complementary and Alternative Medicine. Specific biofield therapies addressed in this article include Therapeutic Touch, Healing Touch, Polarity Therapy, Reiki, and Qigong. This article will identify core concepts in biofield therapies, review controlled trials of the use of biofield therapies with patients with cancer, describe the process of biofield therapies implementation in one cancer center, and suggest research to benefit not only patients with cancer but also family members and oncology professionals.

  9. Good manufacturing practice production of [(68)Ga]Ga-ABY-025 for HER2 specific breast cancer imaging.

    Science.gov (United States)

    Velikyan, Irina; Wennborg, Anders; Feldwisch, Joachim; Lindman, Henrik; Carlsson, Jörgen; Sörensen, Jens

    2016-01-01

    Therapies targeting human epidermal growth factor receptor type 2 (HER2) have revolutionized breast cancer treatment, but require invasive biopsies and rigorous histopathology for optimal patient stratification. A non-invasive and quantitative diagnostic method such as positron emission tomography (PET) for the pre-therapeutic determination of the presence and density of the HER2 would significantly improve patient management efficacy and treatment cost. The essential part of the PET methodology is the production of the radiopharmaceutical in compliance with good manufacturing practice (GMP). The use of generator produced positron emitting (68)Ga radionuclide would provide worldwide accessibility of the agent. GMP compliant, reliable and highly reproducible production of [(68)Ga]Ga-ABY-025 with control over the product peptide concentration and amount of radioactivity was accomplished within one hour. Two radiopharmaceuticals were developed differing in the total peptide content and were validated independently. The specific radioactivity could be kept similar throughout the study, and it was 6-fold higher for the low peptide content radiopharmaceutical. Intrapatient comparison of the two peptide doses allowed imaging optimization. The high peptide content decreased the uptake in healthy tissue, in particular liver, improving image contrast. The later imaging time points enhanced the contrast. The combination of high peptide content radiopharmaceutical and whole-body imaging at 2 hours post injection appeared to be optimal for routine clinical use.

  10. Stress among care givers: The impact of nursing a relative with cancer

    Directory of Open Access Journals (Sweden)

    Priyadarshini Kulkarni

    2014-01-01

    Full Text Available Aims: The aim of the present study is to assess the level and areas of stress among care givers nursing their loved ones suffering from cancer. Setting and Design: An assessment of care givers′ stress providing care to cancer patients at Cipla Palliative Care Center was conducted. The study involves data collection using a questionnaire and subsequent analysis. Materials and Methods: A close-ended questionnaire that had seven sections on different aspects of caregivers′ stress was developed and administered to 137 participants and purpose of conducting the survey was explained to their understanding. Caregivers who were willing to participate were asked to read and/or explained the questions and requested to reply as per the scales given. Data was collected in the questionnaires and was quantitatively analyzed. Results: The study results showed that overall stress level among caregivers is 5.18 ± 0.26 (on a scale of 0-10; of the total, nearly 62% of caregivers were ready to ask for professional help from nurses, medical social workers and counselors to cope up with their stress. Conclusion: Stress among caregivers ultimately affects quality of care that is being provided to the patient. This is also because they are unprepared to provide care, have inadequate knowledge about care giving along with financial burden, physical and emotional stress. Thus interventions are needed to help caregivers to strengthen their confidence in giving care and come out with better quality of care.

  11. The care of my child with cancer: a new instrument to measure caregiving demand in parents of children with cancer.

    Science.gov (United States)

    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

    2002-06-01

    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.

  12. Good quality of oral anticoagulation treatment in general practice using international normalised ratio point of care testing

    DEFF Research Database (Denmark)

    Løkkegaard, Thomas; Pedersen, Tina Heidi; Lind, Bent;

    2015-01-01

    INTRODUCTION: Oral anticoagulation treatment (OACT) with warfarin is common in general practice. Increasingly, international normalised ratio (INR) point of care testing (POCT) is being used to manage patients. The aim of this study was to describe and analyse the quality of OACT with warfarin...... in general practice in the Capital Region of Denmark using INR POCT. METHODS: A total of 20 general practices, ten single-handed and ten group practices using INR POCT, were randomly selected to participate in the study. Practice organisation and patient characteristics were recorded. INR measurements were...... collected retrospectively for a period of six months. For each patient, time in therapeutic range (TTR) was calculated and correlated with practice and patient characteristics using multilevel linear regression models. RESULTS: We identified 447 patients in warfarin treatment in the 20 practices using POCT...

  13. Childhood cancer treatment optimization: In rhabdomyosarcoma and supportive care

    NARCIS (Netherlands)

    Schoot, R.A.

    2015-01-01

    This thesis covers two subjects investigating optimization of cancer cure: prevention and treatment of central venous catheter related complications and improvement of local treatment in head and neck rhabdomyosarcoma survivors. Central venous catheters are indispensable in the modern day treatment

  14. Predictors of home death among palliative cancer patients in a primary care setting

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Vedsted, Peter;

      Background: In most western countries, the majority of palliative cancer patients wish to die at home, where GPs are often deeply involved. However, most research focuses on specialised palliative care, which results in a lack of reliable predictors of home death in primary care. Aim: To analyse...... predictors of home death among deceased palliative cancer patients in a primary care setting. Methods: Using Danish registers, we identified 787 deceased cancer patients and sent a questionnaire to their GPs. The questions concerned the GPs' involvement and the duration of the palliative period at home. We......-of-hours, and whether the GP had had contact with the relatives. Results: 350 questionnaires were filled out. In the preliminary analysis we found that even though many patients died in hospital, this group spent nearly as much of their last time at home as the patients who actually died at home. The analysis...

  15. The effect of multidisciplinary team care on cancer management

    OpenAIRE

    Abdulrahman, Ganiy Opeyemi

    2011-01-01

    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 o...

  16. Evidence-Based Knowledge Management: an approach to effectively promote good health-care decision-making in the Information Era.

    Science.gov (United States)

    Corrao, Salvatore; Arcoraci, Vincenzo; Arnone, Sabrina; Calvo, Luigi; Scaglione, Rosario; Di Bernardo, Cristofaro; Lagalla, Roberto; Caputi, Achille Patrizio; Licata, Giuseppe

    2009-04-01

    The sharing of information and the growth of knowledge together represent a foundation for the promotion of quality improvement of health care systems. This paper concerns knowledge, not only from an epistemological point of view, but also from a pragmatic one. In our paper, knowledge is discussed as the hub to promote better decision making and continuous professional development. Effective thinking is particularly needed. The critical point is to think about how health care systems can develop both an effective knowledge management network and how health-care organizations can actually be based on it. In this way, knowledge and knowledge hierarchy are defined according to Russel Achkoff's vision. Generally, knowledge is crucial in decision-making, and Evidence-Based Medicine has its roots in knowledge. In particular, information management is the basis for a significant production of knowledge to promote good health-care decision-making. Thus, relationships between knowledge management and Evidence-Based Medicine are discussed, and a new paradigm is proposed: the Evidence-Based Knowledge Management. Finally, the role of Evidence-Based Knowledge Management within Clinical Governance is discussed together with some considerations about clinical governance implementation problems in Italy.

  17. Stakeholder engagement for comparative effectiveness research in cancer care: experience of the DEcIDE Cancer Consortium.

    Science.gov (United States)

    Greenberg, Caprice C; Wind, Jennifer K; Chang, George J; Chen, Ronald C; Schrag, Deborah

    2013-03-01

    Stakeholder input is a critical component of comparative effectiveness research. To ensure that the research activities of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Network, supported by the Agency for Healthcare Research and Quality, translate into the greatest impact for everyday practice and policy-making in cancer, we were tasked with soliciting stakeholder input regarding priority areas in cancer-related comparative effectiveness research for the DEcIDE Cancer Consortium. Given the increasing emphasis on stakeholder engagement in research, many investigators are facing a similar task, yet there is limited literature to guide such efforts, particularly in cancer care. To help fill this gap, we present our approach to operationalizing stakeholder engagement and discuss it in the context of other recent developments in the area. We describe challenges encountered in convening stakeholders from multiple vantage points to prioritize topics and strategies used to mitigate these barriers. We offer several recommendations regarding how to best solicit stakeholder input to inform comparative effectiveness research in cancer care. These recommendations can inform other initiatives currently facing the challenges of engaging stakeholders in priority setting for cancer.

  18. The good, the bad and the confusing: the political economy of social care expansion in South Korea.

    Science.gov (United States)

    Peng, Ito

    2011-01-01

    Recent social policy reforms in South Korea indicate a progressive shift by a conservative government to modify the familialistic male breadwinner model that informs its welfare regime. The Korean government has demonstrated support for women through an increase in the provision, regulation and coordination of childcare and workplace support programmes for working parents. At the same time, labour market reforms have also created more pressures on women to seek and maintain paid work outside the home. Conflicting social and economic policy objectives have resulted in a confusing mix of policies, advancing and impeding gender equality at the same time. This contribution examines the recent family–work reconciliation policy reforms in Korea and discusses why these reforms may be good politics but a bad deal for women.

  19. Achieving optimal delivery of follow-up care for prostate cancer survivors: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Hudson SV

    2015-03-01

    Full Text Available Shawna V Hudson,1 Denalee M O’Malley,2 Suzanne M Miller3 1Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Somerset, 2Rutgers School of Social Work, New Brunswick, NJ, 3Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA Background: Prostate cancer is the most commonly diagnosed cancer in men in the US, and the second most prevalent cancer in men worldwide. High incidence and survival rates for prostate cancer have resulted in a large and growing population of long-term prostate cancer survivors. Long-term follow-up guidelines have only recently been developed to inform approaches to this phase of care for the prostate cancer population. Methods: A PubMed search of English literature through August 2014 was performed. Articles were retrieved and reviewed to confirm their relevance. Patient-reported measures that were used in studies of long-term prostate cancer survivors (ie, at least 2 years posttreatment were reviewed and included in the review. Results: A total of 343 abstracts were initially identified from the database search. After abstract review, 105 full-text articles were reviewed of which seven met inclusion criteria. An additional 22 articles were identified from the references of the included articles, and 29 were retained. From the 29 articles, 68 patient-reported outcome measures were identified. The majority (75% were multi-item scales that had been previously validated in existing literature. We identified four main areas of assessment: 1 physical health; 2 quality of life – general, physical, and psychosocial; 3 health promotion – physical activity, diet, and tobacco cessation; and 4 care quality outcomes. Conclusion: There are a number of well-validated measures that assess patient-reported outcomes that document key aspects of long-term follow-up with respect to patient symptoms and quality of life. However

  20. Group Medical Visits to Provide Gynecologic Care for Women Affected by Breast Cancer

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    Sally R. Greenwald

    2017-01-01

    Full Text Available Purpose: Women with breast cancer have complex and unique gynecologic needs that are challenging to effectively and comprehensively meet in a traditional gynecology visit format. Group medical visits are an effective and well-received model of care in other disease settings and can provide comprehensive health education as an adjunct to one-on-one evaluation and treatment. There are limited data regarding the use of this type of health care delivery in providing gynecology-focused care to women affected by breast cancer. Methods: A group medical visit model was created for gynecology providers to see new breast cancer patient consults. From May 2012 to February 2014, 148 patients (3–6 per group participated in a 1-hour informational session followed by a 15- to 30-minute individual visit with a physician that included history, physical examination and evaluation. We surveyed 101 women who attended these visits to evaluate a group model for providing gynecologic care and educational support to women with breast cancer. Results: Of those who responded to the survey question, 100% agreed or somewhat agreed that their expectations for an initial intake visit were met during the group visit; 81% agreed or somewhat agreed that they felt a group visit was preferable to an individual introductory visit. More than 95% agreed or somewhat agreed that the information was understandable and their questions were answered during the visit. Only 5 respondents expressed dissatisfaction with the additional time commitment for this type of visit. Conclusions: The majority of women surveyed expressed satisfaction with their experience with a group visit format. The women who participated preferred this format compared to an individual intake appointment when establishing gynecology care after breast cancer diagnosis/treatment, regardless of age, menopausal status, cancer stage or hormone receptor status. While further studies are warranted to directly compare and

  1. Mouth Cancer for Clinicians. Part 9: The Patient and Care Team.

    Science.gov (United States)

    Kalavrezos, Nicholas; Scully, Crispian

    2016-04-01

    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.

  2. Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality

    Science.gov (United States)

    Stewart, Sherri L.; Townsend, Julie S.; Puckett, Mary C.; Rim, Sun Hee

    2017-01-01

    Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions about how often they refer patients diagnosed with ovarian cancer to gynecologic oncologists, and reasons for lack of referral. We also analyzed these physicians’ knowledge of tests to help determine whether a gynecologic oncologist is needed for a planned surgery. The survey response rate was 52.2%. A total of 84% of primary care physicians (87% of family/general practitioners, 81% of internists and obstetrician/gynecologists) said they always referred patients to gynecologic oncologists for treatment. Common reasons for not always referring were patient preference or lack of gynecologic oncologists in the practice area. A total of 23% of primary care physicians had heard of the OVA1 test, which helps to determine whether gynecologic oncologist referral is needed. Although referral rates reported here are high, it is not clear whether ovarian cancer patients are actually seeing gynecologic oncologists for care. The NCCCP is undertaking several efforts to assist with this, including education of the recommendation among women and providers and assistance with treatment summaries and patient navigation toward appropriate treatment. Expansion of these efforts to all populations may help improve adherence to recommendations and reduce ovarian cancer mortality. PMID:26978124

  3. The Association between Charlson Comorbidity Index and the Medical Care Cost of Cancer: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Seok-Jun Yoon

    2015-01-01

    Full Text Available Background. This study compared comorbidity-related medical care cost associated with different types of cancer, by examining breast (N=287, colon (N=272, stomach (N=614, and lung (N=391 cancer patients undergoing surgery. Methods. Using medical benefits claims data, we calculated Charlson Comorbidity Index (CCI and total medical cost. The effect of comorbidity on the medical care cost was investigated using multiple regression and logistic regression models and controlling for demographic characteristics and cancer stage. Results. The treatment costs incurred by stomach and colon cancer patients were 1.05- and 1.01-fold higher, respectively, in patients with higher CCI determined. For breast cancer, the highest costs were seen in those with chronic obstructive pulmonary disease (COPD, but the increase in cost reduced as CCI increased. Colon cancer patients with diabetes mellitus and a CCI = 1 score had the highest medical costs. The lowest medical costs were incurred by lung cancer patients with COPD and a CCI = 2 score. Conclusion. The comorbidities had a major impact on the use of medical resources, with chronic comorbidities incurring the highest medical costs. The results indicate that comorbidities affect cancer outcomes and that they must be considered strategies mitigating cancer’s economic and social impact.

  4. IMPORTANCIA DE LA INTELIGENCIA EMOCIONAL EN LA PRÁCTICA DEL BUENTRATO EN LA ESCUELA - IMPORTANCE OF THE EMOTIONAL INTELLIGENCE WITHIN GOOD CARE AT SCHOOL

    Directory of Open Access Journals (Sweden)

    FRANCISCO JAVIER VÁSQUEZ DE LA HOZ

    2009-06-01

    Full Text Available In social institutions, among other things, it is possible to learn different skills to relate with the others. So, we may suppose within School, several sceneries are generated so that students achieve skills to establish a relationship with their partners as well with other people. These skills may be noted by good or bad treatments.We think intentional formation/bringing up in emotional intelligence would be important in the construction of pacific coexistence sceneries in Schools. All of this due to the fact students would achieve skills to process emotional information, letting them to prepare for the display of socio-affective competences. Together with these, students would relate since the practice of the good care, peaceful solution of conflicts, equity and the other’s legitimacy, essential elements in the citizen formation, coexistence, respect and promotion of fundamental rights.

  5. A review on cost-effectiveness and cost-utility of psychosocial care in cancer patients

    Directory of Open Access Journals (Sweden)

    Femke Jansen

    2016-01-01

    Full Text Available Several psychosocial care interventions have been found effective in improving psychosocial outcomes in cancer patients. At present, there is increasingly being asked for information on the value for money of this type of intervention. This review therefore evaluates current evidence from studies investigating cost-effectiveness or cost-utility of psychosocial care in cancer patients. A systematic search was conducted in PubMed and Web of Science yielding 539 unique records, of which 11 studies were included in the study. Studies were mainly performed in breast cancer populations or mixed cancer populations. Studied interventions included collaborative care (four studies, group interventions (four studies, individual psychological support (two studies, and individual psycho-education (one study. Seven studies assessed the cost-utility of psychosocial care (based on quality-adjusted-life-years while three studies investigated its cost-effectiveness (based on profile of mood states [mood], Revised Impact of Events Scale [distress], 12-Item Health Survey [mental health], or Fear of Progression Questionnaire [fear of cancer progression]. One study did both. Costs included were intervention costs (three studies, intervention and direct medical costs (five studies, or intervention, direct medical, and direct nonmedical costs (three studies. In general, results indicated that psychosocial care is likely to be cost-effective at different, potentially acceptable, willingness-to-pay thresholds. Further research should be performed to provide more clear information as to which psychosocial care interventions are most cost-effective and for whom. In addition, more research should be performed encompassing potential important cost drivers from a societal perspective, such as productivity losses or informal care costs, in the analyses.

  6. The primary care provider (PCP)-cancer specialist relationship: A systematic review and mixed-methods meta-synthesis.

    Science.gov (United States)

    Dossett, Lesly A; Hudson, Janella N; Morris, Arden M; Lee, M Catherine; Roetzheim, Richard G; Fetters, Michael D; Quinn, Gwendolyn P

    2017-03-01

    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.

  7. Risk Factors, Preventive Practices, and Health Care Among Breast Cancer Survivors, United States, 2010

    Directory of Open Access Journals (Sweden)

    Sherri G. Homan, RN, FNP, PhD

    2016-01-01

    Full Text Available 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.

  8. Health care needs of Jordanian caregivers of patients with cancer receiving chemotherapy on an outpatient basis.

    Science.gov (United States)

    Al-Jauissy, M S

    2010-10-01

    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.

  9. Music-based interventions in palliative cancer care: a review of quantitative studies and neurobiological literature

    OpenAIRE

    Archie, Patrick; Bruera, Eduardo; Cohen, Lorenzo

    2013-01-01

    Purpose This study aimed to review quantitative literature pertaining to studies of music-based interventions in palliative cancer care and to review the neurobiological literature that may bare relevance to the findings from these studies. Methods A narrative review was performed, with particular emphasis on RCTs, meta-analyses, and systematic reviews. The Cochrane Library, Ovid, PubMed, CINAHL Plus, PsycINFO, and ProQuest were searched for the subject headings music, music therapy, cancer, ...

  10. Secondary-care costs associated with lung cancer diagnosed at emergency hospitalisation in the United Kingdom.

    Science.gov (United States)

    Kennedy, Martyn P T; Hall, Peter S; Callister, Matthew E J

    2017-01-30

    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.

  11. Exercise in cancer care in Ireland: a survey of oncology nurses and physiotherapists.

    Science.gov (United States)

    O'Hanlon, E; Kennedy, N

    2014-09-01

    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.

  12. Complementary Therapy for Cancer Survivors: Integrative Nursing Care

    Directory of Open Access Journals (Sweden)

    Kazuko Onishi

    2016-01-01

    Full Text Available Objective: The number of cancer patients who survive more than 5 years after the completion of their initial treatment is increasing. Oncology nurses must consider the needs of long-term cancer survivors in addition to those of cancer patients undergoing treatment because cancer survivors experience anxiety over several issues, including the risk of recurrence and progression of cancer status and symptom management. Methods: We tried to examine the effect of complementary therapy (CT to reduce anxiety. The experimental study compared an intervention group (5 males and 68 females that underwent four CTs and a control group (5 males and 56 females that received no intervention. The intervention group practiced the CTs in their home for 20 min/day, 2 days/week, for 8 weeks, for a total of 16 times, whereas the control group performed their usual routines. Stress response scale-18 (SRS-18 scores consisting of three subscales (depression-anxiety, temper-anger, and lethargy were compared between the groups and across time within each group. Results: The intervention group reduced depression and anxiety significantly than the control group. Furthermore, the intervention group expressed the following positive feedback: "being able to relax," "being distracted from their worries and anxieties," "being able to sleep," "feeling more in-touch with reality," and "wanting to continue the practice." Conclusions: The study might accurately reflect the perspectives of women with cancer because the majority of the patients were women. Meanwhile, the result suggests that CTs might be useful for long-term cancer survivors who experience anxiety that influence their quality of life.

  13. Providing supportive care to cancer patients: a study on inter-organizational relationships

    Directory of Open Access Journals (Sweden)

    Kevin Brazil

    2008-02-01

    Full Text Available Background: Supportive cancer care (SCC has historically been provided by organizations that work independently and possess limited inter-organizational coordination. Despite the recognition that SCC services must be better coordinated, little research has been done to examine inter-organizational relationships that would enable this goal. Objective: The purpose of this study was to describe relationships among programs that support those affected by cancer. Through this description the study objective was to identify the optimal approach to coordinating SCC in the community. Methods: Senior administrators in programs that provided care to persons and their families living with or affected by cancer participated in a personal interview. Setting: South-central Ontario, Canada. Study population: administrators from 43 (97% eligible programs consented to participate in the study. Results: Network analysis revealed a diffuse system where centralization was greater in operational than administrative activities. A greater number of provider cliques were present at the operational level than the administrative level. Respondents identified several priorities to improve the coordination of cancer care in the community including: improving standards of care; establishing a regional coordinating body; increasing resources; and improving communication between programs. Conclusion: Our results point to the importance of developing a better understanding on the types of relationships that exist among service programs if effective integrated models of care are to be developed.

  14. Palliative Care Education: Focusing on Care and Not Just Disease | Division of Cancer Prevention

    Science.gov (United States)

    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. |

  15. Selecting a dynamic simulation modeling method for health care delivery research-part 2: report of the ISPOR Dynamic Simulation Modeling Emerging Good Practices Task Force.

    Science.gov (United States)

    Marshall, Deborah A; Burgos-Liz, Lina; IJzerman, Maarten J; Crown, William; Padula, William V; Wong, Peter K; Pasupathy, Kalyan S; Higashi, Mitchell K; Osgood, Nathaniel D

    2015-03-01

    In a previous report, the ISPOR Task Force on Dynamic Simulation Modeling Applications in Health Care Delivery Research Emerging Good Practices introduced the fundamentals of dynamic simulation modeling and identified the types of health care delivery problems for which dynamic simulation modeling can be used more effectively than other modeling methods. The hierarchical relationship between the health care delivery system, providers, patients, and other stakeholders exhibits a level of complexity that ought to be captured using dynamic simulation modeling methods. As a tool to help researchers decide whether dynamic simulation modeling is an appropriate method for modeling the effects of an intervention on a health care system, we presented the System, Interactions, Multilevel, Understanding, Loops, Agents, Time, Emergence (SIMULATE) checklist consisting of eight elements. This report builds on the previous work, systematically comparing each of the three most commonly used dynamic simulation modeling methods-system dynamics, discrete-event simulation, and agent-based modeling. We review criteria for selecting the most suitable method depending on 1) the purpose-type of problem and research questions being investigated, 2) the object-scope of the model, and 3) the method to model the object to achieve the purpose. Finally, we provide guidance for emerging good practices for dynamic simulation modeling in the health sector, covering all aspects, from the engagement of decision makers in the model design through model maintenance and upkeep. We conclude by providing some recommendations about the application of these methods to add value to informed decision making, with an emphasis on stakeholder engagement, starting with the problem definition. Finally, we identify areas in which further methodological development will likely occur given the growing "volume, velocity and variety" and availability of "big data" to provide empirical evidence and techniques

  16. A randomised, multicentre clinical trial of specialised palliative care plus standard treatment versus standard treatment alone for cancer patients with palliative care needs: the Danish palliative care trial (DanPaCT) protocol

    DEFF Research Database (Denmark)

    Johnsen, Anna Thit; Damkier, Anette; Vejlgaard, Tove Bahn;

    2013-01-01

    Advanced cancer patients experience considerable symptoms, problems, and needs. Early referral of these patients to specialised palliative care (SPC) could improve their symptoms and problems.The Danish Palliative Care Trial (DanPaCT) investigates whether patients with metastatic cancer, who report...... palliative needs in a screening, will benefit from being referred to 'early SPC'....

  17. Onward in my journey: preparing nurses for a new age of cancer care.

    Science.gov (United States)

    Donovan, Tom; Mercer, Dave

    2003-10-01

    Cancer nursing education in the United Kingdom currently is the subject of widespread debate. The imperative to improve cancer care is driven by professional and ethical obligations for clinical excellence and an aggressive political agenda seeking to demonstrate tangible improvements through centrally administered targets and benchmarks. Attempts to provide a holistic approach to care have engendered a range of alternative approaches underpinned by an appreciation of the "cancer journey." Despite the laudable intent of national policy initiatives aimed at improving the experience of cancer treatment, they have evidenced an emerging polarization in the practice arena. Nursing interventions, priorities, and goals are at risk of becoming confused by the competing paradigms of an outcome-driven strategy and a less focused humanistic philosophy of care. This dilemma presents significant problems in the planning of appropriate and effective education preparation for cancer nurses. This article aims to address the tensions produced by a dichotomy between the pragmatics of clinical practice and a professional quest for holism. It focuses on a specialist practitioner cancer nursing program, using case examples to illustrate innovations in teaching and learning. Embracing a postmodern perspective, reflection, and critical thinking, the discussion offers a challenge to diagnostic clinical language through the discursive structures of metaphor, narrative, and story.

  18. Health protection of health care workers from the prospective of ethics, science and good medical practice. Opinions from stakeholders in health care settings.

    Science.gov (United States)

    Porru, S; Cannatelli, P; Cerioli, Beloyanna; Flor, L; Gramegna, Maria; Polato, R; Rodriguez, D

    2012-01-01

    Fitness for work (FFW) in health care workers poses multidisciplinary challenges because of management problems scientific and ethical implications and the implementation of preventive interventions in health care settings. All the relevant stakeholders, including the General Manager, Medical Director, worker's representative, the person responsible for prevention and protection, forensic medicine expert, the person responsible for prevention and health safety at public administration level, commented on: danger to third parties; FFW formulation; human resource management; stress; professional independence; role of the person responsible for prevention and protection and of the person responsible for prevention at public administration level; professional responsibilities. Opinions are reported regarding the main problems related to the role of the Occupational Physician in FFW formulation, such as the difficult balance between autonomy and independence, limited turnover and aging of workforce, need of confidentiality and respect for professional status of the HCW prevalence of susceptibility conditions, rights and duties of stakeholders. The most significant result was the request by the Lombardy Region for more quality in risk assessment and health surveillance; to maintain uniform conduct over all the local health authorities, to allow the board in charge of examining appeals against FFW to fully cooperate with the occupational physician; due attention to the person/worker; the opportunity to convene referral boards for complex FFW management; the challenge of stress management and the need for an observatory for psychological discomforts; the importance of the ICOH Code of Ethics and avoidance of conflicts of interests; the need for individual risk assessment and risk management; the concept of sharing responsibilities and of a real multidisciplinary approach.

  19. A primary care audit of familial risk in patients with a personal history of breast cancer.

    Science.gov (United States)

    Nathan, Paul; Ahluwalia, Aneeta; Chorley, Wendy

    2014-12-01

    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.

  20. Hypnosis for cancer care: over 200 years young.

    Science.gov (United States)

    Montgomery, Guy H; Schnur, Julie B; Kravits, Kate

    2013-01-01

    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.

  1. Good Psychometric Properties of the Addiction Version of the Revised Illness Perception Questionnaire for Health Care Professionals

    Science.gov (United States)

    Dijkstra, Boukje; Golbach, Milou; De Jong, Cor; Schellekens, Arnt

    2016-01-01

    Background Addiction, or substance dependence, is nowadays considered a chronic relapsing condition. However, perceptions of addiction vary widely, also among healthcare professionals. Perceptions of addiction are thought to contribute to attitude and stigma towards patients with addiction. However, studies into perceptions of addiction among healthcare professionals are limited and instruments for reliable assessment of their perceptions are lacking. The Illness Perception Questionnaire (IPQ) is widely used to evaluate perceptions of illness. The aim of this study was to evaluate the psychometric properties of the IPQ: factor structure, internal consistency, and discriminant validity, when applied to evaluate healthcare professionals’ perceptions of addiction. Methods Participants were 1072 healthcare professionals in training and master students from the Netherlands and Indonesia, recruited from various addiction-training programs. The revised version of the IPQ was adapted to measure perceptions of addiction (IPQ-A). Maximum likelihood method was used to explore the best-fit IPQ factor structure. Internal consistency was evaluated for the final factors. The final factor structure was used to assess discriminant validity of the IPQ, by comparing illness perceptions of addiction between 1) medical students from the Netherlands and Indonesia, 2) medical students psychology students and educational science students from the Netherlands, and 3) participants with different training levels: medical students versus medical doctors. Results Factor analysis revealed an eight-factor structure for the perception subscale (demoralization, timeline chronic, consequences, personal control, treatment control, illness coherence, timeline cyclical emotional representations) and a four-factor structure for the attribution subscale (psychological attributions, risk factors, smoking/alcohol, overwork). Internal reliability was acceptable to good. The IPQ-A was able to detect

  2. Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease?

    Science.gov (United States)

    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

    2016-01-01

    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.

  3. End-of-life costs of medical care for advanced stage cancer patients

    Directory of Open Access Journals (Sweden)

    Kovačević Aleksandra

    2015-01-01

    Full Text Available Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care, hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25% had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR and the lowest (4.00 EUR ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs, followed by oncology medical care (21%, radiation therapy and interventional radiology (11%, surgery (9%, imaging diagnostics (9% and laboratory costs (8%. Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients’ quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency. [Projekat Ministarstva nauke

  4. Case management used to optimize cancer care pathways: A systematic review

    Directory of Open Access Journals (Sweden)

    Søndergaard Jens

    2008-11-01

    Full Text Available Abstract Background Reports of inadequate cancer patient care have given rise to various interventions to support cancer care pathways which, overall, seem poorly studied. Case management (CM is one method that may support a cost-effective, high-quality patient-centred treatment and care. The purpose of this article was to summarise intervention characteristics, outcomes of interest, results, and validity components of the published randomized controlled trials (RCTs examining CM as a method for optimizing cancer care pathways. Methods PubMed, Embase, Web of Science, CINAHL and The Cochrane Central Register of Controlled Trials were systematically searched for RCTs published all years up to August 2008. Identified papers were included if they passed the following standards. Inclusion criteria: 1 The intervention should meet the criteria for CM which includes multidisciplinary collaboration, care co-ordination, and it should include in-person meetings between patient and the case manager aimed at supporting, informing and educating the patient. 2 The intervention should focus on cancer patient care. 3 The intervention should aim to improve subjective or objective quality outcomes, and effects should be reported in the paper. Exclusion criteria: Studies centred on cancer screening or palliative cancer care. Data extraction was conducted in order to obtain a descriptive overview of intervention characteristics, outcomes of interest and findings. Elements of CONSORT guidelines and checklists were used to assess aspects of study validity. Results The searches identified 654 unique papers, of which 25 were retrieved for scrutiny. Seven papers were finally included. Intervention characteristics, outcomes studied, findings and methodological aspects were all very diverse. Conclusion Due to the scarcity of papers included (seven, significant heterogeneity in target group, intervention setting, outcomes measured and methodologies applied, no conclusions

  5. "That word, cancer": breast care behavior of Hispanic women in new Mexico background and literature review.

    Science.gov (United States)

    Ginossar, Tamar; De Vargas, Felicia; Sanchez, Christina; Oetzel, John

    2010-01-01

    Despite international efforts, national and ethnic disparities in utilization of breast cancer (BC) screenings prevail. In the United States, Hispanic women have one of the lowest BC screening rates. The purpose of our study was to examine how Hispanic women in New Mexico described their breast care behavior (BCB; BC screening practices, motivation to act, and breast care information behavior). Analysis of focus groups revealed five types of approaches to BCB. These findings have global implications for health care practitioners in directing attention toward the complexity of BC preventive behavior. Implications for other ethnic groups are discussed.

  6. Survivorship Care Plan Information Needs: Perspectives of Safety-Net Breast Cancer Patients

    Science.gov (United States)

    Napoles, Tessa M.; Banks, Priscilla J.; Orenstein, Fern S.; Luce, Judith A.; Joseph, Galen

    2016-01-01

    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

  7. Communication in cancer care: psycho-social, interactional, and cultural issues. A general overview and the example of India.

    Science.gov (United States)

    Chaturvedi, Santosh K; Strohschein, Fay J; Saraf, Gayatri; Loiselle, Carmen G

    2014-01-01

    Communication is a core aspect of psycho-oncology care. This article examines key psychosocial, cultural, and technological factors that affect this communication. Drawing from advances in clinical work and accumulating bodies of empirical evidence, the authors identify determining factors for high quality, efficient, and sensitive communication and support for those affected by cancer. Cancer care in India is highlighted as a salient example. Cultural factors affecting cancer communication in India include beliefs about health and illness, societal values, integration of spiritual care, family roles, and expectations concerning disclosure of cancer information, and rituals around death and dying. The rapidly emerging area of e-health significantly impacts cancer communication and support globally. In view of current globalization, understanding these multidimensional psychosocial, and cultural factors that shape communication are essential for providing comprehensive, appropriate, and sensitive cancer care.

  8. Communication in cancer care: Psycho social, interactional, and cultural issues. A general overview and the example of India

    Directory of Open Access Journals (Sweden)

    SANTOSH K CHATURVEDI

    2014-11-01

    Full Text Available Communication is a core aspect of psycho-oncology care. This article examines key psychosocial, cultural, and technological factors that affect this communication. Drawing from advances in clinical work and accumulating bodies of empirical evidence, the authors identify determining factors for high quality, efficient, and sensitive communication and support for those affected by cancer. Cancer care in India is highlighted as a salient example. Cultural factors affecting cancer communication in India include beliefs about health and illness, societal values, integration of spiritual care, family roles, and expectations concerning disclosure of cancer information, and rituals around death and dying. The rapidly emerging area of e-health significantly impacts cancer communication and support globally. In view of current globalization, understanding these multidimensional psychosocial, and cultural factors that shape communication are essential for providing comprehensive, appropriate and sensitive cancer care.

  9. The comparative palliative care needs of those with heart failure and cancer patients.

    LENUS (Irish Health Repository)

    O'Leary, Norma

    2012-02-01

    PURPOSE OF REVIEW: Patients with heart failure seem particularly suited to palliative care having needs that fall within the prototypical palliative care domains. Despite this there is still much debate as to who should respond to these needs and when. RECENT FINDINGS: Since the early 1990s many studies have been published outlining the unmet needs of patients with heart failure. However, there have been limitations to these studies and they have not guided professionals as to how to respond. More recently comparative studies using cancer as the reference have explored similarities and highlighted differences in need between heart failure and cancer patients. These studies are useful for informing future service development. SUMMARY: Patients with heart failure have variable needs and variable disease trajectories. A targeted response to these needs is required. Palliative triggers or transitions should be recognized by professionals caring for patients with heart failure. It is unlikely that either specialist palliative care or medical specialists working in isolation will be sufficiently experienced to respond to these needs. Research is required to determine the effectiveness of different collaborative approaches; heart failure specialist care aligned with palliative care consultancy or heart failure-oriented palliative care services.

  10. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Helena; Hallström, Inger; Kjaergaard, Hanne

    2011-01-01

    Hospital-based home care (HBHC) is widely applied in Pediatric Oncology. We reviewed the potential effect of HBHC on children's physical health and risk of adverse events, parental and child satisfaction, quality of life of children and their parents, and costs. A search of PubMed, CINAHL...

  11. Nurses' attitudes to sexuality in caring for cancer patients.

    Science.gov (United States)

    Cort, E

    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.

  12. Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB-IV lung cancer patients.

    Science.gov (United States)

    Kim, Yu Jung; Kim, Mi-Jung; Cho, Young-Jae; Park, Jong Sun; Kim, Jin Won; Chang, Hyun; Lee, Jeong-Ok; Lee, Keun-Wook; Kim, Jee Hyun; Yoon, Ho Il; Bang, Soo-Mee; Lee, Jae Ho; Lee, Choon-Taek; Lee, Jong Seok

    2014-03-01

    Critical care for advanced lung cancer patients is still controversial, and the appropriate method for the selection of patients who may benefit from intensive care unit (ICU) care is not clearly defined. We retrospectively reviewed the medical records of stage IIIB-IV lung cancer patients admitted to the medical ICU of a university hospital in Korea between 2003 and 2011. Of 95 patients, 64 (67%) had Eastern Cooperative Oncology Group (ECOG) performance status (PS)≥2, and 79 (84%) had non-small-cell lung cancer. In total, 28 patients (30%) were newly diagnosed or were receiving first-line treatment, and 22 (23%) were refractory or bedridden. Mechanical ventilation was required in 85 patients (90%), and ICU mortality and hospital mortality were 57 and 78%, respectively. According to a multivariate analysis, a PaO2/FiO2 ratiocare. Oncologists should try to discuss palliative care and end-of-life issues in advance to avoid futile care.

  13. Estimation of an optimal chemotherapy utilisation rate for cancer: setting an evidence-based benchmark for quality cancer care.

    Science.gov (United States)

    Jacob, S A; Ng, W L; Do, V

    2015-02-01

    There is wide variation in the proportion of newly diagnosed cancer patients who receive chemotherapy, indicating the need for a benchmark rate of chemotherapy utilisation. This study describes an evidence-based model that estimates the proportion of new cancer patients in whom chemotherapy is indicated at least once (defined as the optimal chemotherapy utilisation rate). The optimal chemotherapy utilisation rate can act as a benchmark for measuring and improving the quality of care. Models of optimal chemotherapy utilisation were constructed for each cancer site based on indications for chemotherapy identified from evidence-based treatment guidelines. Data on the proportion of patient- and tumour-related attributes for which chemotherapy was indicated were obtained, using population-based data where possible. Treatment indications and epidemiological data were merged to calculate the optimal chemotherapy utilisation rate. Monte Carlo simulations and sensitivity analyses were used to assess the effect of controversial chemotherapy indications and variations in epidemiological data on our model. Chemotherapy is indicated at least once in 49.1% (95% confidence interval 48.8-49.6%) of all new cancer patients in Australia. The optimal chemotherapy utilisation rates for individual tumour sites ranged from a low of 13% in thyroid cancers to a high of 94% in myeloma. The optimal chemotherapy utilisation rate can serve as a benchmark for planning chemotherapy services on a population basis. The model can be used to evaluate service delivery by comparing the benchmark rate with patterns of care data. The overall estimate for other countries can be obtained by substituting the relevant distribution of cancer types. It can also be used to predict future chemotherapy workload and can be easily modified to take into account future changes in cancer incidence, presentation stage or chemotherapy indications.

  14. Social Support, a Mediator in Collaborative Depression Care for Cancer Patients

    Science.gov (United States)

    Oh, Hyunsung; Ell, Kathleen

    2015-01-01

    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…

  15. Supportive care in early rehabilitation for advanced-stage radiated head and neck cancer patients

    NARCIS (Netherlands)

    Leeuw, J.A.M. de; Berg, M.G. van den; Achterberg, T. van; Merkx, M.A.W.

    2013-01-01

    Objective To investigate the health-related quality of life (HRQoL) and supportive follow-up care needs 1 month posttreatment for patients with advanced-stage (stage III or IV) radiated head and neck cancer (HNC) who were treated with curative intent. Study Design An exploratory, descriptive analysi

  16. Young Cancer Patients' Perceptions of a Video Game Used to Promote Self Care

    Science.gov (United States)

    Beale, Ivan L.; Marin-Bowling, Veronica M.; Guthrie, Nicole: Kato, Pamela M.

    2006-01-01

    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 also…

  17. Reimbursement of targeted cancer therapies within three different European health care systems

    NARCIS (Netherlands)

    Mihajlovic, Jovan; Dolk, C.; Postma, Maarten

    2014-01-01

    Objectives: To identify differences in the recommendations for targeted cancer therapies (TCT) in three distinctive European health care systems: Serbian, Scottish and Dutch, and to examine the role of cost effectiveness analyses (CEA) in such recommendations. Methods: A list of currently approved T

  18. Home-based specialized palliative care in patients with advanced cancer

    DEFF Research Database (Denmark)

    Nordly, Mie; Vadstrup, Eva Soelberg; Sjøgren, Per

    2016-01-01

    OBJECTIVE: Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information on the organizat......OBJECTIVE: Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information...... on the organization and outcomes of home-based SPC for patients with advanced cancer. Outcomes related to place of death, survival time, quality of life, performance status, and symptom management are included. METHOD: A PICO process search strategy consisting of terms related to cancer, palliation, and home care...... for patients with advanced cancer, resulting in poor information and a lack of evidence. Generally, home-based SPC seems to have some positive effect on pain and dyspnea, but more high-quality studies are required....

  19. Health-related quality of life and health care use in cancer survivors compared with patients with chronic diseases.

    NARCIS (Netherlands)

    Heins, M.J.; Korevaar, J.C.; Hopman, E.P.C.; Donker, G.A.; Schellevis, F.G.; Rijken, P.M.

    2016-01-01

    BACKGROUND: The number of cancer survivors is steadily increasing and these patients often experience long-lasting health problems. To make care for cancer survivors sustainable for the future, it would be relevant to put the effects of cancer in this phase into perspective. Therefore, the authors c

  20. End-of-life care for cancer patients in an Internal Medicine department

    Directory of Open Access Journals (Sweden)

    Luigi Lusiani

    2013-03-01

    Full Text Available Introduction Many cancer patients die in the hospital, in spite of their preference to end their lives at home. Internal Medicine wards are poorly equipped to care for dying patients. Staff members have no specific training in palliative care, and the organization of the ward lacks flexibility. The entire staff (physicians and nurses of the Internal Medicine ward of our hospital took part in a specially designed training program, and a protocol for end-of-life care (EOL-care was implemented to improve the comfort of patients with terminal cancer. The aim of this study was to analyze the impact of this protocol on clinical practice in the ward, in terms of the number of interventions and the degree of control of key symptoms. Materials and methods The EOL-care protocol, which was established in cooperation with the Sue Ryder Foundation, was a modified version of the Liverpool Care Pathway. The main objective was to ensure the comfort of the dying patient through judicious discontinuation of all non-essential medications and interventions, frequent and systematic assessment of the key symptoms, and greater emphasis on communication with the patient and his/her caregivers. We compared 82 unselected cases managed with conventional care, representing the 20% of the deaths that occurred in 2007-2008 in our ward (controls, and 27 consecutive cancer patients cared for with the EOL-care protocol between May 2009 and February 2010 (cases. Results Patients in the case group received fewer interventions than controls (catheterization rate: 0% vs 19.4%; invasive procedure rate: 0% vs 8.5%; parenteral nutrition: 0% vs 3.6%, but they obtained almost complete relief of symptoms (pain, dyspnea, respiratory tract obstruction by secretions, agitation, nausea/vomiting. The most prominent result was pain relief: systematic checks revealed persistent pain in only 2.9% of the EOL-care group versus 59.7% of the controls during the last 48 hours of life. Discussion This

  1. Increasing Access to Modern Multidisciplinary Breast Cancer Care

    Science.gov (United States)

    1999-08-01

    less common breast tumors (tubular, medullary , papillary, mucinous). The good news is that the less common tumors are easier to cure. Often women who...Ratio 95% Cl hematological toxicity reached WHO grade 3-4 in 69% of cycles for neutrope- I nia, with 5 febrile aplasia but without anemia and

  2. Racial Disparities in Palliative Care for Prostate Cancer

    Science.gov (United States)

    2016-01-01

    patients. We are exploring its use as a function of race/ ethnicity to determine whether racial disparities exist in access to this new efficacious...Use in Patients with Prostate Cancer. BACKGROUND: In 2011 the Food and Drug Administration approved abiraterone, an oral CYP17 androgen synthesis... ethnicity , marital sta- tus, and tumor grade as categorical variables. Age categories are ordinal with 5-year increments between categories. Race/ ethnicity

  3. Assessment and implementation of spirituality and religiosity in cancer care: effects on patient outcomes.

    Science.gov (United States)

    Richardson, Penny

    2012-08-01

    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.

  4. Arab American immigrants in New York: health care and cancer knowledge, attitudes, and beliefs.

    Science.gov (United States)

    Shah, Susan M; Ayash, Claudia; Pharaon, Nora Alarifi; Gany, Francesca M

    2008-10-01

    Arab immigrants living in the United States total between 1.5 million and 3.5 million, and have been growing in number each decade. New York's Arab population, at 405,000, ranks third in the U.S. after California and Michigan. Despite the large numbers, little health research has focused on this population. Data about the cancer incidence, mortality, and screening practices of Arab Americans is overwhelmingly lacking. To better understand the health care and cancer knowledge, attitudes, and beliefs of Arab American immigrants, five single-gender focus groups were convened with Arab men and women in New York City. Attention was given to factors that act as barriers to utilization of general health care services, and of cancer prevention, treatment, and support services. The data revealed the importance of providing culturally and linguistically appropriate health interventions in partnership with trusted community leaders, and the need for follow-up research of this understudied immigrant population.

  5. Classification of a palliative care population in a comprehensive cancer centre

    DEFF Research Database (Denmark)

    Benthien, K.S; Nordly, M.; Videbæk, K.;

    2016-01-01

    and receiving specialist palliative care (SPC). METHODS: This is a cross-sectional screening study of patients with cancer in the Department of Oncology, Rigshospitalet, Copenhagen University Hospital for 6 months. Patients were assessed to be included in the DOMUS study: a randomised controlled trial...... of accelerated transition to SPC at home (NCT01885637). The PCP was classified as patients with incurable cancer and limited or no antineoplastic treatment options. Patients with performance status 2-4 were further classified as the essential palliative care population (EPCP). RESULTS: During the study period......, 3717 patients with cancer were assessed. The PCP comprised 513 patients yielding a prevalence of 14 %. The EPCP comprised 256 patients (7 %). The EPCP was older, more likely inpatients, had a higher comorbidity burden and 38 % received SPC. Women, patients without caregivers and patients with breast...

  6. [Massage and music therapy for relief of anxiety of cancer patients in palliative care].

    Science.gov (United States)

    Mantovan, Franco; Rauter, Elisabeth; Müller, Irene

    2009-03-01

    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.

  7. [Professional practice of nurses who care for cancer patients in general hospitals].

    Science.gov (United States)

    da Silva, Josiane Travençolo; Matheus, Maria Clara Cassuli; Fustinoni, Suzete Maria; de Gutiérrez, Maria Gaby Rivero

    2012-01-01

    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.

  8. Participation of the family in hospital-based palliative cancer care: perspective of nurses

    Directory of Open Access Journals (Sweden)

    Marcelle Miranda da Silva

    Full Text Available The objective was to understand the perspective of nurses about the participation of the family in palliative cancer care and to analyze the nursing care strategies to meet their needs. Descriptive and qualitative research, conducted at the National Cancer Institute between January and March 2013, with 17 nurses. Elements of the Roy Adaptation Model were used for the interpretation of the data. Two categoriesemergedfrom the thematic analysis: perspective of nurses about the presence and valuation of family in the hospital; and appointing strategies to encourage family participation in care and meet their needs. This participation is essentialand represents a training opportunity for the purpose of homecare. Nurses create strategies to encourage it and seek to meet the needs. The results contribute to promote the family adaptation and integrity, in order to balance the dependent and independent behaviors, aimingfor quality of life and comfort. Further studies are neededdue to the challenges of the specialty.

  9. Collaboration Around Research and Education (CARE) in Prostate Cancer

    Science.gov (United States)

    2010-08-01

    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

  10. Cancer Patients Use Hospital-Based Care Until Death : A Further Analysis of the Dutch Bone Metastasis Study

    NARCIS (Netherlands)

    Meeuse, Jan J.; van der Linden, Yvette M.; Post, Wendy J.; Wanders, Rinus; Gans, Rijk O. B.; Leer, Jan Willem H.; Reyners, Anna K. L.

    2011-01-01

    Purpose: To describe health care utilization (HCU) at the end of life in cancer patients. These data are relevant to plan palliative care services, and to develop training programs for involved health care professionals. Methods: The Dutch Bone Metastasis Study (DBMS) was a nationwide study proving

  11. Cancer patients use hospital-based care until death: a further analysis of the dutch bone metastasis study

    NARCIS (Netherlands)

    Meeuse, J.J.; Linden, Y.M. van der; Post, W.J.; Wanders, R.; Gans, R.O.; Leer, J.W.H.; Reyners, A.K.

    2011-01-01

    Abstract Purpose: To describe health care utilization (HCU) at the end of life in cancer patients. These data are relevant to plan palliative care services, and to develop training programs for involved health care professionals. Methods: The Dutch Bone Metastasis Study (DBMS) was a nationwide study

  12. Development of an instrument to analyze organizational characteristics in multidisciplinary care pathways; the case of colorectal cancer

    NARCIS (Netherlands)

    Pluimers, Dorine J.; Vliet, van Ellen J.; Niezink, Anne G.H.; Mourik, van Martijn S.; Eddes, Eric H.; Wouters, Michel W.; Tollenaar, Rob A.E.M.; Harten, van Wim H.

    2015-01-01

    Background To analyze the organization of multidisciplinary care pathways such as colorectal cancer care, an instrument was developed based on a recently published framework that was earlier used in analyzing (monodisciplinary) specialist cataract care from a lean perspective. Methods The instrumen

  13. Information at the Point of Care: An Informational Application for Cancer Resources.

    Science.gov (United States)

    Walker, Deborah Kirk; Hardeman, Amber; Owen, Larry; Frank, Jennifer Sandson

    2015-09-01

    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.

  14. Patient-Centered Cancer Care Programs in Italy: Benchmarking Global Patient Education Initiatives.

    Science.gov (United States)

    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

    2016-06-01

    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.

  15. Using Technology to Improve Cancer Care: Social Media, Wearables, and Electronic Health Records.

    Science.gov (United States)

    Fisch, Michael J; Chung, Arlene E; Accordino, Melissa K

    2016-01-01

    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.

  16. Self-care Concept Analysis in Cancer Patients: An Evolutionary Concept Analysis

    Science.gov (United States)

    Hasanpour-Dehkordi, Ali

    2016-01-01

    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

  17. [Guidelines for the early diagnosis of lung cancer for primary care physicians].

    Science.gov (United States)

    2016-01-01

    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

  18. [A guide to good practice for information security in the handling of personal health data by health personnel in ambulatory care facilities].

    Science.gov (United States)

    Sánchez-Henarejos, Ana; Fernández-Alemán, José Luis; Toval, Ambrosio; Hernández-Hernández, Isabel; Sánchez-García, Ana Belén; Carrillo de Gea, Juan Manuel

    2014-04-01

    The appearance of electronic health records has led to the need to strengthen the security of personal health data in order to ensure privacy. Despite the large number of technical security measures and recommendations that exist to protect the security of health data, there is an increase in violations of the privacy of patients' personal data in healthcare organizations, which is in many cases caused by the mistakes or oversights of healthcare professionals. In this paper, we present a guide to good practice for information security in the handling of personal health data by health personnel, drawn from recommendations, regulations and national and international standards. The material presented in this paper can be used in the security audit of health professionals, or as a part of continuing education programs in ambulatory care facilities.

  19. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... about Advanced Cancer Research Managing Cancer Care Finding Health Care Services Costs & Medical Information Advance Directives Using ... Cancer Advanced Cancer & Caregivers Managing Cancer Care Finding Health Care Services Managing Costs and Medical Information Advance ...

  20. Nurse-led follow-up care for cancer patients: what is known and what is needed.

    Science.gov (United States)

    de Leeuw, Jacqueline; Larsson, Maria

    2013-09-01

    Traditionally, cancer patient follow-up has focused on disease surveillance and detecting recurrence. However, an increasing number of patients who have survived cancer acknowledge the importance of cancer rehabilitation issues and the need for more patient-oriented models of care by reporting their unmet physical, emotional, and social needs. Nurse-led follow-up care for cancer patients fulfills this need and has been developing gradually for various cancer diagnoses and prognoses. A growing body of evidence suggests that these services provide high-quality care that is both safe and efficient. Furthermore, patients benefit from the continuity of care and easy access to support for their multitude of needs, provided by such organized care. In this paper, we review the literature published in the past 5 years regarding nurse-led follow-up care for cancer patients in order to provide input and opinion for future research, clinical practice development, and nursing leadership. We pay special attention to head and neck cancer patients, a group that has been largely understudied and hence underreported in the literature. These patients have specific needs with respect to information and education regarding their cancer and potential treatment side-effects as well as a particular need for long-term psychosocial support and practical advice.

  1. Quality of life during chemotherapy and satisfaction with nursing care in Turkish breast cancer patients.

    Science.gov (United States)

    Bayram, Z; Durna, Z; Akin, S

    2014-09-01

    This descriptive cross-sectional study aimed to evaluate quality of life for breast cancer patients (n = 105) undergoing chemotherapy, and to assess their satisfaction with nursing care. It also explored relationships between quality of life, satisfaction with nursing care, and demographic and disease-related characteristics. Ethics approval for this study was provided. The research was carried out between October 2011 and June 2012. Quality of life and satisfaction with nursing care were assessed using the Functional Assessment of Cancer Therapy-General Scale, the Memorial Symptom Assessment Scale and the Newcastle Satisfaction with Nursing Scale. We found that emotional well-being was the area most negatively affected, with patients reporting being afraid of death, feeling sad and being worried about their health. Patients were overall quite satisfied with the nursing care they received at the hospital. We found a positive correlation between total scores on the Newcastle Satisfaction with Nursing Scale and social and family well-being scores. Breast cancer patients have fears and concerns about their health and need support during chemotherapy for coping with negative changes in their emotional well-being, physical and functional well-being.

  2. Experiences of parents with caring for their child after a cancer diagnosis.

    Science.gov (United States)

    Flury, Maria; Caflisch, Ueli; Ullmann-Bremi, Andrea; Spichiger, Elisabeth

    2011-01-01

    Children and adolescents with cancer are increasingly treated and cared for at home; hospital stays are reduced to a minimum. Taking care of a sick child at home has an impact on the entire family: the sick child, the siblings, and the parents. This qualitative study examines the experiences of parents taking their child home for the first time after the diagnosis. Parents of 10 children newly diagnosed with cancer were interviewed twice around the time of the first discharge; data were analyzed using content analysis methodology. Findings illustrated parents' preparation of and experiences around their child's first discharge, the huge amount of new and changed tasks parents have to fulfill at home when caring for their child with cancer, and consequences for the parents. By providing individualized information and instruction, by having parents anticipate potential problems and solutions, and by describing available community support and integrating district nurses as well as other parents with the same experiences more frequently, health care professionals in the hospital can optimize discharge planning for these parents.

  3. Multidisciplinary care team for cancer patients and its implementation in several Middle Eastern countries.

    Science.gov (United States)

    Silbermann, M; Pitsillides, B; Al-Alfi, N; Omran, S; Al-Jabri, K; Elshamy, K; Ghrayeb, I; Livneh, J; Daher, M; Charalambous, H; Jafferri, A; Fink, R; El-Shamy, M

    2013-10-01

    This article introduces palliative care to cancer patients in Middle Eastern countries. It considers the importance of the multidisciplinary team in providing an adequate service to the patient and his/her family. It provides views of professionals from the various countries with regard to the role of the nurse in such teams; whereby the three elements of palliative care nursing entail: 1. Working directly with patients and families; 2. Working with other health and social care professionals to network and co-ordinate services; and 3. working at an organizational level to plan, develop and manage service provision in local, regional and national settings. This article also details the challenges that nurses face in the Middle East and outlines the preferable ways to overcome such challenges. The latter include more focused educational activities at the undergraduate and graduate levels and continuous clinical training throughout their work as palliative care nurse specialists.

  4. The validity of skin care protocols followed by women with breast cancer receiving external radiation.

    Science.gov (United States)

    Aistars, Juli

    2006-08-01

    Skin care in women receiving external radiation to the breast varies among institutions. Studies have been conducted looking at the effect that various skin care products have on the onset and severity of radiation-induced skin reactions in those patients. Results show that no significant difference exists among these products. The practice of avoiding aluminum-based deodorant on the treated side and avoiding use of any skin care products four hours prior to treatment is not evidence based but often is part of skin care protocols for women receiving breast irradiation. A review of the literature since 1996 in the United States, Canada, United Kingdom, and Australia revealed some evidence to refute the practice but no supporting evidence. Because minimal disruption in a woman's normal hygiene routine could mitigate anxiety and improve coping during a time of extreme stress brought on by a cancer diagnosis, further research is warranted to support changing the practice.

  5. Chinese Herbal Medicine for Symptom Management in Cancer Palliative Care: Systematic Review And Meta-analysis.

    Science.gov (United States)

    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

    2016-02-01

    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.

  6. Research on Cancer Palliative Care%肿瘤姑息治疗的研究

    Institute of Scientific and Technical Information of China (English)

    王杰军; 宋正波

    2016-01-01

    Cancer is the leading cause of death in China, and palliative care is an important treatment for patients with cancer. Studies have proved that positive palliative care can not only reduce the injuries caused by treatments, but also play role in extending the survival time, improving the quality of life, and promoting the reasonable and highly-effective use of the current medical resource. With the increasing challenge of population aging and high incidence rate of cancer in China, palliative care is becoming more and more important. However, palliative care of cancer in China is slowly developed, and the development of palliative care has a long way to go.%癌症目前居于我国居民死亡原因的首位。姑息治疗是癌症治疗中非常重要的一个部分。研究证实,积极的姑息治疗不仅能够降低对患者的创伤,而且对于延长患者生存时间,提高生活质量以及提高现有医疗资源的合理高效使用都起到重要的作用。随着我国老龄化社会的加剧,癌症发病率急剧上升,姑息治疗越来越重要。然而,肿瘤姑息治疗在我国一直发展缓慢。发展肿瘤姑息治疗对我们来讲任重而道远。

  7. Inequity in the provision of and access to palliative care for cancer patients. Results from the Italian survey of the dying of cancer (ISDOC

    Directory of Open Access Journals (Sweden)

    Costantini Massimo

    2007-04-01

    Full Text Available Abstract Background The palliative services and programs have been developed with different intensity and modalities in all countries. Several studies have reported that a geographic variation in the availability and provision of palliative care services between and within countries exists, and that a number of vulnerable groups are excluded from these services. This survey estimates the distribution of places of care for Italian cancer patients during the last three months of their lives, the proportion receiving palliative care support at home and in hospital, and the factors associated with the referral to palliative care services. Methods This is a mortality follow-back survey of 2,000 cancer deaths identified with a 2-stage probability sample, representative of the whole country. Information on patients' experience was gathered from the non-professional caregiver through an interview, using an adapted version of the VOICES questionnaire. A section of the interview concerned the places of care and the palliative care services provided to patients. Multivariate logistic regression analyses were conducted to identify the determinants of palliative care service use. Results Valid interviews were obtained for 67% of the identified caregivers (n = 1,271. Most Italian cancer patients were cared for at home (91% or in hospital (63%, but with substantial differences within the country. Only 14% of Italian cancer patients cared for at home against 20% of those admitted to hospital, received palliative care support. The principal determinants identified for receiving these service were: an extended interval between diagnosis and death (P = 0.01 and the caregiver's high educational level (P = 0.01 for patients at home; the low patient's age (P Conclusion In Italy palliative care services are not equally available across the country. Moreover, access to the palliative care services is strongly associated with socio demographic characteristics of the

  8. The Role of Chinese Medicine in Cancer Care-a Critical Review

    Institute of Scientific and Technical Information of China (English)

    Dan Jiang; Fan-Yi Meng; Lily Li; Fan Qu

    2016-01-01

    Traditional Chinese medicine (TCM) has been widely used in China and other East Asian countries for helping cancer patients. However, it is unavailable to most patients who are treated in NHS in UK, due to there is not enough evidence in using TCM in cancer patients, To try to establish the evidence base for using TCM in cancer patients management, the author reviewed the current available clinical reports to TCM treatment of cancer patients, mainly those of randomly assigned and controlled clinical trials (RCTs) with bigger samples, from maintaining the quality of life, enhancing immune system, remedying the side effects from radiotherapy and chemotherapy respectively, and to propose a role of TCM as an assistant therapy to the main therapies. We then concluded that TCM holds its unique value in maintaining good quality of life, and to help the patients through the operation, chemotherapy and radiotherapy to achieve better outcomes.

  9. Cancer treatment, symptom monitoring, and self-care in adults: pilot study.

    Science.gov (United States)

    Williams, Phoebe Dauz; Piamjariyakul, Ubolrat; Ducey, Kathleen; Badura, Jody; Boltz, Kristin D; Olberding, Karmen; Wingate, Anita; Williams, Arthur R

    2006-01-01

    A descriptive study was conducted on self-reported symptoms and self-care by 37 adults receiving chemotherapy primarily for leukemia, lymphomas, or breast cancer or radiation therapy for head and neck or lung cancers. The Therapy-Related Symptom Checklist and demographic and interview forms on self-care for identified symptoms were used. Severe symptoms on the Therapy-Related Symptom Checklist subscales fatigue, eating, nausea, pain, numbness in fingers/toes, hair loss, and constipation were reported by patients on chemotherapy. Those on radiation therapy reported severe symptoms on the eating, fatigue, skin changes, oropharynx, and constipation subscales.Self-care strategies were in the following categories, using complementary medicine as framework: diet/nutrition/lifestyle change (eg, use of nutritional supplements; modifications of food and of eating habits; naps, sleep, and rest); mind/body control (eg, relaxation methods, prayer, music, attending granddaughter's sports events); biologic treatments (vitamins); herbal treatments (green mint tea); and ethnomedicine (lime juice and garlic). The first category was predominantly used by patients in both treatment types. Medications were prescribed also to help control symptoms (eg, pain and nausea). Symptom monitoring and self-care for symptoms identified may be facilitated by the Therapy-Related Symptom Checklist; based on reported symptom severity, care providers may prioritize interventions. A larger study needs to be done on (a) the use of the Therapy-Related Symptom Checklist as a clinical tool to assess symptoms that oncology patients experience during therapy; (b) whether care providers, based on patient-reported symptom severity, can prioritize interventions--and how this influences the efficiency of care; (c) the self-care strategies used by patients on chemotherapy or radiation therapy or both; and (d) how useful these strategies are in alleviating symptoms.

  10. Palliative care needs at different phases in the illness trajectory: a survey study in patients with cancer.

    Science.gov (United States)

    Beernaert, K; Pardon, K; Van den Block, L; Devroey, D; De Laat, M; Geboes, K; Surmont, V; Deliens, L; Cohen, J

    2016-07-01

    Despite the growing consensus on the benefits of initiating palliative care early in the disease trajectory, it remains unclear at what point palliative care needs emerge. This study investigates quality of life and unmet palliative care needs at three phases in the cancer trajectory, curative, life-prolonging and most advanced (prognosis care needs within the domains of palliative care. We used European reference values of the EORTC QLQ-C30 to compare the mean scores with a norm group. The groups further on in the cancer trajectory reported statistically and clinically poorer functioning compared with earlier phases, also when controlled for the effects of sex, age or type of cancer. Higher symptom burdens for fatigue, pain, dyspnoea and appetite loss were found in groups further into the trajectory, p care needs of patients from diagnosis onwards.

  11. Breast Cancer Diagnosed During Pregnancy: Adapting Recent Advances in Breast Cancer Care for Pregnant Patients

    NARCIS (Netherlands)

    Loibl, S.; Schmidt, A.; Gentilini, O.; Kaufman, B.; Kuhl, C.; Denkert, C.; Minckwitz, G. von; Parokonnaya, A.; Stensheim, H.; Thomssen, C.; Calsteren, K. van; Poortmans, P.; Berveiller, P.; Markert, U.R.; Amant, F.

    2015-01-01

    Breast cancer during pregnancy (BCP), although rare, is becoming more common and treatment should be as similar as possible to that for nonpregnant young patients with breast cancer. A group of specialists convened to review current guidelines and provide guidance on how recent advances in breast ca

  12. Optimal delivery of colorectal cancer follow-up care: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Jorgensen ML

    2015-05-01

    Full Text Available Mikaela L Jorgensen,1 Jane M Young,1,2 Michael J Solomon2,3 1Cancer Epidemiology and Services Research (CESR, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 2Surgical Outcomes Research Centre (SOuRCe, Sydney Local Health District and University of Sydney, Sydney, NSW, Australia; 3Discipline of Surgery, University of Sydney, Sydney, NSW, Australia Abstract: 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

  13. Brachytherapy for Patients With Prostate Cancer: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update.

    Science.gov (United States)

    Chin, Joseph; Rumble, R Bryan; Kollmeier, Marisa; Heath, Elisabeth; Efstathiou, Jason; Dorff, Tanya; Berman, Barry; Feifer, Andrew; Jacques, Arthur; Loblaw, D Andrew

    2017-03-27

    Purpose To jointly update the Cancer Care Ontario guideline on brachytherapy for patients with prostate cancer to account for new evidence. Methods An Update Panel conducted a targeted systematic literature review and identified more recent randomized controlled trials comparing dose-escalated external beam radiation therapy (EBRT) with brachytherapy in men with prostate cancer. Results Five randomized controlled trials provided the evidence for this update. Recommendations For patients with low-risk prostate cancer who require or choose active treatment, low-dose rate brachytherapy (LDR) alone, EBRT alone, and/or radical prostatectomy (RP) should be offered to eligible patients. For patients with intermediate-risk prostate cancer choosing EBRT with or without androgen-deprivation therapy, brachytherapy boost (LDR or high-dose rate [HDR]) should be offered to eligible patients. For low-intermediate risk prostate cancer (Gleason 7, prostate-specific antigen < 10 ng/mL or Gleason 6, prostate-specific antigen, 10 to 20 ng/mL), LDR brachytherapy alone may be offered as monotherapy. For patients with high-risk prostate cancer receiving EBRT and androgen-deprivation therapy, brachytherapy boost (LDR or HDR) should be offered to eligible patients. Iodine-125 and palladium-103 are each reasonable isotope options for patients receiving LDR brachytherapy; no recommendation can be made for or against using cesium-131 or HDR monotherapy. Patients should be encouraged to participate in clinical trials to test novel or targeted approaches to this disease. Additional information is available at www.asco.org/Brachytherapy-guideline and www.asco.org/guidelineswiki .

  14. Patterns of Care and Disparities in the Treatment of Early Breast Cancer

    Science.gov (United States)

    2010-09-01

    breast cancer care across the United States.   33 REFERENCES    1. Malin JL, Schneider EC, Epstein AM, Adams J, Emanuel EJ, Kahn KL. Results of the...McMasters KM, Scoggins CR, Martin RC Jr, Thoene C, Edwards MJ. The use of radiation therapy after breast-conserving surgery in hormonally treated breast...G. Haffty, Frank A. Vicini, Julia R. White, Douglas W. Arthur, Jay R. Harris, and Ya-Chen T. Shih From The University of Texas MD Anderson Cancer

  15. End-of-Life Care for Undocumented Immigrants With Advanced Cancer: Documenting the Undocumented.

    Science.gov (United States)

    Jaramillo, Sylvia; Hui, David

    2016-04-01

    There are approximately 11.1 million undocumented immigrants in the United States, with a majority being Latino. Cancer is now the leading cause of death in Latinos. There is little research guiding providers on how to deliver optimal end-of-life care in this population. We describe a case of an undocumented Latino patient with advanced cancer, and provide a review of the literature on end-of-life care in undocumented immigrants. Our patient encountered many challenges as he navigated through the healthcare system in the last months of life. These included delayed diagnosis, limited social support, financial issues, fear of deportation, and language and cultural barriers, which resulted in significant physical and psychological distress. Within the undocumented patient population, there is often a lack of advance care planning, prognostic understanding, mistrust, religious practices, and cultural beliefs that may affect decision making. Given the growing number of undocumented immigrants in the United States, it is important for clinicians and policy makers to have a better understanding of the issues surrounding end-of-life care for undocumented immigrants, and work together to improve the quality of life and quality of end-of-life care for these disadvantaged individuals.

  16. Strategic planning by the palliative care steering committee of the Middle East Cancer Consortium.

    Science.gov (United States)

    Moore, Shannon Y; Pirrello, Rosene D; Christianson, Sonya K; Ferris, Frank D

    2011-04-01

    High quality comprehensive palliative care is a critical need for millions of patients and families, but remains only a dream in many parts of the world. The failure to do a strategic planning process is one obstacle to advancing education and pain prevention and relief. The Middle Eastern Cancer Consortium Steering Committee attendees completed an initial strategic planning process and identified "developmental steps" to advance palliative care. Underscoring the multi-disciplinary nature of comprehensive palliative care, discipline-specific planning was done (adult and pediatric cancer and medicine, pharmacy, nursing) in a separate process from country-specific planning. Delineating the layers of intersection and differences between disciplines and countries was very powerful. Finding the common strengths and weaknesses in the status quo creates the potential for a more powerful regional response to the palliative care needs. Implementing and refining these preliminary strategic plans will augment and align the efforts to advance palliative care education and pain management in the Middle East. The dream to prevent and relieve suffering for millions of patients with advanced disease will become reality with a powerful strategic planning process well implemented.

  17. Symptom monitoring and self-care practices among Filipino cancer patients.

    Science.gov (United States)

    Williams, Phoebe D; Balabagno, Araceli O; Manahan, Lydia; Piamjariyakul, Ubolrat; Ranallo, Lori; Laurente, Cecilia M; Cajucom, Loyda; Guela, Daisy; Kimbrough, Mercedita; Williams, Arthur R

    2010-01-01

    The purpose of this study was to assess patient-reported symptoms and self-care methods used during cancer treatments, using checklists. A descriptive study was performed at the cancer institute of a national medical center in Manila on 100 patients undergoing combined radiotherapy and chemotherapy, n = 37, or chemotherapy alone, n = 63. Instruments used were (a) 25-item patient-reported Therapy-Related Symptoms Checklist (TRSC), (b) Self-care Methods (with the 25 TRSC items) tool, (c) Karnofsky Scale, (d) Demographic form, and (e) Health form. The TRSC (Philippine version) Cronbach alpha = .83. The TRSC scores inversely, significantly correlated with nurse-rated Karnofsky measure of functional status (r = -0.45; P < .001)-all evidences of internal consistency reliability, construct, and concurrent validity; similar findings were found in Midwestern United States and 2 other Asian settings. Compared with those receiving chemotherapy alone, patients who had combined radiotherapy and chemotherapy reported more symptoms with greater severity on several TRSC subscales. Self-care methods most used were in 2 categories: (a) diet/nutrition/lifestyle change (eg, modify food/eating habits; eat vegetables and fruits (papaya); use nutritional supplements; have naps, rest, sleep) to manage eating, oropharynx, nausea, and fatigue subscale symptoms; and (b) mind/body control (eg, prayer, praying the rosary, music) to relieve fatigue subscale, other symptoms. The TRSC (Philippine version) and Self-care Methods assess patient-reported symptoms and patients' self-care use. Oncology symptom management is enhanced by a valid clinical assessment tool.

  18. Training Providers and Patients to Talk about End-of-Life Care | Division of Cancer Prevention

    Science.gov (United States)

    It has been observed and documented widely; most doctors and patients do not want to talk about death and dying. But failing to discuss transitions of care—from active cancer treatment to end-of-life care once treatment options have been exhausted—can leave doctors unsure of what a patient truly wants at the end of his or her life. And failing to receive end-of-life care in line with their values and wishes can cause both patients and their families great distress. |

  19. Predicting cancer prognosis using interactive online tools: a systematic review and implications for cancer care providers.

    Science.gov (United States)

    Rabin, Borsika A; Gaglio, Bridget; Sanders, Tristan; Nekhlyudov, Larissa; Dearing, James W; Bull, Sheana; Glasgow, Russell E; Marcus, Alfred

    2013-10-01

    Cancer prognosis is of keen interest for patients with cancer, their caregivers, and providers. Prognostic tools have been developed to guide patient-physician communication and decision-making. Given the proliferation of prognostic tools, it is timely to review existing online cancer prognostic tools and discuss implications for their use in clinical settings. Using a systematic approach, we searched the Internet, Medline, and consulted with experts to identify existing online prognostic tools. Each was reviewed for content and format. Twenty-two prognostic tools addressing 89 different cancers were identified. Tools primarily focused on prostate (n = 11), colorectal (n = 10), breast (n = 8), and melanoma (n = 6), although at least one tool was identified for most malignancies. The input variables for the tools included cancer characteristics (n = 22), patient characteristics (n = 18), and comorbidities (n = 9). Effect of therapy on prognosis was included in 15 tools. The most common predicted outcome was cancer-specific survival/mortality (n = 17). Only a few tools (n = 4) suggested patients as potential target users. A comprehensive repository of online prognostic tools was created to understand the state-of-the-art in prognostic tool availability and characteristics. Use of these tools may support communication and understanding about cancer prognosis. Dissemination, testing, refinement of existing, and development of new tools under different conditions are needed.

  20. Existing data sources for clinical epidemiology: Danish Cancer in Primary Care cohort

    Directory of Open Access Journals (Sweden)

    Jensen H

    2014-07-01

    Full Text Available Henry Jensen,1,2 Marie Louise Tørring,1 Mette Bach Larsen,3 Peter Vedsted11Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, 2Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, 3Department of Public Health Programs, Randers Regional Hospital, Randers NOE, Denmark Background: In this paper, we describe the settings, content, and possibilities of the Danish Cancer in Primary Care (CaP cohort as well as some of the key findings so far. Further, we describe the future potential of the cohort as an international resource for epidemiological and health services research studies. Methods: The CaP cohort comprises information from three Danish subcohorts set up in 2004–2005, 2007–2008, and 2010 on newly diagnosed cancer patients aged 18 years or older. General practitioner (GP-reported and patient-reported data from six questionnaires generated information on causes and consequences of delayed diagnosis of cancer, and these data were supplemented with complete information on, eg, death, migration, health care utilization, medication use, and socioeconomic data from Denmark's comprehensive health and administrative registers. The cohort is followed up in terms of emigration, death, hospitalization, medication, and socioeconomics, and data are updated regularly. Results: In total, we identified 22,169 verified incident cancer cases. Completed GP questionnaires were returned for 17,566 (79% of the verified cases, and patient questionnaires were completed by 8,937 (40% respondents. Patients with participating GPs did not differ from patients with nonparticipating GPs in regard to one-year survival, comorbidity, or educational level. However, compared with nonparticipating GPs, patients listed with participating GPs were more likely to be women, younger, to have a higher disposable income, to have more regional or distant spread of tumors, were also more likely to have

  1. Patterns of care for radiotherapy in vulvar cancer: a Gynecologic Cancer Intergroup study

    DEFF Research Database (Denmark)

    Gaffney, David K; Du Bois, Andreas; Narayan, Kailash;

    2009-01-01

    BACKGROUND: This study aimed to describe radiotherapeutic practice in the treatment of vulvar cancer in member study groups of the Gynecologic Cancer Intergroup (GCIG). METHODS: A survey was developed and distributed to representatives of the member study groups of the GCIG, targeting the use...... of radiotherapy (RT) in vulvar cancer. RESULTS: Thirty-two surveys were returned from 12 different cooperative groups. The most common indications for neoadjuvant RT include unresectable disease or International Federation of Gynecology and Obstetrics stage >/=III. For the neoadjuvant treatment of vulvar cancer...... of a broadly accepted standard. This underscores the importance of international cooperation as in GCIG to gather more reliable data for uncommon tumors in gynecologic oncology....

  2. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans.

    Science.gov (United States)

    Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C

    2015-12-01

    Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care.

  3. THE ORGANIZATION WORKS TO IMPROVE THE CLINICAL AND ECONOMIC OUTCOMES OF CARE FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    O. I. Apolikhin

    2015-01-01

    Full Text Available Objective. Improving health outcomes in prostate cancer by developing optimal approaches to early detection, staging and treatment of disease. Materials and methods. Urologic care for patients with prostate cancer in the Voronezh region is divided according to the conception of the Program "Urology" into 4 of standardized, integrated stages. The first stage are primary care physicians. The purpose of this stage is a screening questionnaire for men of Voronezh region between the ages of 45 to 74 years using a modified international questionnaire lower urinary tract symptoms (IPSS and nomograms individual risk of prostate cancer (SWOP №1.            In case of identification of risk groups for prostate cancer, patients were sent to the urologist at the place of residence, which is conducting special examinations (FRA, ultrasound of the kidneys, bladder, TRUS, UFW, forming a risk group for verification of diagnosis. Then the patient is directed to the second stage of inter-regional urology center (ITC, whose task in the diagnostic phase is to verify the diagnosis.    In case of confirmation of the diagnosis by an urologist of ITC there was created the interactive consultation on the basis of remote Advisory portal Nethealth.ru together with leading research Institute of urology and regional urology center they identified the clinical significance of the disease and subsequent treatment strategy. In case of the detection of clinically significant prostate cancer patient is sent to the third stage - Regional or an optional fourth stage (center providing PMF - the Federal urology center, where he is treated with highly specialized medical care and conducted quality control.   In case of detection of clinically insignificant PC assistance was provided at the level of ITC (active surveillance, watchful waiting, hormone therapy on the recommendations of the oncourologist of regional urology center.Results. During the realisation of the

  4. Personalization of loco-regional care for primary breast cancer patients (part 2).

    Science.gov (United States)

    Toi, Masakazu; Winer, Eric P; Benson, John R; Inamoto, Takashi; Forbes, John F; von Minckwitz, Gunter; Robertson, John F R; Grobmyer, Stephen R; Jatoi, Ismail; Sasano, Hironobu; Kunkler, Ian; Ho, Alice Y; Yamauchi, Chikako; Chow, Louis W C; Huang, Chiun-Sheng; Han, Wonshik; Noguchi, Shinzaburo; Pegram, Mark D; Yamauchi, Hideko; Lee, Eun-Sook; Larionov, Alexey A; Bevilacqua, Jose L B; Yoshimura, Michio; Sugie, Tomoharu; Yamauchi, Akira; Krop, Ian E; Noh, Dong Young; Klimberg, V Suzanne

    2015-01-01

    Kyoto Breast Cancer Consensus Conference, Kyoto, Japan, 18-20 February 2014 The loco-regional management of breast cancer is increasingly complex with application of primary systemic therapies, oncoplastic techniques and genetic testing for breast cancer susceptibility. Personalization of loco-regional treatment is integral to optimization of breast cancer care. Clinical and pathological tumor stage, biological features and host factors influence loco-regional treatment strategies and extent of surgical procedures. Key issues including axillary staging, axillary treatment, radiation therapy, primary systemic therapy (PST), preoperative hormonal therapy and genetic predisposition were identified and discussed at the Kyoto Breast Cancer Consensus Conference (KBCCC2014). In the second of a two part conference scene, consensus recommendations for radiation treatment, primary systemic therapies and management of genetic predisposition are reported and focus on the following topics: influence of both clinical response to PST and stage at presentation on recommendations for postmastectomy radiotherapy; use of regional nodal irradiation in selected node-positive patients and those with adverse pathological factors; extent of surgical resection following downstaging of tumors with PST; use of preoperative hormonal therapy in premenopausal women with larger, node-negative luminal A-like tumors and managing increasing demands for contralateral prophylactic mastectomy in patients with a unilateral sporadic breast cancer.

  5. Risk of thrombosis in cancer and the role of supportive care (transfusion, catheters, and growth factors).

    Science.gov (United States)

    Castaman, Giancarlo

    2016-04-01

    Thrombosis in cancer patients is a well-known, frequent complication which can adversely influence treatment outcome and mortality rate. Several cancer-related or patient-related factors may contribute in modulating the magnitude of the risk. Among the treatment-related factors, the use of blood transfusions, erythropoiesis stimulating agents and central venous catheters play a significant role in influencing the epidemiology of thromboembolism in cancer patients. Red cell transfusions may influence the risk of both arterial and venous thromboembolism (VTE), although the mechanisms of causal relationship have not clearly elucidated. A judicious use should be considered, especially for active bleeding with the risk of significant anemia and the presence of cardiovascular risk factors. The use of erythropoiesis stimulating agents carries a definite risk of thrombosis in cancer patients and there is still a debate on whether they can also influence cancer biology and thus clinical outcome. Their use should be carefully weighed considering the duration of chemotherapy courses and the possible short-term benefits of these agents. Catheter-related thrombosis may be present in about 1-5% of cancer patients but asymptomatic cases detected by close ultrasound monitoring may be by far higher. Tailored anti-thrombotic treatment should be undertaken according to the presence of risk of bleeding (e.g., thrombocytopenia). Thrombophylaxis should be considered in patients with a high-risk prothrombotic profile.

  6. TS Gene Polymorphisms Are Not Good Markers of Response to 5-FU Therapy in Stage III Colon Cancer Patients

    Directory of Open Access Journals (Sweden)

    A. Fariña-Sarasqueta

    2010-01-01

    Full Text Available Aim: Although the predictive and prognostic value of thymidylate synthase (TS expression and gene polymorphism in colon cancer has been widely studied, the results are inconclusive probably because of methodological differences. With this study, we aimed to elucidate the role of TS gene polymorphisms genotyping in therapy response in stage III colon carcinoma patients treated with 5-FU adjuvant chemotherapy.

  7. TRIB3 protein denotes a good prognosis in breast cancer patients and is associated with hypoxia sensitivity

    NARCIS (Netherlands)

    Wennemers, M.; Bussink, J.; Grebenchtchikov, N.J.; Sweep, F.C.; Span, P.N.

    2011-01-01

    BACKGROUND: Tribbles homolog 3 (TRIB3) is a pseudokinase involved in the regulation of several signaling pathways involved in cell survival and/or cell stress. Here, we determined the correlation between breast cancer prognosis and TRIB3 protein levels and established the role of TRIB3 in cell survi

  8. Cognitive effects of cancer systemic therapy: implications for the care of older patients and survivors.

    Science.gov (United States)

    Mandelblatt, Jeanne S; Jacobsen, Paul B; Ahles, Tim

    2014-08-20

    The number of patients with cancer who are age 65 years or older (hereinafter "older") is increasing dramatically. One obvious aspect of cancer care for this group is that they are experiencing age-related changes in multiple organ systems, including the brain, which complicates decisions about systemic therapy and assessments of survivorship outcomes. There is a consistent body of evidence from studies that use neuropsychological testing and neuroimaging that supports the existence of impairment following systemic therapy in selected cognitive domains among some older patients with cancer. Impairment in one or more cognitive domains could have important effects in the daily lives of older patients. However, an imperfect understanding of the precise biologic mechanisms underlying cognitive impairment after systemic treatment precludes development of validated methods for predicting which older patients are at risk. From what is known, risks may include lifestyle factors such as smoking, genetic predisposition, and specific comorbidities such as diabetes and cardiovascular disease. Risk also interacts with physiologic and cognitive reserve, because even at the same chronological age and with the same number of illnesses, older patients vary from having high reserve (ie, biologically younger than their age) to being frail (biologically older than their age). Surveillance for the presence of cognitive impairment is also an important component of long-term survivorship care with older patients. Increasing the workforce of cancer care providers who have geriatrics training or who are working within multidisciplinary teams that have this type of expertise would be one avenue toward integrating assessment of the cognitive effects of cancer systemic therapy into routine clinical practice.

  9. Moxibustion for cancer care: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Park Ji-Eun

    2010-04-01

    Full Text Available Abstract Background Moxibustion is a traditional Chinese method that uses the heat generated by burning herbal preparations containing Artemisia vulgaris to stimulate acupuncture points. Considering moxibustion is closely related to acupuncture, it seems pertinent to evaluate the effectiveness of moxibustion as a treatment of symptoms of cancer. The objective of this review was to systematically assess the effectiveness of moxibustion for supportive cancer care. Methods We searched the literature using 11 databases from their inceptions to February 2010, without language restrictions. We included randomised clinical trials (RCTs in which moxibustion was employed as an adjuvant treatment for conventional medicine in patients with any type of cancer. The selection of studies, data extraction, and validations were performed independently by two reviewers. Results Five RCTs compared the effects of moxibustion with conventional therapy. Four RCTs failed to show favourable effects of moxibustion for response rate compared with chemotherapy (n = 229, RR, 1.04, 95% CI 0.94 to 1.15, P = 0.43. Two RCTs assessed the occurrence of side effects of chemotherapy and showed favourable effects of moxibustion. A meta-analysis showed significant less frequency of nausea and vomiting from chemotherapy for moxibustion group (n = 80, RR, 0.38, 95% CIs 0.22 to 0.65, P = 0.0005, heterogeneity: χ2 = 0.18, P = 0.67, I2 = 0%. Conclusion The evidence is limited to suggest moxibustion is an effective supportive cancer care in nausea and vomiting. However, all studies have a high risk of bias so effectively there is not enough evidence to draw any conclusion. Further research is required to investigate whether there are specific benefits of moxibustion for supportive cancer care.

  10. Nursing care for adolescents and young adults with cancer: literature review.

    Science.gov (United States)

    Dreyer, Juliet; Schwartz-Attias, Irit

    2014-01-01

    Cancer patients belonging to the adolescent and young adult (AYA) age group have unique and very specific needs, which require special attention from the caring staff. The difficulty in maintaining the personal and professional development at this age is both natural and normal. Adding to this, coping with a life-threatening disease turns this stage in life into a period with many dilemmas and challenges of quite a complex nature. AYA patients have to deal with issues above and beyond the disease itself, which create a very complex coping picture. On top of that, prognosis for this age group has not improved in recent years, unlike the situation in other age groups like children and adults. The literature on this subject is extensive and comprehensive. However, most of the papers on this subject are very specific and narrow in their approach, each dealing with a specific topic. In this article, we bring together many different papers which make a wide and comprehensive picture of the subject of AYAs coping with cancer, coupled with recommendations for the caring staff. In this review we focus on the various aspects of the disease and treatments in AYAs, based on the conceptual model of quality of life proposed by Ferrell and colleagues [Cancer Nurs 1992;15:153-160; Cancer Nurs 1992;15:247-253], including physical, social, emotional and spiritual aspects. From the psychological standpoint, most of the papers discuss the negative aspects; however, in this article we try to include some articles from the positive psychology school of thought. From our findings it is apparent that there is an opportunity and need to further explore research in this regard. It is apparent that taking a unique approach to AYA cancer patients is needed in order to deal with the unique needs of this age group. This article aims at putting a framework around this issue, with actionable recommendations for the caring staff.

  11. Protecting Family Interests: An Interview Study with Foreign-Born Parents Struggling On in Childhood Cancer Care

    Directory of Open Access Journals (Sweden)

    Pernilla Pergert

    2012-01-01

    Full Text Available Sweden's population is gradually changing to become more multiethnic and diverse and that applies also for recipients of health care, including childhood cancer care. A holistic view on the sick child in the context of its family has always been a cornerstone in childhood cancer care in Sweden. The purpose of this study was to gain knowledge about the experiences and main concern of foreign-born parents in the context of paediatric cancer care. Interviews were performed with eleven foreign-born parents and data were analysed using a classic grounded theory approach. Foreign-born parents often feel in a position of powerless dependence, but family interests are protected in their approaches to interaction with healthcare staff, through cooperation, contesting, and reluctant resigning. Healthcare staff need to listen to foreign-born parents and deal with their concerns seriously to prevent powerless-dependence and work for trustful cooperation in the common fight against childhood cancer.

  12. Usability and feasibility of health IT interventions to enhance Self-Care for Lymphedema Symptom Management in breast cancer survivors

    Directory of Open Access Journals (Sweden)

    Mei R. Fu, PhD, RN, FAAN

    2016-09-01

    Conclusions: This usability study provided evidence on breast cancer survivor's acceptance and highly positive evaluation of TOLF's usability as well as feasibility of using technologically-driven delivery model to enhance self-care strategies for lymphedema symptom management.

  13. In a unique position or squeezed out? The professional roles of general practitioners in cancer care in general and of young adult cancer patients in particular

    DEFF Research Database (Denmark)

    Hølge-Hazelton, B.; Christensen, I.

    2009-01-01

    language, they experience that their patients disappear, they are seldom involved, and they lack knowledge. CONCLUSIONS: GPs have few experiences with YA cancer patients, but they have a potentially unique role in general primary cancer care if they develop their vocational vocabulary, relate more...

  14. How do patients with colorectal cancer perceive treatment and care compared with the treating health care professionals?

    DEFF Research Database (Denmark)

    Mathiesen, Tanja Pagh; Willaing, Ingrid; Freil, Morten

    2007-01-01

    . OBJECTIVES: We sought to examine how well professional and patient assessments of hospital health care correspond. METHODS: We undertook a prospective study in which information from a national clinical register was combined with questionnaires to patients, surgeons, and nurses. The study included 527......BACKGROUND: Patient evaluations are widely used in quality assessment of health services. It is widely recognized that patients and professionals provide a different perspective on quality. However, the extent to which they differ and the conceptual areas in which they differ is not well understood...... patients after surgery for colorectal cancer. The patients and their professionals assessed the same questions. For 336 patients, all questionnaires and register information were available. The response rate was 64%. The main measures were assessments of technical, interpersonal, and organizational aspects...

  15. Realising the Value of Linked Data to Health Economic Analyses of Cancer Care: A Case Study of Cancer 2015.

    Science.gov (United States)

    Lorgelly, Paula K; Doble, Brett; Knott, Rachel J

    2016-02-01

    There is a growing appetite for large complex databases that integrate a range of personal, socio-demographic, health, genetic and financial information on individuals. It has been argued that 'Big Data' will provide the necessary catalyst to advance both biomedical research and health economics and outcomes research. However, it is important that we do not succumb to being data rich but information poor. This paper discusses the benefits and challenges of building Big Data, analysing Big Data and making appropriate inferences in order to advance cancer care, using Cancer 2015 (a prospective, longitudinal, genomic cohort study in Victoria, Australia) as a case study. Cancer 2015 has been linked to State and Commonwealth reimbursement databases that have known limitations. This partly reflects the funding arrangements in Australia, a country with both public and private provision, including public funding of private healthcare, and partly the legislative frameworks that govern data linkage. Additionally, linkage is not without time delays and, as such, achieving a contemporaneous database is challenging. Despite these limitations, there is clear value in using linked data and creating Big Data. This paper describes the linked Cancer 2015 dataset, discusses estimation issues given the nature of the data and presents panel regression results that allow us to make possible inferences regarding which patient, disease, genomic and treatment characteristics explain variation in health expenditure.

  16. Indicators of malnutrition in children with cancer: A study of 690 patients from a tertiary care cancer center

    Directory of Open Access Journals (Sweden)

    R Srivastava

    2015-01-01

    Full Text Available Background: Large data pertaining to indicators of malnutrition in children with cancer is lacking from India. In view of this, we prospectively analyzed consecutive de novo childhood patients with cancer presenting at a tertiary care center. Materials And Methods: Height and weight of each child (n = 690 were compared with World Health Organization child growth standards-2006 for that particular age and sex to get weight-for-age, height-for-age, and weight-for-height indices and below 2SD of the reference median on these indices were considered as underweight, stunted, and wasted, respectively. Body mass index (BMI for age was also analyzed for thinness and obesity. Results: Prevalence of malnutrition based on Z-score for weight-for-age, height-for-age, weight-for-height, and BMI-for-age was 30%, 31%, 35%, and 41%, respectively. Weight-for-age (underweight was significantly associated (P = 0.018 with solid tumors. Height-for-age, weight-for-age, and BMI-for-age were significantly associated (P = 0.007, P = 0.016, and P ≤ 0.001, respectively with rural community. Conclusion: Malnutrition was observed in approximately one-third of children with cancer. Malnutrition is associated with solid tumors and those coming from rural community. Wasting has a higher prevalence in children with cancer in <5 years of age group.

  17. RFID technology in health environment opportunities and challenges for modern cancer care.

    Science.gov (United States)

    Safdari, Reza; Maserat, Elham; Maserat, Elnaz

    2012-01-01

    Cancers are significant contributors to the mortality and health care expenditures. Cancer can be reduced and monitored by new information technology. Radio frequency identification or RFID is a wireless identification technology. The use of this technology can be employed for identifying and tracking clinical staff, patients, supplies, medications and equipments. RFID can trace and manage chemotherapy drugs. There are different types of RFID. Implantable RFID allowing a chip to be embedded under the skin and that store the cancer patient's identifier. These are concerns about applications of RFID. Privacy, security and legal issues are key problems. This paper describes capabilities, benefits and confidentiality aspects in radio frequency identification systems and solutions for overcoming challenges.

  18. Risk of Lymphoma and Solid Cancer among Patients with Rheumatoid Arthritis in a Primary Care Setting

    DEFF Research Database (Denmark)

    Andersen, Christen Bertel L; Lindegaard, Hanne Merete; Vestergaard, Hanne;

    2014-01-01

    lymphoproliferative malignancies or solid cancers. These risk estimates did not change when eosinophilia, CRP, and comorbidities were included in the models. CONCLUSIONS: In this large cohort of patients with RA of short or long duration recruited from a primary care resource, RA was not associated with an increased...... risk of lymphoproliferative or solid cancers during 4 years of follow-up, when the models were adjusted for confounders. Blood eosinophilia could not be identified as a mediator of cancer development in the present setting.......BACKGROUND: Several studies have demonstrated an association between rheumatoid arthritis (RA) and lymphoproliferative malignancies, but pathogenic mechanisms remain unclear. We investigated 1) the risk of lymphoproliferative malignancies and solid tumors in adults with RA identified in primary...

  19. Effectiveness of community-based football compared to usual care in men with prostate cancer

    DEFF Research Database (Denmark)

    Bjerre, Eik; Bruun, Ditte Marie; Tolver, Anders;

    2016-01-01

    . The intervention period will be six months. The primary outcome is quality of life assessed after 12 weeks based on the change from baseline in the Functional Assessment of Cancer Therapy-Prostate questionnaire. Secondary outcomes are change from baseline to six months in quality of life, lean body mass, fat mass...... has been suggested and previously studies have shown improvements of disease specific quality of life and a reduction in treatment-related toxicity. Cohort studies with long term follow up have suggested that physical activity is associated with improved survival in prostate cancer patients....... Previously one randomised controlled trial has examined the efficacy of football in prostate cancer patients undergoing androgen deprivation therapy to usual care and reported positive effects on lean body mass and bone markers. Against this background, we wish to examine the effectiveness of community...

  20. Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng

    2014-01-01

    Full Text Available Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23 service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P<0.01, those undergoing wide local excision (P<0.01 and those with ductal carcinoma-in situ or early stage breast cancer (P<0.01, were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

  1. [The Nutritional Care Experience of a Post-Operative Periampullary Cancer Patient With Cachexia].

    Science.gov (United States)

    Liou, Yan-Ting; Chiang, Pin-Yi; Shun, Shiow-Ching

    2016-04-01

    Cachexia is one of the most widely overlooked of the syndromes that are experienced by cancer patients. This syndrome is especially prevalent among patients with gastroenterology tract cancer. Although the National Comprehensive Cancer Network (NCCN) issued palliative-care practice guidelines for cachexia in 2015, guidelines have yet to be issued for the clinical setting. The authors reviewed the literature and applied their clinical experience to create an approach for identifying the degree of cachexia in a post-operative patient with periampullary cancer. This approach assesses the nutritional status, physical status, laboratory results, and gastrointestinal system functions of the patient using the Cachexia Assessment Scale (CAS) and NCCN Practice Guidelines for Cachexia. The patient improved under nursing care with an increase in nutritional intake and physical activity facilitating their process of post-surgical physical recovery. The authors hope that this experience using the combined CAS-NCCN Practice Guidelines will help clinical caregivers better understand how to apply the relevant guidelines in clinical settings. The developed approach may help nurses assess the comprehensive nutrition status of patients and related factors in order to provide interventions that will decrease the progression of cachexia effectively and promote quality of life.

  2. Implementation of cancer clinical care pathways: a successful model of collaboration between payers and providers.

    Science.gov (United States)

    Feinberg, Bruce A; Lang, James; Grzegorczyk, James; Stark, Donna; Rybarczyk, Thomas; Leyden, Thomas; Cooper, Joseph; Ruane, Thomas; Milligan, Scott; Stella, Philip; Scott, Jeffrey A

    2012-05-01

    Despite rising medical costs within the US health care system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of health care in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the health care cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology health care consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program.

  3. Mechanisms that Trigger a Good Health-Care Response to Intimate Partner Violence in Spain. Combining Realist Evaluation and Qualitative Comparative Analysis Approaches

    OpenAIRE

    2015-01-01

    Background. Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León...

  4. Distress among women taking part in surgical continuity of care for breast cancer - a mixed methods study

    DEFF Research Database (Denmark)

    Jørgensen, Lone

    Breast cancer is the most common cancer among women worldwide. In Denmark, one in every 9 women will be diagnosed with breast cancer during her life. The initial treatment is removal of the tumour and the surrounding tissue, or removal of the breast. The axillary is examined to stage spread...... of cancer and if metastases are detected, an axillary clearance is performed. Consequences of breast cancer are manifold and vary within individuals, but the most cited are anxiety, depression, pain, sleep disturbance, fatigue, and/or altered body image. These consequences may cause distress at some point...... during breast cancer trajectory. Overall, distress has been linked to suffering, and lower quality of life, increased admission rates, and greater health care costs. This thesis uses mixed methods to investigate the prevalence of distress among women taking part in surgical continuity of care at time...

  5. Treatment of Pancreatic and Periampullary Cancers at a Community Hospital: Successful Application of Tertiary Care Treatment Standards

    Directory of Open Access Journals (Sweden)

    Robert C. Moesinger

    2011-01-01

    Full Text Available Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented. Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006–2010 at two community hospitals. Results. There were 51 successful resections of 70 explorations (73% including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards. Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care.

  6. Cancer survival in the elderly: Effects of socio-economic factors and health care system features (ELDCARE project)

    NARCIS (Netherlands)

    M. Vercelli (Marina); R. Lillini (Roberto); R. Capocaccia (Riccardo); A. Micheli; J.W.W. Coebergh (Jan Willem); M.J. Quinn (M.); C. Martinez-Garcia (Carmen); A. Quaglia (Alberto); W. Oberaigner; J. Ajmová (J.); T. Aareleid (T.); J. Palo (Jukka); T. Hakulinen (Timo); P. Grosclaude (P.); H. Ziegler (H.); L. Tryggvadottir (Laufey); F. Langmark (F.); A. Andersen; M. Bielska-Lasota (Magdalena); M.A. Pinheiro (Magda Avelar); I. Pleško (I.); V. Pompe-Kirn (V.); P. Ecimovic (P.); T. Möller (Thomas); J.-M. Lutz (J.)

    2006-01-01

    textabstractThe purpose of the ELDCARE project is to study differences in cancer survival for elderly patients by country, taking into account the socio-economic conditions and the characteristics of health care systems at the ecological level. Fifty-three European cancer registries, from 19 countri

  7. The chimeric transcript RUNX1-GLRX5: a biomarker for good postoperative prognosis in Stage IA non-small-cell lung cancer.

    Science.gov (United States)

    Ishikawa, Rie; Amano, Yosuke; Kawakami, Masanori; Sunohara, Mitsuhiro; Watanabe, Kousuke; Kage, Hidenori; Ohishi, Nobuya; Yatomi, Yutaka; Nakajima, Jun; Fukayama, Masashi; Nagase, Takahide; Takai, Daiya

    2016-02-01

    Stage IA non-small-cell lung cancer cases have been recognized as having a low risk of relapse; however, occasionally, relapse may occur. To predict clinical outcome in Stage IA non-small-cell lung cancer patients, we searched for chimeric transcripts that can be used as biomarkers and identified a novel chimeric transcript, RUNX1-GLRX5, comprising RUNX1, a transcription factor, and GLRX5. This chimera was detected in approximately half of the investigated Stage IA non-small-cell lung cancer patients (44/104 cases, 42.3%). Although there was no significant difference in the overall survival rate between RUNX1-GLRX5-positive and -negative cases (P = 0.088), a significantly lower relapse rate was observed in the RUNX1-GLRX5-positive cases (P = 0.039), indicating that this chimera can be used as a biomarker for good prognosis in Stage IA patients. Detection of the RUNX1-GLRX5 chimeric transcript may therefore be useful for the determination of a postoperative treatment plan for Stage IA non-small-cell lung cancer patients.

  8. Worry Is Good for Breast Cancer Screening: A Study of Female Relatives from the Ontario Site of the Breast Cancer Family Registry

    Directory of Open Access Journals (Sweden)

    Li Rita Zhang

    2012-01-01

    Full Text Available Background. Few prospective studies have examined associations between breast cancer worry and screening behaviours in women with elevated breast cancer risks based on family history. Methods. This study included 901 high familial risk women, aged 23–71 years, from the Ontario site of the Breast Cancer Family Registry. Self-reported breast screening behaviours at year-one followup were compared between women at low (N=305, medium (N=433, and high (N=163 levels of baseline breast cancer worry using logistic regression. Nonlinear relationships were assessed using likelihood ratio tests. Results. A significant non-linear inverted “U” relationship was observed between breast cancer worry and mammography screening (P=0.034 for all women, where women at either low or high worry levels were less likely than those at medium to have a screening mammogram. A similar significant non-linear inverted “U” relationship was also found among all women and women at low familial risk for worry and screening clinical breast examinations (CBEs. Conclusions. Medium levels of cancer worries predicted higher rates of screening mammography and CBE among high-risk women.

  9. Moving guidelines into action: a report from Cancer Care Ontario’s event Let’s Get Moving: Exercise and Rehabilitation for Cancer Patients

    Science.gov (United States)

    Tomasone, J.R.; Zwaal, C.; Kim, G.; Yuen, D.; Sussman, J.; Segal, R.

    2017-01-01

    The need for an improved understanding of the rehabilitation services landscape in Ontario and for promotion of Cancer Care Ontario’s newly developed Exercise for People with Cancer guideline brought Cancer Care Ontario’s Psychosocial Oncology and Survivorship Programs together to host a knowledge translation and exchange event. The primary objectives of the event were to understand recommendations from Cancer Care Ontario’s new exercise guideline, to discuss key considerations and determine strategies for the implementation of the guideline recommendations, and to explore the current state and future directions of cancer rehabilitation in Ontario. The event was attended by 124 stakeholders, including clinicians, allied health care professionals, administrators, patients, community partners, and academics representing each of the 13 regional cancer programs in Ontario. Attendees participated in two small-group activities that focused on determining the best approach for implementing the guideline recommendations into practice and discussing current barriers and the future state of cancer rehabilitation in Ontario. The activities allowed for networking and collaboration between attendees. The event provided an opportunity for the Psychosocial Oncology and Survivorship Programs to learn about the types of goals and plans that could be feasible in implementing the guideline in each region, and about ways to prioritize gaps in access to rehabilitation services and the types of implementation strategies that might be used to address the gaps. Overall, attendees were highly satisfied with the event, and the findings are being used to help inform research and practice activities with respect to guideline implementation and rehabilitation practice.

  10. Personalization of loco-regional care for primary breast cancer patients (part 1).

    Science.gov (United States)

    Toi, Masakazu; Winer, Eric P; Benson, John R; Inamoto, Takashi; Forbes, John F; von Minckwitz, Gunter; Robertson, John F R; Grobmyer, Stephen R; Jatoi, Ismail; Sasano, Hironobu; Kunkler, Ian; Ho, Alice Y; Yamauchi, Chikako; Chow, Louis W C; Huang, Chiun-Sheng; Han, Wonshik; Noguchi, Shinzaburo; Pegram, Mark D; Yamauchi, Hideko; Lee, Eun-Sook; Larionov, Alexey A; Bevilacqua, Jose L B; Yoshimura, Michio; Sugie, Tomoharu; Yamauchi, Akira; Krop, Ian E; Noh, Dong Young; Klimberg, V Suzanne

    2015-01-01

    ABSTRACT  Kyoto Breast Cancer Consensus Conference, Kyoto, Japan, 18-20 February 2014 The loco-regional management of breast cancer is increasingly complex with application of primary systemic therapies, oncoplastic techniques and genetic testing for breast cancer susceptibility. Personalization of loco-regional treatment is integral to optimization of breast cancer care. Clinical and pathological tumor stage, biological features and host factors influence loco-regional treatment strategies and extent of surgical procedures. Key issues including axillary staging, axillary treatment, radiation therapy, primary systemic therapy (PST), preoperative hormonal therapy and genetic predisposition were identified and discussed at the Kyoto Breast Cancer Consensus Conference (KBCCC2014). In the first of a two part conference scene, consensus recommendations for axillary management are presented and focus on the following topics: indications for completion axillary lymph node dissection in primary surgical patients with ≤2 macrometastases or any sentinel nodal deposits after PST; the timing of sentinel lymph node biopsy in the context of PST; use of axillary irradiation as a component of primary treatment plans and the role of intraoperative node assessment in the post-Z0011 era.

  11. Excess of health care use in general practice and of comorbid chronic conditions in cancer patients compared to controls

    Directory of Open Access Journals (Sweden)

    Jabaaij Lea

    2012-06-01

    Full Text Available Abstract Background The number of cancer patients and the number of patients surviving initial treatments is expected to rise. Traditionally, follow-up monitoring takes place in secondary care. The contribution of general practice is less visible and not clearly defined. This study aimed to compare healthcare use in general practice of patients with cancer during the follow-up phase compared with patients without cancer. We also examined the influence of comorbid conditions on healthcare utilisation by these patients in general practice. Methods We compared health care use of N=8,703 cancer patients with an age and gender-matched control group of patients without cancer from the same practice. Data originate from the Netherlands Information Network of General Practice (LINH, a representative network consisting of 92 general practices with 350,000 enlisted patients. Health care utilisation was assessed using data on contacts with general practice, prescription and referral rates recorded between 1/1/2001 and 31/12/2007. The existence of additional comorbid chronic conditions (ICPC coded was taken into account. Results Compared to matched controls, cancer patients had more contacts with their GP-practice (19.5 vs. 11.9, p Conclusion We found that cancer patients in the follow-up phase consulted general practice more often and suffered more often from comorbid chronic conditions, compared to patients without cancer. It is expected that the number of cancer patients will rise in the years to come and that primary health care professionals will be more involved in follow-up care. Care for comorbid chronic conditions, communication between specialists and GPs, and coordination of tasks then need special attention.

  12. Improving clinical research and cancer care delivery in community settings: evaluating the NCI community cancer centers program

    Directory of Open Access Journals (Sweden)

    Fennell Mary L

    2009-09-01

    Full Text Available Abstract Background In this article, we describe the National Cancer Institute (NCI Community Cancer Centers Program (NCCCP pilot and the evaluation designed to assess its role, function, and relevance to the NCI's research mission. In doing so, we describe the evolution of and rationale for the NCCCP concept, participating sites' characteristics, its multi-faceted aims to enhance clinical research and quality of care in community settings, and the role of strategic partnerships, both within and outside of the NCCCP network, in achieving program objectives. Discussion The evaluation of the NCCCP is conceptualized as a mixed method multi-layered assessment of organizational innovation and performance which includes mapping the evolution of site development as a means of understanding the inter- and intra-organizational change in the pilot, and the application of specific evaluation metrics for assessing the implementation, operations, and performance of the NCCCP pilot. The assessment of the cost of the pilot as an additional means of informing the longer-term feasibility and sustainability of the program is also discussed. Summary The NCCCP is a major systems-level set of organizational innovations to enhance clinical research and care delivery in diverse communities across the United States. Assessment of the extent to which the program achieves its aims will depend on a full understanding of how individual, organizational, and environmental factors align (or fail to align to achieve these improvements, and at what cost.

  13. Survivorship Care Planning in Improving Quality of Life in Survivors of Ovarian Cancer

    Science.gov (United States)

    2017-02-19

    Cancer Survivor; Stage IA Ovarian Epithelial Cancer; Stage IB Ovarian Epithelial Cancer; Stage IC Ovarian Epithelial Cancer; Stage IIA Ovarian Epithelial Cancer; Stage IIB Ovarian Epithelial Cancer; Stage IIC Ovarian Epithelial Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIC Ovarian Epithelial Cancer

  14. A qualitative analysis of lung cancer screening practices by primary care physicians.

    Science.gov (United States)

    Henderson, Susan; DeGroff, Amy; Richards, Thomas B; Kish-Doto, Julia; Soloe, Cindy; Heminger, Christina; Rohan, Elizabeth

    2011-12-01

    Lung cancer is the leading cause of cancer death in the United States, but no scientific organization currently recommends screening because of limited evidence for its effectiveness. Despite this, physicians often order screening tests such as chest X-rays and computerized tomography scans for their patients. Limited information is available about how physicians decide when to order these tests. To identify factors that affect whether physicians' screen patients for lung cancer, we conducted five 75-min telephone-based focus groups with 28 US primary care physicians and used inductive qualitative research methods to analyze their responses. We identified seven factors that influenced these physicians' decisions about screening patients for lung cancer: (1) their perception of a screening test's effectiveness, (2) their attitude toward recommended screening guidelines, (3) their practice experience, (4) their perception of a patient's risk for lung cancer, (5) reimbursement and payment for screening, (6) their concern about litigation, and (7) whether a patient requested screening. Because these factors may have conflicting effects on physicians' decisions to order screening tests, physicians may struggle in determining when screening for lung cancer is appropriate. We recommend (1) more clinician education, beginning in medical school, about the existing evidence related to lung cancer screening, with emphasis on the benefit of and training in tobacco use prevention and cessation, (2) more patient education about the benefits and limitations of screening, (3) further studies about the effect of patients' requests to be screened on physicians' decisions to order screening tests, and (4) larger, quantitative studies to follow up on our formative data.

  15. PREVALENCE OF INCIDENTAL GALLBLADDER CANCER IN A TERTIARY-CARE HOSPITAL FROM PERNAMBUCO, BRAZIL

    Directory of Open Access Journals (Sweden)

    Euclides Dias MARTINS-FILHO

    2015-09-01

    Full Text Available BackgroundGallbladder cancer is sometimes incidentally uncovered following cholecystectomy for gallstones diseases. The supposed highly variable prevalence of incidental gallbladder cancer through our country is unknown.ObjectiveTo explore the prevalence of incidental gallbladder cancer in our tertiary-care hospital.MethodsA cross-sectional study was carried out on patients who consecutively underwent cholecystectomy due to gallstones disease at Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira - FPS/IMIP, from January, 2007 to December, 2010. Data on incidental gallbladder cancer patients were explored for prevalence estimation and description of our experience with the management of this malignancy.ResultsOur analysis involved 2018 patients with a marked predominance of women (n=1.697; 84.1% over men (n=321; 15.9%. The 3-year prevalence estimate of 0.34% was recorded for incidental gallbladder cancer in our sample. Regarding tumor staging, there were 1 T1a, 1 T1b, and 5 T2 adenocarcinoma tumors. Laparoscopic cholecystectomy alone was performed for the T1a tumor, and additional radical surgery was performed in five others. One patient presented metastatic disease at the time of repeat surgery. The final pathology revealed residual/additional disease in all T2 tumors after radical surgery whereas the T1b patient underwent a salvage Whipple’s procedure due to a secondary distal cholangiocarcinoma. The patient with T1a tumor is alive after 3-year follow-up but all of the others died because of disease recurrence/progression up to 12 months.ConclusionThis study confirms the poor prognosis of Gallbladder cancer even when incidentally diagnosed following cholecystectomy and supposes a 3-year prevalence estimate of 0.34% for incidental gallbladder cancer in our Center from Pernambuco State, Brazil.

  16. Late Cardiac Events after Childhood Cancer: Methodological Aspects of the Pan-European Study PanCareSurFup

    Science.gov (United States)

    Feijen, Elizabeth A. M.; Font-Gonzalez, Anna; van Dalen, Elvira C.; van der Pal, Helena J. H.; Reulen, Raoul C.; Winter, David L.; Kuehni, Claudia E.; Haupt, Riccardo; Alessi, Daniela; Byrne, Julianne; Bardi, Edit; Jakab, Zsuzsanna; Grabow, Desiree; Garwicz, Stanislaw; Jankovic, Momcilo; Levitt, Gill A.; Skinner, Roderick; Zadravec Zaletel, Lorna; Hjorth, Lars; Tissing, Wim J. E.; de Vathaire, Florent; Hawkins, Mike M.; Kremer, Leontien C. M.

    2016-01-01

    Background and Aim Childhood cancer survivors are at high risk of long-term adverse effects of cancer and its treatment, including cardiac events. The pan-European PanCareSurFup study determined the incidence and risk factors for cardiac events among childhood cancer survivors. The aim of this article is to describe the methodology of the cardiac cohort and nested case-control study within PanCareSurFup. Methods Eight data providers in Europe participating in PanCareSurFup identified and validated symptomatic cardiac events in their cohorts of childhood cancer survivors. Data on symptomatic heart failure, ischemia, pericarditis, valvular disease and arrhythmia were collected and graded according to the Criteria for Adverse Events. Detailed treatment data, data on potential confounders, lifestyle related risk factors and general health problems were collected. Results The PanCareSurFup cardiac cohort consisted of 59,915 5-year childhood cancer survivors with malignancies diagnosed between 1940 and 2009 and classified according to the International Classification of Childhood Cancer 3. Different strategies were used to identify cardiac events such as record linkage to population/ hospital or regional based databases, and patient- and general practitioner-based questionnaires. Conclusion The cardiac study of the European collaborative research project PanCareSurFup will provide the largest cohort of 5-year childhood cancer survivors with systematically ascertained and validated data on symptomatic cardiac events. The result of this study can provide information to minimize the burden of cardiac events in childhood cancer survivors by tailoring the follow-up of childhood cancer survivors at high risk of cardiac adverse events, transferring this knowledge into evidence-based clinical practice guidelines and providing a platform for future research studies in childhood cancer patients.  PMID:27643694

  17. Breast Cancer among Women Living in Poverty: Better Care in Canada than in the United States.

    Science.gov (United States)

    Gorey, Kevin M; Richter, Nancy L; Luginaah, Isaac N; Hamm, Caroline; Holowaty, Eric J; Zou, GuangYong; Balagurusamy, Madhan K

    2015-05-21

    This historical study estimated the protective effects of a universally accessible, single-payer health care system versus a multi-payer system that leaves many uninsured or underinsured by comparing breast cancer care of women living in high poverty neighborhoods in Ontario or California between 1996 and 2011. Women in Canada experienced better care particularly as compared to women who were inadequately insured in the United States. Women in Canada were diagnosed earlier (rate ratio [RR] = 1.12) and enjoyed better access to breast conserving surgery (RR = 1.48), radiation (RR = 1.60) and hormone therapies (RR = 1.78). Women living in high poverty Canadian neighborhoods even experienced shorter waits for surgery (RR = 0.58) and radiation therapy (RR = 0.44) than did such women in the US. Consequently, women in Canada were much more likely to survive longer. Regression analyses indicated that health insurance could explain most of the better care and better outcomes in Canada. Over this study's 15-year timeframe 31,500 late diagnoses, 94,500 sub-optimum treatment plans and 103,500 early deaths were estimated in high poverty US neighborhoods due to relatively inadequate health insurance coverage. Implications for social work practice, including advocacy for future reforms of US health care are discussed.

  18. Hospice Care for Children With Cancer: Where Do These Children Die?

    Science.gov (United States)

    Thienprayoon, Rachel; Lee, Simon C; Leonard, David; Winick, Naomi

    2015-07-01

    Hospice is an important provider of end of life care; many children who die of cancer enroll in hospice programs. How frequently such children remain in hospice to die at home, or disenroll from hospice and die in the hospital, has not been described. A child's location of death has important implications for quality of life and parental adaptation. This represents a subanalysis of a retrospective study of 202 consecutive oncology patients who died at a single center between January 1, 2006 and December 31, 2010. Of 95 children who enrolled in hospice, 82 had known location of death. Sixty (73%) died at home or an inpatient hospice unit, 15 (18%) died in the oncology unit, 5 (6%) died in the intensive care unit, and 2 (2%) died in the emergency department. The median length of hospice services was 41 days, twice the national median of 21 days reported in adults. One quarter of children disenrolled from hospice care, ultimately dying in an acute care setting. Further studies are warranted to explore the hospice experience in children, and to address modifiable factors that may impact a family's choice to withdraw from hospice care.

  19. Primary care physician characteristics associated with cancer screening: a retrospective cohort study in Ontario, Canada.

    Science.gov (United States)

    Lofters, Aisha K; Ng, Ryan; Lobb, Rebecca

    2015-02-01

    Primary care physicians can serve as both facilitators and barriers to cancer screening, particularly for under-screened groups such as immigrant patients. The objective of this study was to inform physician-targeted interventions by identifying primary care physician characteristics associated with cancer screening for their eligible patients, for their eligible immigrant patients, and for foreign-trained physicians, for their eligible immigrant patients from the same world region. A population-based retrospective cohort study was performed, looking back 3 years from 31 December 2010. The study was performed in urban primary care practices in Ontario, Canada's largest province. A total of 6303 physicians serving 1,156,627 women eligible for breast cancer screening, 2,730,380 women eligible for cervical screening, and 2,260,569 patients eligible for colorectal screening participated. Appropriate breast screening was defined as at least one mammogram in the previous 2 years, appropriate cervical screening was defined as at least one Pap test in the previous 3 years, and appropriate colorectal screening as at least one fecal occult blood test in the previous 2 years or at least one colonoscopy or barium enema in the previous 10 years. Just fewer than 40% of physicians were female, and 26.1% were foreign trained. In multivariable analyses, physicians who attended medical schools in the Caribbean/Latin America, the Middle East/North Africa, South Asia, and Western Europe were less likely to screen their patients than Canadian graduates. South Asian-trained physicians were significantly less likely to screen South Asian women for cervical cancer than other foreign-trained physicians who were seeing region-congruent patients (adjusted odds ratio: 0.56 [95% confidence interval 0.32-0.98] versus physicians from the USA, Australia and New Zealand). South Asian patients were the most vulnerable to under-screening, and decreasing patient income quintile was consistently

  20. A new mode of organizing in health care? Governmentality and managed networks in cancer services in England.

    Science.gov (United States)

    Ferlie, Ewan; McGivern, Gerry; Fitzgerald, Louise

    2012-02-01

    We explore the argument that a new mode of health care organizing is emerging which moves beyond the established professional dominance versus New Public Management (NPM) debate. We review Foucault's work on 'governmentality', as applied to health care organizations. We specify two specific Foucauldian themes (the power/knowledge nexus in Evidence Based Medicine (EBM); and the technologies of the clinical managerial self) to analyse organizing in the English cancer services field. We introduce two qualitative case studies of Managed Cancer Networks. We suggest their governance can be fruitfully seen through a 'governmentality' lens. We consider implications for developing Foucauldian analysis of health care organizations.