WorldWideScience

Sample records for effective cancer care

  1. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Evaluating the effect of clinical care pathways on quality of cancer care: analysis of breast, colon and rectal cancer pathways.

    Science.gov (United States)

    Bao, Han; Yang, Fengjuan; Su, Shaofei; Wang, Xinyu; Zhang, Meiqi; Xiao, Yaming; Jiang, Hao; Wang, Jiaying; Liu, Meina

    2016-05-01

    Substantial gaps exist between clinical practice and evidence-based cancer care, potentially leading to adverse clinical outcomes and decreased quality of life for cancer patients. This study aimed to evaluate the usefulness of clinical pathways as a tool for improving quality of cancer care, using breast, colon, and rectal cancer pathways as demonstrations. Newly diagnosed patients with invasive breast, colon, and rectal cancer were enrolled as pre-pathway groups, while patients with the same diagnoses treated according to clinical pathways were recruited for post-pathway groups. Compliance with preoperative core biopsy or fine-needle aspiration, utilization of sentinel lymph node biopsy, and proportion of patients whose tumor hormone receptor status was stated in pathology report were significantly increased after implementation of clinical pathway for breast cancer. For colon cancer, compliance with two care processes was significantly improved: surgical resection with anastomosis and resection of at least 12 lymph nodes. Regarding rectal cancer, there was a significant increase in compliance with preoperative evaluation of depth of tumor invasion, total mesorectal excision treatment of middle- or low-position rectal cancer, and proportion of patients who had undergone rectal cancer surgery whose pathology report included margin status. Moreover, total length of hospital stay was decreased remarkably for all three cancer types, and postoperative complications remained unchanged following implementation of the clinical pathways. Clinical pathways can improve compliance with standard care by implementing evidence-based quality indicators in daily practice, which could serve as a useful tool for narrowing the gap between clinical practice and evidence-based care.

  3. Spiritual Care Training for Mothers of Children with Cancer: Effects on Quality of Care and Mental Health of Caregivers.

    Science.gov (United States)

    Borjalilu, Somaieh; Shahidi, Shahriar; Mazaheri, Mohammad Ali; Emami, Amir Hossein

    2016-01-01

    The purpose of this study was to explore the effectiveness of a spiritual care training package in maternal caregivers of children with cancer. This study was a quasi-experimental study with pretest and posttest design consisting of a sample of 42 mothers of children diagnosed as having cancer. Participants were randomly assigned to either an experimental or a control group. The training package consisted of seven group training sessions offered in a children's hospital in Tehran. All mothers completed the Spirituality and Spiritual Care Rating Scale (SSCRS) and the Depression, Anxiety and Stress Scale (DASS-21) at pre and post test and after a three month follow up. There was significant difference between anxiety and spiritual, religious, Personalized care and total scores spiritual care between the intervention and control groups at follow-up (Pspiritual care training program promotes spirituality, personalized care, religiosity and spiritual care as well as decreasing anxiety in mothers of children with cancer and decreases anxiety. It may be concluded that spiritual care training could be used effectively in reducing distressful spiritual challenges in mothers of children with cancer.

  4. 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.

  5. Effect of hospital volume on processes of breast cancer care: A National Cancer Data Base study.

    Science.gov (United States)

    Yen, Tina W F; Pezzin, Liliana E; Li, Jianing; Sparapani, Rodney; Laud, Purushuttom W; Nattinger, Ann B

    2017-05-15

    The purpose of this study was to examine variations in delivery of several breast cancer processes of care that are correlated with lower mortality and disease recurrence, and to determine the extent to which hospital volume explains this variation. Women who were diagnosed with stage I-III unilateral breast cancer between 2007 and 2011 were identified within the National Cancer Data Base. Multiple logistic regression models were developed to determine whether hospital volume was independently associated with each of 10 individual process of care measures addressing diagnosis and treatment, and 2 composite measures assessing appropriateness of systemic treatment (chemotherapy and hormonal therapy) and locoregional treatment (margin status and radiation therapy). Among 573,571 women treated at 1755 different hospitals, 38%, 51%, and 10% were treated at high-, medium-, and low-volume hospitals, respectively. On multivariate analysis controlling for patient sociodemographic characteristics, treatment year and geographic location, hospital volume was a significant predictor for cancer diagnosis by initial biopsy (medium volume: odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.05-1.25; high volume: OR = 1.30, 95% CI = 1.14-1.49), negative surgical margins (medium volume: OR = 1.15, 95% CI = 1.06-1.24; high volume: OR = 1.28, 95% CI = 1.13-1.44), and appropriate locoregional treatment (medium volume: OR = 1.12, 95% CI = 1.07-1.17; high volume: OR = 1.16, 95% CI = 1.09-1.24). Diagnosis of breast cancer before initial surgery, negative surgical margins and appropriate use of radiation therapy may partially explain the volume-survival relationship. Dissemination of these processes of care to a broader group of hospitals could potentially improve the overall quality of care and outcomes of breast cancer survivors. Cancer 2017;123:957-66. © 2016 American Cancer Society. © 2016 American Cancer Society.

  6. 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 ...

  7. Communicating Effectively in Pediatric Cancer Care: Translating Evidence into Practice

    Directory of Open Access Journals (Sweden)

    Lindsay J. Blazin

    2018-03-01

    Full Text Available Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers. This review aims to identify key communication skills that healthcare providers can employ throughout the illness journey to provide information, encourage shared decision-making, promote therapeutic alliance, and empathically address end-of-life concerns. By reviewing the relevant evidence and providing practical tips for skill development, we strive to help healthcare providers understand the value of effective communication and master these critical skills.

  8. Effect of home care service on the quality of life in patients with gynecological cancer.

    Science.gov (United States)

    Aktas, Demet; Terzioglu, Fusun

    2015-01-01

    The purpose of the research was to determine the effect of home care service on the quality of life in patients with gynecological cancer. This randomized case control study was carried out in a womans hospital between September 2011 and February 2012. Women undergoing gynecological cancer treatment were separated into intervention and control groups, of 35 patients each. The intervention group was provided with nursing care service through hospital and home visits (1st, 12th weeks) within the framework of a specifically developed nursing care plan. The control group was monitored without any intervention through the hospital routine protocols (1st, 12th weeks). Data were collected using An Interview Form, Home Visit Monitoring Form and Quality of Life Scale/Cancer Survivors. Effects of home care service on the quality of life in gynecological cancer patients were investigated using chi-square tests, McNemar's test, independent t-test and ANOVA. This study found that the intervention group receiving home care service had a moderately high quality of life (average mean: 6.01±0.64), while the control group had comparatively lower quality (average mean: 4.35±0.79) within the 12 week post- discharge period (phome care services to be efficient in improving the quality of life in patients with gynecological cancer.

  9. 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

    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. 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). 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%, pgastric 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.

  10. 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.

  11. 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.

  12. The effect of nurse navigation on timeliness of breast cancer care at an academic comprehensive cancer center.

    Science.gov (United States)

    Basu, Mohua; Linebarger, Jared; Gabram, Sheryl G A; Patterson, Sharla Gayle; Amin, Miral; Ward, Kevin C

    2013-07-15

    A patient navigation process is required for accreditation by the National Accreditation Program for Breast Centers (NAPBC). Patient navigation has previously been shown to improve timely diagnosis in patients with breast cancer. This study sought to assess the effect of nurse navigation on timeliness of care following the diagnosis of breast cancer by comparing patients who were treated in a comprehensive cancer center with and without the assistance of nurse navigation. Navigation services were initiated at an NAPBC-accredited comprehensive breast center in July 2010. Two 9-month study intervals were chosen for comparison of timeliness of care: October 2009 through June 2010 and October 2010 through June 2011. All patients with breast cancer diagnosed in the cancer center with stage 0 to III disease during the 2 study periods were identified by retrospective cancer registry review. Time from diagnosis to initial oncology consultation was measured in business days, excluding holidays and weekends. Overall, 176 patients met inclusion criteria: 100 patients prior to and 76 patients following nurse navigation implementation. Nurse navigation was found to significantly shorten time to consultation for patients older than 60 years (B = -4.90, P = .0002). There was no change in timeliness for patients 31 to 60 years of age. Short-term analysis following navigation implementation showed decreased time to consultation for older patients, but not younger patients. Further studies are indicated to assess the long-term effects and durability of this quality improvement initiative. © 2013 American Cancer Society.

  13. 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.

  14. Increasing Information Dissemination in Cancer Communication: Effects of Using "Palliative," "Supportive," or "Hospice" Care Terminology.

    Science.gov (United States)

    Fishman, Jessica M; Greenberg, Patricia; Bagga, Margy Barbieri; Casarett, David; Propert, Kathleen

    2018-04-20

    When attempting to share information about comfort-oriented care, many use "palliative," "supportive," and "hospice" care terminology interchangeably, but we lack evidence about the effects of using these different terms. This study was designed to test whether the use of "palliative," "supportive," or "hospice" terminology can improve the dissemination of information among breast cancer patients-a large and growing oncology population. Design, Setting, and Measurement: This experimental study was conducted at a major U.S. hospital serving a diverse population. Patients visiting a cancer clinic encountered opportunities to learn more about cancer care. They were offered health materials that were described as reporting on "palliative," "supportive," or "hospice" care and the primary outcome was whether a patient decided to select or reject each. As a secondary outcome, the study measured the patient's level of interest in receiving each. Compared with alternatives, materials labeled as "supportive" care were most likely to be selected and considered valuable (p value information labeled as being about "supportive" care was significantly more likely to be selected. If these effects are supported by additional research, there may be low-cost, highly feasible changes in language choice that increase the dissemination of relevant health information.

  15. Hypnosis in Cancer Care.

    Science.gov (United States)

    Wortzel, Joshua; Spiegel, David

    2017-07-01

    Cancer affects a growing proportion of the population as survival improves. The illness and its treatment brings a substantial burden of symptoms, including pain, anxiety, insomnia, and grief. Here, the uses of hypnosis in the treatment of these cancer-related problems will be reviewed. The utility of measuring hypnotizability in the clinical setting will be discussed. The current neurobiology of hypnotizability and hypnosis will be reviewed. Methods and results of using hypnosis for pain control in acute and chronic settings will be presented. Effects of hypnotic analgesia in specific brain regions associated with pain reduction, notably the dorsal anterior cingulate cortex and the somatosensory cortex, underlies its utility as a potent and side-effect free analgesic. Methods for helping those with cancer to better manage their anxiety, insomnia, and grief will be described. These involve facing disease-related stressors while dissociating the experience from somatic arousal. Given the serious complications of medications widely used to treat pain, anxiety, and insomnia, this article provides methods and an evidence base for wider use of techniques involving hypnosis in cancer care. Altering patients' perception of pain, disease-related stress, and anxiety can help change the reality of their life with cancer.

  16. 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 ...

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

    Directory of Open Access Journals (Sweden)

    Kun-Siang Huang

    Full Text Available 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.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.Among the 174 patients, 84% had advanced stage (stage III or stage IV cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001 and those cared by other physicians (63% vs 41%, p = 0.004. Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, p<0.001, intubation (1% vs 27%, p<0.001, cardiopulmonary-cerebral resuscitation (0% vs 11%, p = 0.001, ventilator use (1% vs 27%, p<0.001, inotropic agent use (8% vs 46%, p<0.001, total or partial parenteral nutrition use (38% vs. 58%, p = 0.029, and blood transfusion (45% vs 74%, p<0.001. Besides, the hospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR orders (95% vs 37%, p<0.001, receiving home hospice care (16% vs 1%, p<0.001, and indicating home as the realistically preferred place of death (41% vs 19%, p = 0.001. The hospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014.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.

  18. Cancer Care Coordinators to Improve Tamoxifen Persistence in Breast Cancer: How Heterogeneity in Baseline Prognosis Impacts on Cost-Effectiveness.

    Science.gov (United States)

    Nair, Nisha; Kvizhinadze, Giorgi; Blakely, Tony

    2016-12-01

    To assess the cost-effectiveness of a cancer care coordinator (CCC) in helping women with estrogen receptor positive (ER+) early breast cancer persist with tamoxifen for 5 years. We investigated the cost-effectiveness of a CCC across eight breast cancer subtypes, defined by progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, and local/regional spread. These subtypes range from excellent to poorer prognoses. The CCC helped in improving tamoxifen persistence by providing information, checking-in by phone, and "troubleshooting" concerns. We constructed a Markov macrosimulation model to estimate health gain (in quality-adjusted life-years or QALYs) and health system costs in New Zealand, compared with no CCC. Participants were modeled until death or till the age of 110 years. Some input parameters (e.g., the impact of a CCC on tamoxifen persistence) had sparse evidence. Therefore, we used estimates with generous uncertainty and conducted sensitivity analyses. The cost-effectiveness of a CCC for regional ER+/PR-/HER2+ breast cancer (worst prognosis) was NZ $23,400 (US $15,800) per QALY gained, compared with NZ $368,500 (US $248,800) for local ER+/PR+/HER2- breast cancer (best prognosis). Using a cost-effectiveness threshold of NZ $45,000 (US $30,400) per QALY, a CCC would be cost-effective only in the four subtypes with the worst prognoses. There is value in investigating cost-effectiveness by different subtypes within a disease. In this example of breast cancer, the poorer the prognosis, the greater the health gains from a CCC and the better the cost-effectiveness. Incorporating heterogeneity in a cost-utility analysis is important and can inform resource allocation decisions. It is also feasible to undertake in practice. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  19. Benchmarking comprehensive cancer care

    NARCIS (Netherlands)

    Wind, Anke

    2017-01-01

    The number of cancer patients and survivors is steadily increasing and despite or perhaps because of rapid improvements in diagnostics and therapeutics, important inequalities in cancer survival exist within and between different countries in Europe. Improving the quality of care is part of the

  20. Effective communication about the use of complementary and integrative medicine in cancer care.

    Science.gov (United States)

    Frenkel, Moshe; Cohen, Lorenzo

    2014-01-01

    Complementary and integrative medicine (CIM) is becoming an increasingly popular and visible component of oncology care. Many patients affected by cancer and their family members are looking for informed advice and desire communication with their physicians about CIM use. Patients affected by cancer come to discuss CIM use with intense emotions and are experiencing an existential crisis that cannot be ignored. Effective communication is crucial in establishing trust with these patients and their families. Communication is now recognized as a core clinical skill in medicine, including cancer care, and is important to the delivery of high-quality care. The quality of communication affects patient satisfaction, decision-making, patient distress and well-being, compliance, and even malpractice litigation. The communication process about CIM use requires a very sensitive approach that depends on effective communication skills, such as experience in listening, encouraging hope, and ability to convey empathy and compassion. This process can be divided into two parts: the "how" and the "what". The "how" relates to the change in clinician attitude, the process of gathering information, addressing patients' unmet needs and emotions, and dealing with uncertainty. The "what" relates to the process of information exchange while assisting patients in decisions about CIM use by using reliable information sources, leading to informed decision-making.

  1. Integrating Acupuncture into Cancer Care

    Directory of Open Access Journals (Sweden)

    Tsai-Ju Chien

    2013-10-01

    Full Text Available Oncology acupuncture has become a new and promising field of research because more and more cancer patients have sought non-pharmacological alternatives for symptom management. While different mechanisms have been proposed to explain its efficacy, including theories of the neural system, endocrine cytokine or immunological regulation, its eventual role has become that of alleviating the side effects induced by chemotherapy or radiotherapy. In this paper, we have reviewed the related articles focusing on acupuncture mechanisms and applications in cancer care to provide a quick sketch of acupuncture in cancer care. A detailed search was performed to identify the randomized controlled trials (RCTs and systematic reviews on acupuncture in oncology, using PUBMED and Cochrane. The search terms included: Acupuncture, acupressure, and cancer. Additional terms were used to target specific symptoms (i.e., breast cancer, hot flash, xerostomia, nausea, vomiting, cancer pain, insomnia, fatigue. Two authors independently extracted data for analysis and review. Ultimately, 25 articles underwent full-text review. Recent trials made efforts in studying (a hot flashes in breast cancer, (b xerostomia induced by radiotherapy in head and neck cancer, (c nausea and vomiting post-chemotherapy, (d cancer pain, and (e fatigue and insomnia in cancer patients. Controversial results for acupuncture application in cancer care appeared in different categories, but a trend emerged that acupuncture can palliate cancer-related symptoms. The research to date certainly offers us a valid complementary therapy in treating cancer-related symptoms. Meanwhile, practical strategies with safe measures for enhancing the efficacy are needed in further interventions, as well as continuing research with a validated methodology.

  2. [Cancer nursing care education programs: the effectiveness of different teaching methods].

    Science.gov (United States)

    Cheng, Yun-Ju; Kao, Yu-Hsiu

    2012-10-01

    In-service education affects the quality of cancer care directly. Using classroom teaching to deliver in-service education is often ineffective due to participants' large workload and shift requirements. This study evaluated the learning effectiveness of different teaching methods in the dimensions of knowledge, attitude, and learning satisfaction. This study used a quasi-experimental study design. Participants were cancer ward nurses working at one medical center in northern Taiwan. Participants were divided into an experimental group and control group. The experimental group took an e-learning course and the control group took a standard classroom course using the same basic course material. Researchers evaluated the learning efficacy of each group using a questionnaire based on the quality of cancer nursing care learning effectiveness scale. All participants answered the questionnaire once before and once after completing the course. (1) Post-test "knowledge" scores for both groups were significantly higher than pre-test scores for both groups. Post-test "attitude" scores were significantly higher for the control group, while the experimental group reported no significant change. (2) after a covariance analysis of the pre-test scores for both groups, the post-test score for the experimental group was significantly lower than the control group in the knowledge dimension. Post-test scores did not differ significantly from pre-test scores for either group in the attitude dimension. (3) Post-test satisfaction scores between the two groups did not differ significantly with regard to teaching methods. The e-learning method, however, was demonstrated as more flexible than the classroom teaching method. Study results demonstrate the importance of employing a variety of teaching methods to instruct clinical nursing staff. We suggest that both classroom teaching and e-learning instruction methods be used to enhance the quality of cancer nursing care education programs. We

  3. Ovarian cancer survivors' acceptance of treatment side effects evolves as goals of care change over the cancer continuum.

    Science.gov (United States)

    Frey, Melissa K; Ellis, Annie E; Koontz, Laura M; Shyne, Savannah; Klingenberg, Bernhard; Fields, Jessica C; Chern, Jing-Yi; Blank, Stephanie V

    2017-08-01

    Women with ovarian cancer can have long overall survival and goals of treatment change over time from cure to remission to stable disease. We sought to determine whether survivors' acceptance of treatment side effects also changes over the disease continuum. Women with ovarian cancer completed an online survey focusing on survivors' goals and priorities. The survey was distributed through survivor networks and social media. Four hundred and thirty-four women visited the survey website and 328 (76%) completed the survey. Among participants, 141 (43%) identified themselves as having ever recurred, 119 (36%) were undergoing treatment at the time of survey completion and 86 (26%) had received four or more chemotherapy regimens. Respondents' goals of care were cure for 115 women (35%), remission for 156 (48%) and stable disease for 56 (17%). When asked what was most meaningful, 148 women (45%) reported overall survival, 135 (41%) reported quality of life and 40 (12%) reported progression-free survival. >50% of survivors were willing to tolerate the following symptoms for the goal of cure: fatigue (283, 86%), alopecia (281, 86%), diarrhea (232, 71%), constipation (227, 69%), neuropathy (218, 66%), arthralgia (210, 64%), sexual side effects (201, 61%), reflux symptoms (188, 57%), memory loss (180, 55%), nausea/vomiting (180, 55%), hospitalization for treatment side effects (179, 55%) and pain (169, 52%). The rates of tolerance for most symptoms decreased significantly as the goal of treatment changed from cure to remission to stable disease. Women with ovarian cancer willingly accept many treatment side effects when the goal of treatment is cure, however become less accepting when the goal is remission and even less so when the goal is stable disease. Physicians and survivors must carefully consider treatment toxicities and quality of life effects when selecting drugs for patients with incurable disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. CancerCare

    Science.gov (United States)

    ... E-News Blog En Español Facebook Twitter YouTube Instagram LinkedIn Get Support Through counseling, support groups, education ... HOPE (4673) info@cancercare.org Facebook Twitter YouTube Instagram LinkedIn © 2017 Cancer Care ® — All Rights Reserved Copyright ...

  5. Regional Multiteam Systems in Cancer Care Delivery

    Science.gov (United States)

    Monson, John R.T.; Rizvi, Irfan; Savastano, Ann; Green, James S.A.; Sevdalis, Nick

    2016-01-01

    Teamwork is essential for addressing many of the challenges that arise in the coordination and delivery of cancer care, especially for the problems that are presented by patients who cross geographic boundaries and enter and exit multiple health care systems at various times during their cancer care journeys. The problem of coordinating the care of patients with cancer is further complicated by the growing number of treatment options and modalities, incompatibilities among the vast variety of technology platforms that have recently been adopted by the health care industry, and competing and misaligned incentives for providers and systems. Here we examine the issue of regional care coordination in cancer through the prism of a real patient journey. This article will synthesize and elaborate on existing knowledge about coordination approaches for complex systems, in particular, in general and cancer care multidisciplinary teams; define elements of coordination derived from organizational psychology and human factors research that are applicable to team-based cancer care delivery; and suggest approaches for improving multidisciplinary team coordination in regional cancer care delivery and avenues for future research. The phenomenon of the mobile, multisystem patient represents a growing challenge in cancer care. Paradoxically, development of high-quality, high-volume centers of excellence and the ease of virtual communication and data sharing by using electronic medical records have introduced significant barriers to effective team-based cancer care. These challenges urgently require solutions. PMID:27650833

  6. Effects of the Affordable Care Act on Young Women With Gynecologic Cancers.

    Science.gov (United States)

    Smith, Anna Jo Bodurtha; Fader, Amanda N

    2018-06-01

    To evaluate the effects of the dependent coverage mandate of the 2010 Affordable Care Act (ACA) on insurance status, stage at diagnosis, and receipt of fertility-sparing treatment among young women with gynecologic cancer. We used a difference-in-differences design to assess insurance status, stage at diagnosis (stage I-II vs III-IV), and receipt of fertility-spearing treatment before and after the 2010 ACA among young women aged 21-26 years vs women aged 27-35 years. We used the National Cancer Database with the 2004-2009 surveys as the pre-ACA years and the 2011-2014 surveys as the post-ACA years. Women with uterine, cervical, ovarian, vulvar, or vaginal cancer were included. We analyzed outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level. A total of 1,912 gynecologic cancer cases pre-ACA and 2,059 post-ACA were identified for women aged 21-26 years vs 9,782 cases pre-ACA and 10,456 post-ACA for women aged 27-35 years. The ACA was associated with increased insurance (difference in differences 2.2%, 95% CI -4.0 to 0.1, P=.04) for young women aged 21-26 years vs women aged 27-35 years and with a significant improvement in early stage at cancer diagnosis (difference in differences 3.6%, 95% CI 0.4-6.9, P=.03) for women aged 21-26 years. Receipt of fertility-sparing treatment increased for women in both age groups post-ACA (P for trend=.004 for women aged 21-26 years and .001 for women aged 27-35 years); there was no significant difference in differences between age groups. Privately insured women were more likely to be diagnosed at an early stage and receive fertility-sparing treatment than publicly insured or uninsured women throughout the study period (P<.001). Under the ACA's dependent coverage mandate, young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.

  7. Survivorship and the chronic cancer patient: Patterns in treatment-related effects, follow-up care, and use of survivorship care plans.

    Science.gov (United States)

    Frick, Melissa A; Vachani, Carolyn C; Bach, Christina; Hampshire, Margaret K; Arnold-Korzeniowski, Karen; Metz, James M; Hill-Kayser, Christine E

    2017-11-01

    The survivorship needs of patients living with chronic cancer (CC) and their use of survivorship care plans (SCPs) have been overlooked and underappreciated. A convenience sample of 39,088 SCPs completed for cancer survivors with an Internet-based SCP tool was examined; it included 5847 CC survivors (15%; CC was defined as chronic leukemia and/or recurrent/metastatic cancer of another nature). Patient-reported treatment effects and follow-up care patterns were compared between CC survivors and survivors treated with curative intent (CI). Responses from a follow-up survey regarding SCP satisfaction and use were reviewed. CC survivors had greater odds of experiencing multiple treatment-related effects than survivors treated with CI; these effects included fatigue, cognitive changes, dyspnea, peripheral neuropathy, lymphedema, and erectile dysfunction. Nearly half of CC survivors were managed by an oncologist alone, and they were less likely than CI patients to be comanaged by a primary care provider and an oncologist. Fewer SCPs were generated by health care providers (HCPs) for CC survivors versus CI survivors. A smaller proportion of CC users versus CI users rated their experience and satisfaction with the SCP tool as very good or excellent, and CC users were less likely to share the HCP summary with their health care team. A substantial number of CC survivors, often considered incurable but treatable, seek survivorship support. Tools to facilitate participation, communication, and coordination of care are valuable for these patients, and future iterations of SCPs should be designed to address the particular circumstances of living with CC. Cancer 2017;123:4268-4276. © 2017 American Cancer Society. © 2017 American Cancer Society.

  8. Evaluation of the Effectiveness of Testicular Cancer and Testicular Self-Examination Training for Patient Care Personnel: Intervention Study

    Science.gov (United States)

    Akar, Serife Zehra; Bebis, Hatice

    2014-01-01

    Testicular cancer (TC) is the most common malignancy among men aged 15-35 years. Testicular self-examination (TSE) is an important tool for preventing late-stage TC diagnoses. This study aimed to assess health beliefs and knowledge related to TC and TSE and the effectiveness of TC and TSE training for patient care staff in a hospital. This was a…

  9. EEG-Based Analysis of the Emotional Effect of Music Therapy on Palliative Care Cancer Patients

    Science.gov (United States)

    Ramirez, Rafael; Planas, Josep; Escude, Nuria; Mercade, Jordi; Farriols, Cristina

    2018-01-01

    Music is known to have the power to induce strong emotions. The present study assessed, based on Electroencephalography (EEG) data, the emotional response of terminally ill cancer patients to a music therapy intervention in a randomized controlled trial. A sample of 40 participants from the palliative care unit in the Hospital del Mar in Barcelona was randomly assigned to two groups of 20. The first group [experimental group (EG)] participated in a session of music therapy (MT), and the second group [control group (CG)] was provided with company. Based on our previous work on EEG-based emotion detection, instantaneous emotional indicators in the form of a coordinate in the arousal-valence plane were extracted from the participants’ EEG data. The emotional indicators were analyzed in order to quantify (1) the overall emotional effect of MT on the patients compared to controls, and (2) the relative effect of the different MT techniques applied during each session. During each MT session, five conditions were considered: I (initial patient’s state before MT starts), C1 (passive listening), C2 (active listening), R (relaxation), and F (final patient’s state). EEG data analysis showed a significant increase in valence (p = 0.0004) and arousal (p = 0.003) between I and F in the EG. No significant changes were found in the CG. This results can be interpreted as a positive emotional effect of MT in advanced cancer patients. In addition, according to pre- and post-intervention questionnaire responses, participants in the EG also showed a significant decrease in tiredness, anxiety and breathing difficulties, as well as an increase in levels of well-being. No equivalent changes were observed in the CG. PMID:29551984

  10. EEG-Based Analysis of the Emotional Effect of Music Therapy on Palliative Care Cancer Patients

    Directory of Open Access Journals (Sweden)

    Rafael Ramirez

    2018-03-01

    Full Text Available Music is known to have the power to induce strong emotions. The present study assessed, based on Electroencephalography (EEG data, the emotional response of terminally ill cancer patients to a music therapy intervention in a randomized controlled trial. A sample of 40 participants from the palliative care unit in the Hospital del Mar in Barcelona was randomly assigned to two groups of 20. The first group [experimental group (EG] participated in a session of music therapy (MT, and the second group [control group (CG] was provided with company. Based on our previous work on EEG-based emotion detection, instantaneous emotional indicators in the form of a coordinate in the arousal-valence plane were extracted from the participants’ EEG data. The emotional indicators were analyzed in order to quantify (1 the overall emotional effect of MT on the patients compared to controls, and (2 the relative effect of the different MT techniques applied during each session. During each MT session, five conditions were considered: I (initial patient’s state before MT starts, C1 (passive listening, C2 (active listening, R (relaxation, and F (final patient’s state. EEG data analysis showed a significant increase in valence (p = 0.0004 and arousal (p = 0.003 between I and F in the EG. No significant changes were found in the CG. This results can be interpreted as a positive emotional effect of MT in advanced cancer patients. In addition, according to pre- and post-intervention questionnaire responses, participants in the EG also showed a significant decrease in tiredness, anxiety and breathing difficulties, as well as an increase in levels of well-being. No equivalent changes were observed in the CG.

  11. Characteristics of Oral Problems and Effects of Oral Care in Terminally Ill Patients With Cancer.

    Science.gov (United States)

    Nakajima, Nobuhisa

    2017-06-01

    Various distresses appear in the terminal stage of cancer. Oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care. The study subjects were consecutive terminally ill cancer patients admitted over the past 2 years. Patients were divided based on the status of oral food intake into good oral food intake group (≥30%) and poor oral food intake group. The following 3 items were retrospectively investigated: 1) The incidences of these oral problems, 2) Severity of dry mouth and complication with other oral problems, 3) Improvement of dry mouth using standard oral care by nursing staff and specialist oral care including dentists as needed. There were 115 and 158 patients in good and poor oral intake groups, respectively. 1) The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in poor oral intake group ( p oral intake groups, respectively ( p oral intake group ( p = 0.0002). 3) The rate of dry mouth improvement by oral care was 100% in Grade-1, 86% in Grade-2 and 81% in Grade-3. Oral problems occur in many of terminally ill cancer patients. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.

  12. Palliative Care in Cancer

    Science.gov (United States)

    ... care is usually provided by palliative care specialists, health care practitioners who have received special training and/or certification in palliative care. They provide holistic care to the patient and family or caregiver ...

  13. Scenarios cancer in primary care.

    NARCIS (Netherlands)

    Velden, L.F.J. van der; Schellevis, F.G.

    2011-01-01

    Introduction: Previous studies predicted an increase in both the incidence and prevalence of cancer in the Netherlands. Other studies showed that cancer patients use primary care more frequently than non-cancer patients. Finally, during the “chronic phase” of the disease, task substitution from

  14. Effect of nutritional support on terminally ill patients with cancer in a palliative care unit.

    Science.gov (United States)

    Amano, Koji; Morita, Tatsuya; Baba, Mika; Kawasaki, Muneyoshi; Nakajima, Shinichiro; Uemura, Minako; Kobayashi, Yuka; Hori, Moeko; Wakayama, Hiroshi

    2013-11-01

    The role of nutritional support on terminally ill patients with cancer in a palliative care unit has not been clarified. A total of 63 patients were retrospectively investigated; the patients receiving individualized nutritional support (intervention group [n = 22]) were compared to the others (control group [n = 41]). The intervention group received individualized nutritional support. There were no significant differences in the characteristics of patients between the groups. The prevalence of bedsores was significantly lower in the intervention group (14% vs 46%, P = .012). The prevalence of edema and the use of antibiotic therapies tended to be lower in the intervention group than in the control group (36% vs 54%, P = .19; 14% vs 27%, P = .34, respectively). Some terminally ill patients with cancer in a palliative care unit might benefit from nutritional support.

  15. Effects of melatonin on physical fatigue and other symptoms in patients with advanced cancer receiving palliative care

    DEFF Research Database (Denmark)

    Lund Rasmussen, Charlotte; Klee Olsen, Marc; Thit Johnsen, Anna

    2015-01-01

    BACKGROUND: Patients with advanced cancer often experience fatigue and other symptoms that negatively impact their quality of life. The current trial investigated the effect of melatonin on fatigue and other symptoms in patients with advanced cancer. METHODS: Patients who were aged ≥18 years, had...... the placebo and melatonin periods were found for physical fatigue, secondary outcomes, or explorative outcomes. CONCLUSIONS: In the current study, oral melatonin at a dose of 20 mg was not found to improve fatigue or other symptoms in patients with advanced cancer....... a histologically confirmed stage IV cancer (TNM Classification), and who reported feeling significantly tired were recruited from the palliative care unit at the study institution. The study was a double-blind, randomized, placebo-controlled crossover trial. Patients received 1 week of melatonin at a dose of 20 mg...

  16. Cancer Survivorship Care: Person Centered Care in a Multidisciplinary Shared Care Model

    Directory of Open Access Journals (Sweden)

    Jacqueline Loonen

    2018-01-01

    Full Text Available Survivors of childhood and adult-onset cancer are at lifelong risk for the development of late effects of treatment that can lead to serious morbidity and premature mortality. Regular long-term follow-up aiming for prevention, early detection and intervention of late effects can preserve or improve health. The heterogeneous and often serious character of late effects emphasizes the need for specialized cancer survivorship care clinics. Multidisciplinary cancer survivorship care requires a coordinated and well integrated health care environment for risk based screening and intervention. In addition survivors engagement and adherence to the recommendations are also important elements. We developed an innovative model for integrated care for cancer survivors, the “Personalized Cancer Survivorship Care Model”, that is being used in our clinic. This model comprises 1. Personalized follow-up care according to the principles of Person Centered Care, aiming to empower survivors and to support self management, and 2. Organization according to a multidisciplinary and risk based approach. The concept of person centered care is based on three components: initiating, integrating and safeguarding the partnership with the patient. This model has been developed as a universal model of care that will work for all cancer survivors in different health care systems. It could be used for studies to improve self efficacy and the cost-effectiveness of cancer survivorship care.

  17. Psychosocial cancer care

    African Journals Online (AJOL)

    family members to cancer is an increasing interest in education, ... all stages of the cancer journey and is passionate about enabling more professionals in South Africa to provide psychosocial cancer .... therapeutic support together with more.

  18. Radiotherapy in Cancer Care. Chapter 1

    International Nuclear Information System (INIS)

    Rosenblatt, E.; Zubizarreta, E.; Camacho, R.; Vikram, B.

    2017-01-01

    Cancer control, cancer care and cancer treatment are three different concepts, although the terms are often used interchangeably. Cancer control is the reduction in the incidence, morbidity and mortality of cancer, as well as the improvement in the quality of life of cancer patients and their families. As such, cancer control includes actions relating to prevention, early detection and screening, diagnosis, treatment and palliative care. Cancer care includes all actions and interventions aimed at supporting, assisting and treating cancer patients. Cancer care includes cancer treatment, but also other forms of support such as nutrition, symptom relief, speech therapy, physiotherapy, stoma care, nursing care, lymphoedema care and psychosocial care. Cancer treatment includes medical interventions aimed at the cure or palliation of a patient who has been diagnosed with cancer. As such, cancer treatment modalities include surgery, radiotherapy, systemic therapies such as chemotherapy, hormone therapy, immunotherapy, gene therapy and other investigational strategies.

  19. Overview on Patient Centricity in Cancer Care

    Directory of Open Access Journals (Sweden)

    Šarunas Narbutas

    2017-10-01

    Full Text Available Successful implementation of treatment in cancer care partially depends on how patients' perspectives are taken into account, as preferences of health care professionals and patients may differ. Objectives of this exploratory research were (I to identify patient preferences and values (PPVs in cancer care as indicated by patient organizations (POs, (II to determine how these PPVs are captured in cancer care guidelines and (III to review how guidelines take into account these PPVs. Based on a survey developed and completed by 19 POs, a literature review was conducted to analyse how patient perspectives are incorporated in oncology treatment guidelines. Based on survey results traditional health technology assessment value propositions of oncology care, such as extended life, treatment-free remission and pain reduction, were also highly rated by POs. However, the heterogeneity of cancer PPVs were clearly reflected in the survey results. PPVs in cancer care guidelines were mostly limited to those micro-level aspects that are strictly related to health care provision, such as side-effects and comorbidities. Patient experience, emotional support and convenience of care were relatively neglected fields in the reviewed guidelines. Patient engagement was rarely presented in the guideline development phase. POs believe that patients should be encouraged to take an active role in their own care due to the heterogeneity of cancer patients and PPVs. Even if patient-centricity is a leading paradigm in cancer policy, based on our research it is not yet standard practice to include patients or POs at all appropriate levels of decision-making processes that are related to their health and well-being. Patient engagement should be an integral part of cancer care decision-making. This complexity must be reflected throughout policy making, avoiding a population level “one-size-fits-all” solution.

  20. The effect of EUSOMA certification on quality of breast cancer care.

    Science.gov (United States)

    van Dam, P A; Tomatis, M; Marotti, L; Heil, J; Wilson, R; Rosselli Del Turco, M; Mayr, C; Costa, A; Danei, M; Denk, A; Emons, G; Friedrichs, K; Harbeck, N; Kiechle, M; Koheler, U; Kuemmel, S; Maass, N; Marth, C; Prové, A; Kimmig, R; Rageth, C; Regolo, L; Salehi, L; Sarlos, D; Singer, C; Sohn, C; Staelens, G; Tinterri, C; Ponti, A

    2015-10-01

    The European Society of Breast Cancer Specialists (EUSOMA) has fostered a voluntary certification process for breast units to establish minimum standards and ensure specialist multidisciplinary care. In the present study we assess the impact of EUSOMA certification for all breast units for which sufficient information was available before and after certification. For 22 EUSOMA certified breast units data of 30,444 patients could be extracted from the EUSOMA database on the evolution of QI's before and after certification. On the average of all units, the minimum standard of care was achieved for 12/13 QI's before and after EUSOMA certification (not met for DCIS receiving just one operation). There was a significant improvement of 5 QI's after certification. The proportion of patients with invasive cancer undergoing an axillary clearance containing >9 lymph nodes (91.5% vs 89.4%, p 0.003) and patients with invasive cancer having just 1 operation (83.1% vs 80.4%, p importance as complete adherence to guidelines is difficult to achieve. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. The cost-effectiveness of training US primary care physicians to conduct colorectal cancer screening in family medicine residency programs.

    Science.gov (United States)

    Edwardson, Nicholas; Bolin, Jane N; McClellan, David A; Nash, Philip P; Helduser, Janet W

    2016-04-01

    Demand for a wide array of colorectal cancer screening strategies continues to outpace supply. One strategy to reduce this deficit is to dramatically increase the number of primary care physicians who are trained and supportive of performing office-based colonoscopies or flexible sigmoidoscopies. This study evaluates the clinical and economic implications of training primary care physicians via family medicine residency programs to offer colorectal cancer screening services as an in-office procedure. Using previously established clinical and economic assumptions from existing literature and budget data from a local grant (2013), incremental cost-effectiveness ratios are calculated that incorporate the costs of a proposed national training program and subsequent improvements in patient compliance. Sensitivity analyses are also conducted. Baseline assumptions suggest that the intervention would produce 2394 newly trained residents who could perform 71,820 additional colonoscopies or 119,700 additional flexible sigmoidoscopies after ten years. Despite high costs associated with the national training program, incremental cost-effectiveness ratios remain well below standard willingness-to-pay thresholds under base case assumptions. Interestingly, the status quo hierarchy of preferred screening strategies is disrupted by the proposed intervention. A national overhaul of family medicine residency programs offering training for colorectal cancer screening yields satisfactory incremental cost-effectiveness ratios. However, the model places high expectations on primary care physicians to improve current compliance levels in the US. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Cannabis in cancer care.

    Science.gov (United States)

    Abrams, D I; Guzman, M

    2015-06-01

    Cannabis has been used in medicine for thousands of years prior to achieving its current illicit substance status. Cannabinoids, the active components of Cannabis sativa, mimic the effects of the endogenous cannabinoids (endocannabinoids), activating specific cannabinoid receptors, particularly CB1 found predominantly in the central nervous system and CB2 found predominantly in cells involved with immune function. Delta-9-tetrahydrocannabinol, the main bioactive cannabinoid in the plant, has been available as a prescription medication approved for treatment of cancer chemotherapy-induced nausea and vomiting and anorexia associated with the AIDS wasting syndrome. Cannabinoids may be of benefit in the treatment of cancer-related pain, possibly synergistic with opioid analgesics. Cannabinoids have been shown to be of benefit in the treatment of HIV-related peripheral neuropathy, suggesting that they may be worthy of study in patients with other neuropathic symptoms. Cannabinoids have a favorable drug safety profile, but their medical use is predominantly limited by their psychoactive effects and their limited bioavailability. © 2015 American Society for Clinical Pharmacology and Therapeutics.

  3. Spirituality in Cancer Care (PDQ)

    Science.gov (United States)

    ... Data Conducting Clinical Trials Statistical Tools and Data Terminology Resources NCI Data Catalog Cryo-EM NCI's Role ... help patients with spiritual needs during cancer care, medical staff will listen to the wishes of the ...

  4. 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...

  5. Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors.

    Science.gov (United States)

    Kale, Hrishikesh P; Carroll, Norman V

    2016-04-15

    Cancer-related financial burden has been linked to cancer survivors (CS) forgoing/delaying medical care, skipping follow-up visits, and discontinuing medications. To the authors' knowledge, little is known regarding the effect of financial burden on the health-related quality of life of CS. The authors analyzed 2011 Medical Expenditure Panel Survey data. Financial burden was present if one of the following problems was reported: borrowed money/declared bankruptcy, worried about paying large medical bills, unable to cover the cost of medical care visits, or other financial sacrifices. The following outcomes were evaluated: Physical Component Score (PCS) and Mental Component Score (MCS) of the 12-Item Short-Form Health Survey (SF-12), depressed mood, psychological distress, and worry related to cancer recurrence. The authors also assessed the effect of the number of financial problems on these outcomes. Of the 19.6 million CS analyzed, 28.7% reported financial burden. Among them, the average PCS (42.3 vs 44.9) and MCS (48.1 vs 52.1) were lower for those with financial burden versus those without. In adjusted analyses, CS with financial burden had significantly lower PCS (β = -2.45), and MCS (β = -3.05), had increased odds of depressed mood (odds ratio, 1.95), and were more likely to worry about cancer recurrence (odds ratio, 3.54). Survivors reporting ≥ 3 financial problems reported statistically significant and clinically meaningful differences (≥3 points) in the mean PCS and MCS compared with survivors without financial problems. Cancer-related financial burden was associated with lower health-related quality of life, increased risk of depressed mood, and a higher frequency of worrying about cancer recurrence among CS. © 2015 American Cancer Society.

  6. Diversity in cancer care

    DEFF Research Database (Denmark)

    Nyholm, Nanna; Halvorsen, Ida; Mygind, Anna

    2018-01-01

    BACKGROUND: The burden of breast cancer is a key challenge for women's health globally. Rehabilitation needs and strategies for living with long-term consequences of breast cancer and its treatment cannot be isolated from the social contexts of patients, including relationships with relatives...... and healthcare professionals. AIM: This study explores how healthcare professionals' categorisations engage with breast cancer patients' social identities in encounters about rehabilitation before hospital discharge. METHOD: We conducted a multiperspective case-based qualitative study at a Danish department...... for a greater focus on improving encounters between breast cancer patients and healthcare professionals to ensure that rehabilitation needs are accommodated for among diverse patient groups....

  7. Financial Toxicity among Patients with Bladder Cancer: Reasons for Delay in Care and Effect on Quality of Life.

    Science.gov (United States)

    Casilla-Lennon, Marianne M; Choi, Seul Ki; Deal, Allison M; Bensen, Jeannette T; Narang, Gopal; Filippou, Pauline; McCormick, Benjamin; Pruthi, Raj; Wallen, Eric; Tan, Hung-Jui; Woods, Michael; Nielsen, Matthew; Smith, Angela

    2018-05-01

    Costly surveillance and treatment of bladder cancer can lead to financial toxicity, a treatment related financial burden. Our objective was to define the prevalence of financial toxicity among patients with bladder cancer and identify delays in care and its effect on health related quality of life. We identified patients with bladder cancer in the University of North Carolina Health Registry/Cancer Survivorship Cohort. Financial toxicity was defined as agreement with having "to pay more for medical care than you can afford." Health related quality of life was measured using general and cancer specific validated questionnaires. Statistical analyses were performed using the Fisher exact test and the Student t-test. A total of 138 patients with bladder cancer were evaluated. Median age was 66.9 years, 75% of the patients were male and 89% were white. Of the participants 33 (24%) endorsed financial toxicity. Participants who were younger (p = 0.02), black (p = 0.01), reported less than a college degree (p = 0.01) and had noninvasive disease (p = 0.04) were more likely to report financial toxicity. On multivariable analysis only age was a significant predictor of financial toxicity. Patients who endorsed financial toxicity were more likely to report delaying care (39% vs 23%, p = 0.07) due to the inability to take time off work or afford general expenses. On general health related quality of life questionnaires patients with financial toxicity reported worse physical and mental health (p = 0.03 and life (p = 0.01), physical well-being (p = 0.01) and functional well-being (p = 0.05). Financial toxicity is a major concern among patients with bladder cancer. Younger patients were more likely to experience financial toxicity. Those who endorsed financial toxicity experienced delays in care and poorer health related quality of life, suggesting that treatment costs should have an important role in medical decision making. Copyright © 2018 American Urological Association

  8. Effectiveness of a primary care practice intervention for increasing colorectal cancer screening in Appalachian Kentucky.

    Science.gov (United States)

    Dignan, Mark; Shelton, Brent; Slone, Stacey A; Tolle, Cheri; Mohammad, Sohail; Schoenberg, Nancy; Pearce, Kevin; Van Meter, Emily; Ely, Gretchen

    2014-01-01

    This report describes findings from a randomized controlled trial of an intervention to increase colorectal cancer (CRC) screening in primary care practices in Appalachian Kentucky. Sixty-six primary care practices were randomized to early or delayed intervention groups. The intervention was provided at practices using academic detailing, a method of education where providers receive information on a specific topic through personal contact. Data were collected in cross-sectional surveys of medical records at baseline and six months post-intervention. A total of 3844 medical records were reviewed at baseline and 3751 at the six-month follow-up. At baselines, colonoscopy was recommended more frequently (43.4%) than any other screening modality, followed by fecal occult blood testing (18.0%), flexible sigmoidoscopy (0.4%), and double-contrast barium enema (0.3%). Rates of documented screening results were higher for all practices at the six-month follow-up for colonoscopy (31.8% vs 29.6%) and fecal occult blood testing (12.2% vs 11.2%). For early intervention practices that recommended screening, colonoscopy rates increased by 15.7% at six months compared to an increase of 2.4% in the delayed intervention practices (p=.01). Using academic detailing to reach rural primary care providers with a CRC screening intervention was associated with an increase in colonoscopy. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Palliative care content on cancer center websites.

    Science.gov (United States)

    Vater, Laura B; Rebesco, Gina; Schenker, Yael; Torke, Alexia M; Gramelspacher, Gregory

    2018-03-01

    Professional guidelines recommend that palliative care begin early in advanced cancer management, yet integration of palliative and cancer care remains suboptimal. Cancer centers may miss opportunities to provide palliative care information online. In this study, we described the palliative care content on cancer center websites. We conducted a systematic content analysis of 62 National Cancer Institute- (NCI) designated cancer center websites. We assessed the content of center homepages and analyzed search results using the terms palliative care, supportive care, and hospice. For palliative and supportive care webpages, we assessed services offered and language used to describe care. Two researchers analyzed all websites using a standardized coding manual. Kappa values ranged from 0.78 to 1. NCI-designated cancer center homepages presented information about cancer-directed therapy (61%) more frequently than palliative care (5%). Ten percent of cancer centers had no webpage with palliative care information for patients. Among centers with information for patients, the majority (96%) defined palliative or supportive care, but 30% did not discuss delivery of palliative care alongside curative treatment, and 14% did not mention provision of care early in the disease process. Cancer center homepages rarely mention palliative care services. While the majority of centers have webpages with palliative care content, they sometimes omit information about early use of care. Improving accessibility of palliative care information and increasing emphasis on early provision of services may improve integration of palliative and cancer care.

  10. Involving the patient: A prospective study on use, appreciation and effectiveness of an information system in head and neck cancer care

    NARCIS (Netherlands)

    J.L. van den Brink (Jaap); P.W. Moorman (Peter); M.F. de Boer (Maarten); J.F.A. Pruyn (Jean); C.D.A. Verwoerd (Carel); J.H. van Bemmel (Jan)

    2005-01-01

    textabstractObjective: To determine use, appreciation and effectiveness of an electronic health information support system in head and neck (H&N) cancer care. Design: A prospective evaluation study. The evaluated system has four different functions: (1) communication amongst health care providers

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

    Science.gov (United States)

    Effective communication in cancer care between the health care team, cancer patients, and their family is important. Learn about communication skills that support a patient-centered practice and how to talk with adults and children about their diagnosis, prognosis, and transition to end-of-life care in this expert-reviewed summary.

  12. Oral hygiene care of patients with oral cancer during postoperative irradiation. An alleviating effect on acute radiation mucositis

    International Nuclear Information System (INIS)

    Katsura, Kouji; Masuko, Noriko; Hayashi, Takafumi; Sugita, Tadashi; Sakai, Kunio; Tsuchida, Emiko; Matsumoto, Yasuo; Sasamoto, Ryuta

    2000-01-01

    To evaluate the effect of oral hygiene care of patients with oral cancer on alleviating acute radiation mucositis. Eighteen patients receiving postoperative radiotherapy for tongue and oral floor cancer were evaluated. Radiotherapy was given in 2 Gy per fraction, 5 times a week for a total dose of 50 Gy in most patients. Radiation field included the tongue and oral floor. During radiotherapy, 8 patients were treated by dento-maxillofacial radiologists with special concern on oral hygiene (oral hygiene group) and the remaining 10 patients were treated with routine dental care (standard medication group). Mucositis were evaluated using JCOG grade and EORTC/RTOG score by radiotherapists or dento-maxillofacial radiologists at 10 Gy intervals. Oral hygiene plans comprised motivation to maintain oral hygiene and establishing the habits of oral self care 4 times per day. Once a week, oral hygiene and oral cleaning of patients were checked by dento-maxillofacial radiologists. Oral self care included mechanical tooth brushing and a chemical mouthwash. No patients with grade 3 and score 4 mucositis were noted in the oral hygiene group. Severe mucositis occurred less frequently in the oral hygiene group than in the standard medication group. Interruption of radiotherapy due to severe mucositis did not occur in the oral hygiene group. On the other hand, interruption of radiotherapy occurred in four patients in the standard medication group, and in three it was due to severe oral pain. Our results suggested that our method of oral hygiene was more effective for alleviating acute radiation mucositis than other methods so far reported. In addition, our method is considered to be useful in preventing rampant dental caries and severe periodontitis due to the xerostomia induced by radiotherapy. (author)

  13. Oral hygiene care of patients with oral cancer during postoperative irradiation. An alleviating effect on acute radiation mucositis

    Energy Technology Data Exchange (ETDEWEB)

    Katsura, Kouji; Masuko, Noriko; Hayashi, Takafumi [Niigata Univ. (Japan). School of Dentistry; Sugita, Tadashi; Sakai, Kunio; Tsuchida, Emiko; Matsumoto, Yasuo; Sasamoto, Ryuta

    2000-09-01

    To evaluate the effect of oral hygiene care of patients with oral cancer on alleviating acute radiation mucositis. Eighteen patients receiving postoperative radiotherapy for tongue and oral floor cancer were evaluated. Radiotherapy was given in 2 Gy per fraction, 5 times a week for a total dose of 50 Gy in most patients. Radiation field included the tongue and oral floor. During radiotherapy, 8 patients were treated by dento-maxillofacial radiologists with special concern on oral hygiene (oral hygiene group) and the remaining 10 patients were treated with routine dental care (standard medication group). Mucositis were evaluated using JCOG grade and EORTC/RTOG score by radiotherapists or dento-maxillofacial radiologists at 10 Gy intervals. Oral hygiene plans comprised motivation to maintain oral hygiene and establishing the habits of oral self care 4 times per day. Once a week, oral hygiene and oral cleaning of patients were checked by dento-maxillofacial radiologists. Oral self care included mechanical tooth brushing and a chemical mouthwash. No patients with grade 3 and score 4 mucositis were noted in the oral hygiene group. Severe mucositis occurred less frequently in the oral hygiene group than in the standard medication group. Interruption of radiotherapy due to severe mucositis did not occur in the oral hygiene group. On the other hand, interruption of radiotherapy occurred in four patients in the standard medication group, and in three it was due to severe oral pain. Our results suggested that our method of oral hygiene was more effective for alleviating acute radiation mucositis than other methods so far reported. In addition, our method is considered to be useful in preventing rampant dental caries and severe periodontitis due to the xerostomia induced by radiotherapy. (author)

  14. The effect of preventive oral care on treatment outcomes of a cohort of oral cancer patients.

    Science.gov (United States)

    Morais, Marilia Oliveira; Elias, Marcela Ramos Abrahão; Leles, Cláudio Rodrigues; Dourado Pinezi, Juliana Castro; Mendonça, Elismauro Francisco

    2016-04-01

    The purpose of this study was to assess patient adherence to an oral preventive measures (OPM) protocol and its impact on cancer treatment outcomes. A retrospective cohort of oral cancer of 133 patients submitted to radiotherapy (RT) was selected, excluding those with metastasis. Patients were grouped according to their local tumor response after finishing RT (favorable or unfavorable) and adherence to an OPM (none, ≤6 months, and >6 months). OPM included education and counseling about adverse effects, elimination of infection foci, restorative procedures, fluoride therapy, oral rehydration, and maintenance and supervision of oral hygiene throughout treatment. Clinical and pathological characteristics were recorded, and patient outcomes (frequency of adverse effects, RT interruption, and overall survival) were analyzed. Patients with higher adherence to the OPM had greater occurrence of RT interruption as a consequence of symptoms (p = 0.01); however, these patients were more likely to complete the established RT protocol (p = 0.02). Overall survival (p = 0.01) was higher in the group with higher adherence. This study suggests that the implementation of oral preventive measures may contribute to improving the prognosis of squamous cell carcinoma (SCC) treatment by reducing the negative impact of oral complications.

  15. Supportive care for children with cancer

    NARCIS (Netherlands)

    van de Wetering, Marianne D.; Schouten-van Meeteren, Netteke Y. N.

    2011-01-01

    In developed countries the survival rate of children with cancer exceeds 75%. Optimal supportive care is necessary to deliver the burdensome treatment protocols. As the intensity of primary treatment has escalated, so have the side effects like myelosuppression and infection. Children who receive

  16. Disparity in cancer care: a Canadian perspective

    OpenAIRE

    Ahmed, S.; Shahid, R.K.

    2012-01-01

    Canada is facing cancer crisis. Cancer has become the leading cause of death in Canada. Despite recent advances in cancer management and research, growing disparities in cancer care have been noticed, especially in socio-economically disadvantaged groups and under-served communities. With the rising incidence of cancer and the increasing numbers of minorities and of social disparities in general, and without appropriate interventions, cancer care disparities will become only more pronounced. ...

  17. 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

  18. Effects of multidisciplinary team care on the survival of patients with different stages of non-small cell lung cancer: a national cohort study.

    Directory of Open Access Journals (Sweden)

    Chien-Chou Pan

    Full Text Available In Taiwan, cancer is the top cause of death, and the mortality rate of lung cancer is the highest of all cancers. Some studies have demonstrated that multidisciplinary team (MDT care can improve survival rates of non-small cell lung cancer (NSCLC patients. However, no study has discussed the effect of MDT care on different stages of NSCLC. The target population for this study consisted of patients with NSCLC newly diagnosed in the 2005-2010 Cancer Registry. The data was linked with the 2002-2011 National Health Insurance Research Database and the 2005-2011 Cause of Death Statistics Database. The multivariate Cox proportional hazards model was used to explore whether the involvement of MDT care had an effect on survival. This study applied the propensity score as a control variable to reduce selection bias between patients with and without involvement of MDT care. The adjusted hazard ratio (HR of death of MDT participants with stage III & IV NSCLC was significantly lower than that of MDT non-participants (adjusted HR = 0.87, 95% confidence interval = 0.84-0.90. This study revealed that MDT care are significantly associated with higher survival rate of patients with stage III and IV NSCLC, and thus MDT care should be used in the treatment of these patients.

  19. Breast cancer prevention across the cancer care continuum.

    Science.gov (United States)

    Klemp, Jennifer R

    2015-05-01

    To review the current state of breast cancer prevention from primary prevention through survivorship, highlight cross-cutting issues, and discuss strategies for clinical integration and future research. Published articles between 1985 and 2015 and original research. Cancer risk persists across the lifespan. Interprofessional strategies to reduce morbidity and mortality from cancer include primary, secondary, and tertiary prevention (survivorship). Prevention strategies across the cancer care continuum are cross-cutting and focus on measures to: prevent the onset of disease, identify and treat asymptomatic persons who have already developed risk factors or preclinical disease, and restore function, minimize the negative effects of disease, and prevent disease-related complications. Oncology nurses and advanced practice nurses are vital in the delivery of breast cancer prevention strategies. Published by Elsevier Inc.

  20. Home care to Older adult with cancer

    International Nuclear Information System (INIS)

    Villagra, J; Castro, C; Meneses, S.

    2004-01-01

    Objective: Home care of the elderly with cancer. After the development of a program of oncology home care and over a period of five years, we believe that the evaluation allows us to have our proposal and challenges in the continuity of the program. This evidence is based in our old advanced Uruguayan population, and consequently increase this cancer population, we should define which pointed toward our objective, in order to get the best quality life. After one year with a project based on general rules, the evidence threw an evaluation, that we should review the model of care with which we were working. We continue to Auto-care model Dorothea Orem. The main objective became q uality of life : Take care as the primary Older Adult; Specific care their cancer to become symptomatic secondary complications to the evolution of tumor biology; Secondary prevention of cause therapeutic effect; Family integration, without changing the pace of life that the elderly had before being with cancer. Nursing challenge: Maintain autonomy achieved in these 5 years. Deepen the social equilibrium that we are committed daily between patient and family.Do not miss the professionalism achieved today.Proposal for nursing: Consider a wide field of nursing and for this achievement is need knowledge of 2nd level of community work, knowledge Clinical knowledge in Oncology Nursing, autonomy in decision making. For older adults with cancer: No out of its middle. Maintain priority habits and customs. Do not let it lose their self-esteem with their own values. Caution changes must take care to better manage the evolution of their illness. Conclusion: Oncology nursing is a specialty. Without this formation will be ever more away the development of these programs in our environment, or fall in applying for only economic convenience, losing professionalism. Our population is increasing

  1. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2): a randomised trial to determine the effectiveness and cost-effectiveness of adding a complex intervention for major depressive disorder to usual care for cancer patients.

    Science.gov (United States)

    Walker, Jane; Cassidy, Jim; Sharpe, Michael

    2009-03-30

    Depression Care for People with Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. In a 'proof of concept' trial (Symptom Management Research Trials in Oncology-1) Depression Care for People with Cancer improved depression more than usual care alone. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2 Trial) will test its effectiveness and cost-effectiveness in a 'real world' setting. A two arm parallel group multi-centre randomised controlled trial. TRIAL PROCEDURES: 500 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of cancer (of various types); an estimated life expectancy of twelve months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is 'treatment response' measured at 24 week outcome data collection. 'Treatment response' will be defined as a reduction of 50% or more in the patient's baseline depression score, measured using the 20-item Symptom Checklist (SCL-20D). Secondary outcomes include remission of major depressive disorder, depression severity and patients' self-rated improvement of depression. Current controlled trials ISRCTN40568538 TRIAL HYPOTHESES: (1) Depression Care for People with Cancer as a supplement to usual care will be more effective than usual care alone in achieving a 50% reduction in baseline SCL-20D score at 24 weeks. (2) Depression Care for People with Cancer as a supplement to usual care will cost more than usual care alone but will be

  2. LGBT Populations' Barriers to Cancer Care.

    Science.gov (United States)

    Boehmer, Ulrike

    2018-02-01

    To describe lesbian, gay, bisexual, and transgender (LGBT) individuals' barriers to accessing and receiving quality cancer care. Published data on cancer care and studies of LGBT individuals. There is a clustering of barriers among LGBT individuals, which suggests multiple inequities exist in LGBT individuals' cancer care, although data on disparities along the cancer control continuum are not consistently available. Nurses can make a difference in LGBT individuals' cancer care by obtaining training on LGBT health and their cancer-related needs and by providing a welcoming and respectful relationship with LGBT patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Effects of back massage on chemotherapy-related fatigue and anxiety: supportive care and therapeutic touch in cancer nursing.

    Science.gov (United States)

    Karagozoglu, Serife; Kahve, Emine

    2013-11-01

    This quasi-experimental and cross-sectional study was carried out to determine the efficacy of back massage, a nursing intervention, on the process of acute fatigue developing due to chemotherapy and on the anxiety level emerging in cancer patients receiving chemotherapy during this process. The study was conducted on 40 patients. To collect the data, the Personal Information Form, the State Anxiety part of Spielberger State-Trait Anxiety Inventory and the Brief Fatigue Inventory were used. In our study, it was determined that mean anxiety scores decreased in the intervention group patients after chemotherapy. The level of fatigue in the intervention group decreased statistically significantly on the next day after chemotherapy (p=.020; effect size=0.84). At the same time, the mean anxiety scores of the patients in the intervention group decreased right after the massage provided during chemotherapy (p=.109; effect size=0.37) and after chemotherapy. In line with our study findings, it can be said that back massage given during chemotherapy affects anxiety and fatigue suffered during the chemotherapy process and that it significantly reduces state anxiety and acute fatigue. Therefore, the effective use of back massage in the process of chemotherapy by oncology nurses who have a key role in cancer treatment and care can make it more modulated. © 2013.

  4. Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care

    Science.gov (United States)

    Hui, David; Frisbee-Hume, Susan; Wilson, Annie; Dibaj, Seyedeh S.; Nguyen, Thuc; De La Cruz, Maxine; Walker, Paul; Zhukovsky, Donna S.; Delgado-Guay, Marvin; Vidal, Marieberta; Epner, Daniel; Reddy, Akhila; Tanco, Kimerson; Williams, Janet; Hall, Stacy; Liu, Diane; Hess, Kenneth; Amin, Sapna; Breitbart, William; Bruera, Eduardo

    2017-01-01

    IMPORTANCE The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. OBJECTIVE To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. DESIGN, SETTING, AND PARTICIPANTS Single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016. INTERVENTIONS Lorazepam (3 mg) intravenously (n = 47) or placebo (n = 43) in addition to haloperidol (2 mg) intravenously upon the onset of an agitation episode. MAIN OUTCOMES AND MEASURES The primary outcome was change in Richmond Agitation-Sedation Scale (RASS) score (range, −5 [unarousable] to 4 [very agitated or combative]) from baseline to 8 hours after treatment administration. Secondary end points were rescue neuroleptic use, delirium recall, comfort (perceived by caregivers and nurses), communication capacity, delirium severity, adverse effects, discharge outcomes, and overall survival. RESULTS Among 90 randomized patients (mean age, 62 years; women, 42 [47%]), 58 (64%) received the study medication and 52 (90%) completed the trial. Lorazepam + haloperidol resulted in a significantly greater reduction of RASS score at 8 hours (−4.1 points) than placebo + haloperidol (−2.3 points) (mean difference, −1.9 points [95% CI, −2.8 to −0.9]; P haloperidol group required less median rescue neuroleptics (2.0 mg) than the placebo + haloperidol group (4.0 mg) (median difference, −1.0 mg [95% CI, −2.0 to 0]; P = .009) and was perceived to be more comfortable by both blinded caregivers and nurses (caregivers: 84% for the lorazepam + haloperidol group vs 37% for the placebo + haloperidol group; mean difference, 47

  5. Mobile Technology Applications in Cancer Palliative Care.

    Science.gov (United States)

    Freire de Castro Silva, Sandro Luís; Gonçalves, Antônio Augusto; Cheng, Cezar; Fernandes Martins, Carlos Henrique

    2018-01-01

    Mobile devices frequently used in other specialties can find great utility in palliative care. For healthcare professionals, the use of mobile technology not only can bring additional resources to the care, but it can actually radically change the cancer remote care practices. The Brazilian National Cancer Institute (INCA) has developed the largest cancer home care program in Latin America, which currently benefits more than 500 patients. The purpose of this paper is to show the development of an ICT environment of mobile applications developed to support the palliative cancer care program at INCA.

  6. The effect of a supportive educational program based on COPE model on caring burden and quality of life in family caregivers of women with breast cancer.

    Science.gov (United States)

    Bahrami, Masoud; Farzi, Saba

    2014-03-01

    The family caregivers of the people with cancer such as breast cancer experience a decrease in their quality of life and an increase of their caring burden. In most of the cases, the researchers consider the quality of life and physical and psychological problems in patients with cancer and pay less attention to the family caregivers. To reduce the caring burden imposed to the caregivers and improve their quality of life, supportive strategies such as problem solving can be used. These interventions may have benefits for the caregivers although the research results are contradictory. The aim of this research was to determine the effect of a supportive educational program, based on COPE model, which focuses on creativity, optimism, planning, and expert information on individuals, on the caring burden and quality of life in the family caregivers of women with breast cancer. The present study is a clinical trial, which was conducted in Seyed-Al-Shohada Hospital of Isfahan University of Medical Sciences and a private center of chemotherapy in 2012. In this study, researchers investigated the effect of a supportive educational program based on COPE model on the caring burden and quality of life in the family caregivers of women with breast cancer. This supportive educational program included two hospital visits and two telephone sessions based on COPE model for 9 days. A total of 64 patients were selected based on the inclusion criteria and randomly assigned into two groups. Data were collected by use of Caregiver Quality of Life Index-Cancer (CQOL-C), World Health Organization Quality of Life - Bref(WHOQOL-Bref)_, and Zarit caring burden at the beginning of the intervention and a month after the intervention. The results showed that in the experimental group, the mean score of physical, mental, spiritual, environmental domains and overall quality of life in the family caregivers was significantly increased compared to the control group, but there was no change in the

  7. Palliative Care Specialist Consultation Is Associated With Supportive Care Quality in Advanced Cancer.

    Science.gov (United States)

    Walling, Anne M; Tisnado, Diana; Ettner, Susan L; Asch, Steven M; Dy, Sydney M; Pantoja, Philip; Lee, Martin; Ahluwalia, Sangeeta C; Schreibeis-Baum, Hannah; Malin, Jennifer L; Lorenz, Karl A

    2016-10-01

    Although recent randomized controlled trials support early palliative care for patients with advanced cancer, the specific processes of care associated with these findings and whether these improvements can be replicated in the broader health care system are uncertain. The aim of this study was to evaluate the occurrence of palliative care consultation and its association with specific processes of supportive care in a national cohort of Veterans using the Cancer Quality ASSIST (Assessing Symptoms Side Effects and Indicators of Supportive Treatment) measures. We abstracted data from 719 patients' medical records diagnosed with advanced lung, colorectal, or pancreatic cancer in 2008 over a period of three years or until death who received care in the Veterans Affairs Health System to evaluate the association of palliative care specialty consultation with the quality of supportive care overall and by domain using a multivariate regression model. All but 54 of 719 patients died within three years and 293 received at least one palliative care consult. Patients evaluated by a palliative care specialist at diagnosis scored seven percentage points higher overall (P specialist consultation is associated with better quality of supportive care in three advanced cancers, predominantly driven by improvements in information and care planning. This study supports the effectiveness of early palliative care consultation in three common advanced cancers within the Veterans Affairs Health System and provides a greater understanding of what care processes palliative care teams influence. Published by Elsevier Inc.

  8. Cost-Effectiveness Analysis of Systemic Therapies in Advanced Pancreatic Cancer in the Canadian Health Care System.

    Science.gov (United States)

    Coyle, Doug; Ko, Yoo-Joung; Coyle, Kathryn; Saluja, Ronak; Shah, Keya; Lien, Kelly; Lam, Henry; Chan, Kelvin K W

    2017-04-01

    To assess the cost-effectiveness of gemcitabine (G), G + 5-fluorouracil, G + capecitabine, G + cisplatin, G + oxaliplatin, G + erlotinib, G + nab-paclitaxel (GnP), and FOLFIRINOX in the treatment of advanced pancreatic cancer from a Canadian public health payer's perspective, using data from a recently published Bayesian network meta-analysis. Analysis was conducted through a three-state Markov model and used data on the progression of disease with treatment from the gemcitabine arms of randomized controlled trials combined with estimates from the network meta-analysis for the newer regimens. Estimates of health care costs were obtained from local providers, and utilities were derived from the literature. The model estimates the effect of treatment regimens on costs and quality-adjusted life-years (QALYs) discounted at 5% per annum. At a willingness-to-pay (WTP) threshold of greater than $30,666 per QALY, FOLFIRINOX would be the most optimal regimen. For a WTP threshold of $50,000 per QALY, the probability that FOLFIRINOX would be optimal was 57.8%. There was no price reduction for nab-paclitaxel when GnP was optimal. From a Canadian public health payer's perspective at the present time and drug prices, FOLFIRINOX is the optimal regimen on the basis of the cost-effectiveness criterion. GnP is not cost-effective regardless of the WTP threshold. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  9. 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.

  10. 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....

  11. Pilot Study: The Effectiveness of Complex Decongestive Therapy for Lymphedema in Palliative Care Patients with Advanced Cancer.

    LENUS (Irish Health Repository)

    Cobbe, Sinead

    2017-12-05

    Complex decongestive therapy (CDT) is a regimen of physical treatment for lymphedema. Its effectiveness is unknown in advanced cancer patients. This study evaluates effectiveness of CDT in this population.

  12. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: A multicenter case-control study with propensity score matching analysis.

    Science.gov (United States)

    Soutome, Sakiko; Yanamoto, Souichi; Funahara, Madoka; Hasegawa, Takumi; Komori, Takahide; Yamada, Shin-Ichi; Kurita, Hiroshi; Yamauchi, Chika; Shibuya, Yasuyuki; Kojima, Yuka; Nakahara, Hirokazu; Oho, Takahiko; Umeda, Masahiro

    2017-08-01

    The aim of this study was to investigate the effectiveness of oral care in prevention of postoperative pneumonia associated with esophageal cancer surgery.Postoperative pneumonia is a severe adverse event associated with esophageal cancer surgery. It is thought to be caused by aspiration of oropharyngeal fluid containing pathogens. However, the relationship between oral health status and postoperative pneumonia has not been well investigated.This study included 539 patients with esophageal cancer undergoing surgery at 1 of 7 university hospitals. While 306 patients received perioperative oral care, 233 did not. Various clinical factors as well as occurrence of postoperative pneumonia were retrospectively evaluated. Propensity-score matching was performed to minimize selection biases associated with comparison of retrospective data between the oral care and control groups. Factors related to postoperative pneumonia were analyzed by logistic regression analysis.Of the original 539 patients, 103 (19.1%) experienced postoperative pneumonia. The results of multivariate analysis of the 420 propensity score-matched patients revealed longer operation time, postoperative dysphagia, and lack of oral care intervention to be significantly correlated with postoperative pneumonia.The present findings demonstrate that perioperative oral care can reduce the risk of postoperative pneumonia in patients undergoing esophageal cancer surgery.

  13. Health reforms as examples of multilevel interventions in cancer care.

    Science.gov (United States)

    Flood, Ann B; Fennell, Mary L; Devers, Kelly J

    2012-05-01

    To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

  14. Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery.

    Science.gov (United States)

    Trosman, Julia R; Carlos, Ruth C; Simon, Melissa A; Madden, Debra L; Gradishar, William J; Benson, Al B; Rapkin, Bruce D; Weiss, Elisa S; Gareen, Ilana F; Wagner, Lynne I; Khan, Seema A; Bunce, Mikele M; Small, Art; Weldon, Christine B

    2016-11-01

    Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. We examined challenges faced by a patient with early-stage breast cancer that resulted from difficulties in understanding and managing task interdependence across clinical domains involved in this patient's care. We used team science supported by the project management discipline to discuss how various task interdependence aspects can be recognized, deliberately designed, and systematically managed to prevent care breakdowns. This case highlights how effective task interdependence management facilitated by project management methods could markedly improve the course of a patient's care. This work informs efforts of cancer centers and practices to redesign cancer care delivery through innovative, practical, and patient-centered approaches to management of task interdependence in cancer care. Future patient-reported outcomes research will help to determine optimal ways to engage patients, including those who are medically underserved, in managing task interdependence in their own care.

  15. 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.

  16. [Supportive care during chemotherapy for lung cancer in daily practice].

    Science.gov (United States)

    Müller, Veronika; Tamási, Lilla; Gálffy, Gabriella; Losonczy, György

    2012-09-01

    Active oncotherapy, combination chemotherapy of lung cancer is accompanied with many side effects which may impair patients' quality of life and compromise the effectiveness of chemotherapy. Most side effects of chemotherapy are preventable or treatable with optimal supportive care which enhances success in patient care and treatment. The aim of this review is to summarize the most important conditions that may be associated with combined chemotherapy of lung cancer from the practical point of view.

  17. Specialized palliative care in advanced cancer

    DEFF Research Database (Denmark)

    Holmenlund, Kristina; Sjogren, Per; Nordly, Mie

    2017-01-01

    Objective: Due to the multiple physical, psychological, existential, and social symptoms involved, patients with advanced cancer often have a reduced quality of life (QoL), which requires specialized palliative care (SPC) interventions. The primary objective of the present systematic review...... was to review the existing literature about SPC and its effect on QoL, on physical and psychological symptoms, and on survival in adult patients with advanced cancer. Method: We utilized a search strategy based on the PICO (problem/population, intervention, comparison, and outcome) framework and employed....... The evidence in this field of study in general is still nascent, but there is growing support for the utilization of SPC to improve the quality of life of adult patients with advanced cancer. The evidence that SPC reduces physical and psychological symptoms is moderate, while the evidence that it prolongs...

  18. Surveying the effect of a self-care education program on severity of nausea and emesis in colorectal cancer patients under chemotherapy

    Directory of Open Access Journals (Sweden)

    Karimi S

    2017-08-01

    Full Text Available Saba Karimi,1 Behnam Reza Makhsosi,2 Seyed Jalil Seyedi-Andi,3 Maryam Behzadi,4 Yasaman Moghofeh,5 Kourosh Mohammadinasrabadi,1 Alireza Abdi,1 Pegah Ahmadi1 1School of Nursing and Midwifery, 2Surgical Department, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, 3Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, 4Taleghani Hospital, 5Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Background and objective: Colorectal cancer is one of the main causes of mortality in both developed and developing countries, including Iran. One of the treatments available for colorectal cancer is chemotherapy, of which nausea and emesis are the side effects. Owing to problems in controlling the side effects, a combination of medicine and non-medicine interventions is usually used. Self-care is one of the non-medicine interventions in this regard. The present study was aimed at surveying the effect of a self-care education program on severity of nausea and emesis in colorectal cancer patients under chemotherapy.Methods: A semi-experimental study was carried out in Imam Reza Hospital of Kermanshah, Iran. The sample group comprised 52 patients with colorectal cancer under chemotherapy. Data gathering tools included a demographics questionnaire and Morrow Assessment of Nausea and Emesis. To control intensity of nausea and emesis, a package of self-care measures including muscular progressive relaxation, music, and education on nutrition was used. Afterward, the collected data were analyzed using statistical tests such as Shapiro–Wilk test (to check normal distribution of the data, Mann–Whitney U test, Wilcoxon test, and chi-square test with the help of SPSS 20.Results: The results showed a considerable decrease in intensity and frequency of nausea and emesis after the intervention. The p-value of Mann–Whitney U test results with regard to intensity of nausea in

  19. Adoption, Acceptability, and Effectiveness of a Mobile Health App for Personalized Prostate Cancer Survivorship Care: Protocol for a Realist Case Study of the Ned App.

    Science.gov (United States)

    Pham, Quynh; Cafazzo, Joseph A; Feifer, Andrew

    2017-10-12

    By 2030, prostate cancer will be the most commonly diagnosed cancer in North America. To mitigate this impending challenge, comprehensive support mechanisms for disease- and treatment-specific changes in health and well-being must be proactively designed and thoughtfully implemented for streamlined survivorship care. mHealth apps have been lauded as a promising complement to current outpatient treatment and monitoring strategies, but have not yet been widely used to support prostate cancer survivorship needs. A realist evaluation is needed to examine the impact of such apps on the prostate cancer survivorship experience. We seek to gain an understanding of how an mHealth app for prostate cancer survivorship care called Ned (No Evident Disease) is adopted and accepted by patients, caregivers, and clinicians. We also aim to determine the effect of Ned on health-related quality of life, satisfaction with cancer care, unmet needs, self-efficacy, and prostate cancer-related levels of anxiety. The Ned case study is a 12-month mixed-methods embedded single-case study with a nested within-group pre-post comparison of health outcomes. We will give 400 patients, 200 caregivers, and 10 clinicians access to Ned. Participants will be asked to complete study assessments at baseline, 2 months, 6 months, and 12 months. We will conduct 30 semistructured qualitative interviews with patients (n=20) and their caregivers (n=10) poststudy to gain insight into their experience with the app. We recruited our first survivor in October 2017 and anticipate completing this study by May 2019. This will, to our knowledge, be the first realist case study to evaluate an app for prostate cancer survivorship care. Prostate cancer survivors are set to increase in number and longevity, heightening the need for integrated survivorship solutions to provide them with optimal and durable outcomes. The knowledge gained from this study will comprehensively inform how and why Ned works, for whom, and in

  20. Area-level variations in cancer care and outcomes.

    Science.gov (United States)

    Keating, Nancy L; Landrum, Mary Beth; Lamont, Elizabeth B; Bozeman, Samuel R; McNeil, Barbara J

    2012-05-01

    : Substantial regional variations in health-care spending exist across the United States; yet, care and outcomes are not better in higher-spending areas. Most studies have focused on care in fee-for-service Medicare; whether spillover effects exist in settings without financial incentives for more care is unknown. : We studied care for cancer patients in fee-for-service Medicare and the Veterans Health Administration (VA) to understand whether processes and outcomes of care vary with area-level Medicare spending. : An observational study using logistic regression to assess care by area-level measures of Medicare spending. : Patients with lung, colorectal, or prostate cancers diagnosed during 2001-2004 in Surveillance, Epidemiology, and End Results (SEER) areas or the VA. The SEER cohort included fee-for-service Medicare patients aged older than 65 years. : Recommended and preference-sensitive cancer care and mortality. : In fee-for-service Medicare, higher-spending areas had higher rates of recommended care (curative surgery and adjuvant chemotherapy for early-stage non-small-cell lung cancer and chemotherapy for stage III colon cancer) and preference-sensitive care (chemotherapy for stage IV lung and colon cancer and primary treatment of local/regional prostate cancer) and had lower lung cancer mortality. In the VA, we observed minimal variation in care by area-level Medicare spending. : Our findings suggest that intensity of care for Medicare beneficiaries is not driving variations in VA care, despite some overlap in physician networks. Although the Dartmouth Atlas work has been of unprecedented importance in demonstrating variations in Medicare spending, new measures may be needed to better understand variations in other populations.

  1. 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.

  2. Cultural aspects of communication in cancer care.

    Science.gov (United States)

    Surbone, A

    2006-01-01

    Cancer is increasing in incidence and prevalence worldwide, and the WHO has recently included cancer and its treatments as a health priority in developed and developing countries. The cultural diversity of oncology patients is bound to increase, and cultural sensitivity and competence are now required of all oncology professionals. A culturally competent cancer care leads to improved therapeutic outcome and it may decrease disparities in medical care. Cultural competence in medicine is a complex multilayered accomplishment, requiring knowledge, skills and attitudes whose acquisition is needed for effective cross-cultural negotiation in the clinical setting. Effective cultural competence is based on knowledge of the notion of culture; on awareness of possible biases and prejudices related to stereotyping, racism, classism, sexism; on nurturing appreciation for differences in health care values; and on fostering the attitudes of humility, empathy, curiosity, respect, sensitivity and awareness. Cultural competence in healthcare relates to individual professionals, but also to organizations and systems. A culturally competent healthcare system must consider in their separateness and yet in there reciprocal influences social, racial and cultural factors. By providing a framework of reference to interpret the external world and relate to it, culture affects patients' perceptions of disease, disability and suffering; degrees and expressions of concern about them; their responses to treatments and their relationship to individual physicians and to the healthcare system. Culture also influences the interpretation of ethical norms and principles, and especially of individual autonomy, which can be perceived either as synonymous with freedom or with isolation depending on the cultural context. This, in turn, determines the variability of truth-telling attitudes and practices worldwide as well as the different roles of family in the information and decision-making process of

  3. Effects of being uninsured or underinsured and living in extremely poor neighborhoods on colon cancer care and survival in California: historical cohort analysis, 1996—2011

    Directory of Open Access Journals (Sweden)

    Gorey Kevin M

    2012-10-01

    Full Text Available Abstract Background We examined the mediating effects of health insurance on poverty-colon cancer care and survival relationships and the moderating effects of poverty on health insurance-colon cancer care and survival relationships among women and men in California. Methods We analyzed registry data for 3,291 women and 3,009 men diagnosed with colon cancer between 1996 and 2000 and followed until 2011 on lymph node investigation, stage at diagnosis, surgery, chemotherapy, wait times and survival. We obtained socioeconomic data for individual residences from the 2000 census to categorize the following neighborhoods: high poverty (30% or more poor, middle poverty (5-29% poor and low poverty (less than 5% poor. Primary health insurers were Medicaid, Medicare, private or none. Results Evidence of mediation was observed for women, but not for men. For women, the apparent effect of poverty disappeared in the presence of payer, and the effects of all forms of health insurance seemed strengthened. All were advantaged on 6-year survival compared to the uninsured: Medicaid (RR = 1.83, Medicare (RR = 1.92 and private (RR = 1.83. Evidence of moderation was also only observed for women. The effects of all forms of health insurance were stronger for women in low poverty neighborhoods: Medicaid (RR = 2.90, Medicare (RR = 2.91 and private (RR = 2.60. For men, only main effects of poverty and payers were observed, the advantaging effect of private insurance being largest. Across colon cancer care processes, Medicare seemed most instrumental for women, private payers for men. Conclusions Health insurance substantially mediates the quality of colon cancer care and poverty seems to make the effects of being uninsured or underinsured even worse, especially among women in the United States. These findings are consistent with the theory that more facilitative social and economic capital is available in more affluent neighborhoods, where women

  4. 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.

  5. Social Media Use in Cancer Care.

    Science.gov (United States)

    Watson, Joni

    2018-05-01

    To describe the increasing professional use of social media within oncology health care practice. Peer-reviewed and lay publications. Social media has changed the communication landscape over the last 15 years. An integral part of worldwide culture, oncology health care professionals can utilize social media to listen, learn, engage, and co-create to advance cancer care. Nurses must be aware of the professional uses for social media, how to use the media, and where to find evidence supporting health care social media efforts within cancer care. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. [The Effectiveness of Cooling Packaging Care in Relieving Chemotherapy-Induced Skin Toxicity Reactions in Cancer Patients Receiving Chemotherapy: A Systematic Review].

    Science.gov (United States)

    Hsu, Ya-Hui; Hung, Hsing-Wei; Chen, Shu-Ching

    2017-08-01

    Anti-cancer chemotherapy may cause skin-toxicity reactions. Different types of cooling packages affect chemotherapy-induced skin toxicity reactions differently. To evaluate the effects of cooling packing care on chemotherapy-induced skin toxicity reactions in cancer patients receiving chemotherapy. A systematic review approach was used. Searches were conducted in databases including Cochrane Library, Embase, MEDLINE, PubMed and Airiti Library using the keywords "chemotherapy cutaneous toxicity", "chemotherapy skin reaction", "chemotherapy skin toxicity", "frozen glove", "frozen sock", "cooling packaging care", "ice gloves", "ice socks", "usual care", "severity", "comfort", "satisfaction", "severity", and "comfort". The search focused on articles published before December 2016. Based on the inclusion and exclusion criteria, 5 articles involving relevant randomized controlled trials were extracted for review. Elasto-Gel ice gloves or ice socks that were chilled to -25°C- -30°C and used for 15 mins during initial chemotherapy, for one hour during chemotherapy infusion, and for 15 mins after chemotherapy were shown to improve the frequency and severity of chemotherapy-induced skin toxicity reactions. Several studies were limited by small sample sizes and different types of cooling packing programs, temperature, timing, and frequency. Thus, further research is recommended to verify the effects of cooling packing care. Cancer patients who were treated with docetaxel or PLD and who used ice gloves or ice socks that were chilled to -25°C- -30°C for 15 mins during initial chemotherapy, for one hour during chemotherapy infusion, and for 15 mins after chemotherapy improved significantly in terms of the frequency and severity of their chemotherapy-induced skin toxicity reactions. Local cooling packing care is a non-pharmacotherapy approach that is low cost and free of side effects. This review is intended to provide a reference for clinical care.

  7. Knowledge, attitudes, and practice behaviors (KAPb) of nurses and the effectiveness of a training program in psychosocial cancer care.

    Science.gov (United States)

    Mahendran, Rathi; Chua, Joanne; Peh, Chao Xu; Lim, Haikel A; Ang, Emily N K; Lim, Siew Eng; Kua, Ee Heok

    2014-08-01

    Psychosocial distress in oncology patients may significantly interfere with their health outcomes and quality of life. Nurses work closely with their patients and are in the best position to screen for distress and provide timely intervention. It is thus important for nurses working in oncology settings to be equipped and prepared to address distressing psychosocial issues. The present study aims to investigate the impact of a training program in psychosocial care on nurses' knowledge, attitudes, and clinical practice behaviors. A total of 180 nurses working in medical oncology and radiation oncology departments at the National University Cancer Institute Singapore underwent a training program in psychosocial care as part of their continuing nursing education curriculum. One hundred fifty four of these nurses completed a self-designed questionnaire on nurses' knowledge, attitudes, and practice behaviors (KAPb) at all four time points: baseline, post-training, and at 6 and 12 weeks post-training, respectively. The self-designed KAPb questionnaire proved adequate for this study. Positive gains on applied knowledge and practice behaviors were sustained over a 12-week period. There were no changes in theoretical knowledge. A decreasing trend in attitudes was noted, although this was specific to the participants' attitudes toward the importance of emotional concerns as compared to physical concerns in cancer treatment. Enrolled nurses seemed to have higher starting levels of theoretical knowledge than their registered counterparts were. There were no other differences on demographic variables in relation to the efficacy of the training program. The training program was successful in improving the applied knowledge and practice behaviors of nurses in providing psychosocial care for cancer patients. However, further refinement to the program, with particular attention to nurses' existing training and years of clinical nursing experience, would enhance staff empowerment

  8. Survivorship care needs among LGBT cancer survivors.

    Science.gov (United States)

    Seay, Julia; Mitteldorf, Darryl; Yankie, Alena; Pirl, William F; Kobetz, Erin; Schlumbrecht, Matthew

    2018-05-23

    To better understand survivorship care needs among LGBT cancer survivors. We administered an anonymous online survey. LGBT cancer survivors living in the United States. Participants were recruited via the National LGBT Cancer Project. The survey measured sociodemographic characteristics, social support, posttraumatic stress, and survivorship care needs. Approximately 72% of our 114 participants were cisgender male and 87% were white. Almost all participants reported at least some unmet survivorship care needs (73%), with over half of participants reporting unmet psychological and sexuality care needs. Participants who reported their oncologist was not LGBT-competent had greater unmet needs (t(82) = 2.5, p = 0.01) and greater posttraumatic stress (t(91) = 2.1, p = 0.035). LGBT cancer survivors have significant unmet survivorship care needs, and lack of oncologist LGBT-competence is associated with unmet needs. Implications for Psychosocial Providers: Our results suggest the need for LGBT competency training for providers.

  9. The effect of weekly specialist palliative care teleconsultations in patients with advanced cancer -a randomized clinical trial.

    NARCIS (Netherlands)

    Hoek, P.D.; Schers, H.J.; Bronkhorst, E.M.; Vissers, K.C.P.; Hasselaar, J.G.J.

    2017-01-01

    BACKGROUND: Teleconsultation seems to be a promising intervention for providing palliative care to home-dwelling patients; however, its effect on clinically relevant outcome measures remains largely unexplored. Therefore, the purpose of this study was to determine whether weekly teleconsultations

  10. Managing Cancer Care - Finding Health Care Services

    Science.gov (United States)

    ... my condition? Has it been rated by state, consumer, or other groups for its quality of care? ... be both rewarding and demanding. It can change relationships and require families to cope with all aspects ...

  11. Examining the Effects of Childhood Cancer on the Parental Subsystem: Implications for Parents and Health Care Professionals-Part 3.

    Science.gov (United States)

    Moules, Nancy J; Estefan, Andrew; McCaffrey, Graham; Tapp, Dianne M; Strother, Douglas

    2016-11-01

    This article is the third part of a hermeneutic research study examining the impact of childhood cancer experiences on the parental relationship. In Part 1, we offered an exploration of the phenomenon with background literature; a description of the research question, method, and design; and finally a discussion of relationships that survived, thrived, or demised, with an emphasis on the notions of difference and trading. In Part 2, we furthered the interpretations to look at the complexities of issues such as teams, roles, focus, protection, intimacy, grieving, putting relationships on hold, and reclaiming them. In this article, we discuss the advice that the participants offered us and how that advice might have implications for other parents in similar situations and health care professionals working with families experiencing childhood cancer. © The Author(s) 2016.

  12. The effects of multi-disciplinary psycho-social care on socio-economic problems in cancer patients: a cluster-randomized trial.

    Science.gov (United States)

    Singer, Susanne; Roick, Julia; Meixensberger, Jürgen; Schiefke, Franziska; Briest, Susanne; Dietz, Andreas; Papsdorf, Kirsten; Mössner, Joachim; Berg, Thomas; Stolzenburg, Jens-Uwe; Niederwieser, Dietger; Keller, Annette; Kersting, Anette; Danker, Helge

    2018-06-01

    We examined whether multi-disciplinary stepped psycho-social care decreases financial problems and improves return-to-work in cancer patients. In a university hospital, wards were randomly allocated to either stepped or standard care. Stepped care comprised screening for financial problems, consultation between doctor and patient, and the provision of social service. Outcomes were financial problems at the time of discharge and return-to-work in patients financial problems at baseline were less likely to have financial problems at discharge when they had received stepped care (odds ratio (OR) 0.2, 95% confidence interval (CI) 0.1, 0.7; p = 0.01). There was no evidence for an effect of stepped care on financial problems in patients without such problems at baseline (OR 1.1, CI 0.5, 2.6; p = 0.82). There were 399 patients Financial problems can be avoided more effectively with multi-disciplinary stepped psycho-social care than with standard care in patients who have such problems.

  13. 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.

  14. Documenting coordination of cancer care between primary care providers and oncology specialists in Canada.

    Science.gov (United States)

    Brouwers, Melissa C; Vukmirovic, Marija; Tomasone, Jennifer R; Grunfeld, Eva; Urquhart, Robin; O'Brien, Mary Ann; Walker, Melanie; Webster, Fiona; Fitch, Margaret

    2016-10-01

    establishing a motivated and skilled project or program team. The lack of evaluative data made it difficult to identify the most effective interventions or models of care. The CanIMPACT Casebook documents Canadian efforts to improve or support the coordination of cancer care by PCPs and oncology specialists as a means to improve patient outcomes and cancer system performance. Copyright© the College of Family Physicians of Canada.

  15. 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.

  16. Radiotherapy in Palliative Cancer Care: Development and Implementation

    International Nuclear Information System (INIS)

    2012-01-01

    It is estimated that in 2008 there were over 12 million new cancer diagnoses and 7 million cancer deaths worldwide. The World Health Organisation (WHO) predicts that cancer rates will increase from 10 million to 24 million in the next 50 years. More than half of cancer cases will be diagnosed in low income nations, where 80% or more of patients will have incurable disease at diagnosis. In situations where most patients are diagnosed with incurable disease or where curative treatment is logistically unavailable, as is the case in many low income countries, the allocation of limited health care resources should reflect a greater emphasis on palliative care. Ironically, access to palliative care is greater in health care systems with well developed infrastructures and facilities for prevention, early detection, and curative treatment of cancer. To provide comprehensive cancer care, a multidisciplinary approach is needed. This maximizes the available treatments and interventions, whilst ensuring a cost effective and ethically sound approach to the treatment of patients at each stage of the disease. Barriers to palliative care may result from its low prioritization in health care policy and education. The WHO expert committee on cancer pain and palliative care report of 1990 called for the integration of efforts directed at maintaining patient quality of life through all stages of cancer treatment. As a result supportive interventions aimed at improving quality of life are needed for patients undergoing both curative and palliative cancer treatment. The International Atomic Energy Agency is currently collaborating with the Open Society Institute to develop palliative care programmes in Eastern Europe, Africa and India, as well as supporting programmes in other regions of the world, through the International Palliative Care Initiative. OSI partners with the IAEA's Programme of Action for Cancer Therapy, the World Health Organization, the International Agency for Research

  17. [Phase II trial evaluating the effect of megestrol acetate-prednisolone combination in the treatment of anorexia during the palliative-care phase of lung cancer].

    Science.gov (United States)

    Jeanfaivre, T; Souday, V; Chaleil, D; Maillet, F; Tuchais, E

    2000-09-01

    Anorexia is one of the most frequent complaints in patients who have reached the palliative-care phase of lung cancer. Megestrol acetate (or medroxyprogesterone acetate) and corticosteroids have been used with success, but the effect of their combination remains unknown. We conducted a phase II trial to assess the impact of combination therapy. Patients with lung cancer given palliative care and who developed anorexia with or without weight loss were given 320 mg/d megestrol acetate in 2 doses and 40 mg/d prednisolone in one dose in the morning for 1 month. The principal outcome criterion was anorexia assessed on a visual analog scale prior to treatment and then at day 15 and day 30. Variation in daily calorie intake and weight were also recorded. We used an Armitage sequential plan to determine the number of inclusions necessary and the preference method (closed schema) to evaluate the principal outcome criterion. Inclusions were stopped after the eighth patient (giving panorexia in patients with lung cancer in the palliative-care phase and allowed a significant improvement in calorie intake and body weight.

  18. Caregiving and Its Resulting Effects-The Care Study to Evaluate the Effects of Caregiving on Caregivers of Patients with Advanced Cancer in Singapore.

    Science.gov (United States)

    Chua, Cheryl Kai Ting; Wu, Jun Tian; Wong, Yin Yee; Qu, Limin; Tan, Yung Ying; Neo, Patricia Soek Hui; Pang, Grace Suyin

    2016-11-15

    Informal caregivers (IC) are key to enabling home deaths, where preferred, at the end-of-life. Significant morbidity from advanced cancer can make caregiving burdensome. However, knowledge about the nature of the caregiving burden for caregivers in Singapore is limited. Hence, the key objective in this study was to examine the impact of the caregiving burden on quality of life (QOL), mental health and work capacity among local ICs. Eligible English-speaking ICs of hospitalized advanced cancer patients were recruited through non-random sampling. The Zarit Burden Interview (ZBI), Caregiver Quality of Life Index-Cancer (CQOLC), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), and Work Productivity and Activity Impairment Questionnaire (WPAI) were interviewer-administered to eligible ICs. Altogether, 16 ICs were surveyed. The mean age of ICs was 43.8 years. Most were children of patients (43.8%), and eight ICs had high burden (ZBI > 17). Those with ZBI > 17 had lower QOL, higher depression scores as well as greater work and activity impairment. In conclusion, high caregiver burden has adverse effects on QOL, mental health and work productivity. Non-physical elements of caregiving (particularly financial and decision-making) and increased number of care roles undertaken by a single IC contribute to high burden. Future interventions for caregiving burden in Singapore should also address the financial and decision-making aspects of caregiving. Outsourcing selected aspects of the caregiving role to community services may reduce the number of caregiving aspects undertaken by a single IC and caregiver burden.

  19. Improving Symptom Control, QOL, and Quality of Care for Women with Breast Cancer: Developing a Research Program on Neurological Effects via Doctoral Education

    Science.gov (United States)

    2006-06-01

    orQOL "I CAN’T tell where my feet are" <is> Root Footwear Issues <is> Root Emotional Rx:: Mood effects <is> Root Sx Description <is...time, holding a pen and “scrawling” handwriting , “loss of fine motor skills”, “loss of strength”, “dropping things • LEISURE: turning book pages...interventions on pain in adults with cancer. Oncology Nursing Forum, 31(2), 313-319. Devine, E., & Westlake, S. (1995). The effects of psychoeducational care

  20. Effect of comprehensive breast care on breast cancer outcomes: a community hospital based study from Mumbai, India.

    Science.gov (United States)

    Gadgil, Anita; Roy, Nobhojit; Sankaranarayanan, Rengaswamy; Muwonge, Richard; Sauvaget, Catherine

    2012-01-01

    Breast cancer is the second most common cancer in women in India and the disease burden is increasing annually. The lack of awareness initiatives, structured screening, and affordable treatment facilities continue to result in poor survival. We present a breast cancer survival scenario, in urban population in India, where standardised care is distributed equitably and free of charge through an employees' healthcare scheme. We studied 99 patients who were treated at our hospital during the period 2005 to 2010 and our follow-up rates were 95.95%. Patients received evidence-based standardised care in line with the tertiary cancer centre in Mumbai. One-, three- and five-year survival rates were calculated using Kaplan-Meier method. Socio-demographic, reproductive and tumor factors, relevant to survival, were analysed. Mortality hazard ratios (HR) were calculated using Cox proportional hazard method. Survival in this series was compared to that in registries across India and discrepancies were discussed. Patients mean age was 56 years, mean tumor size was 3.2 cms, 85% of the tumors belonged to T1 and T2 stages, and 45% of the patients belonged to the composite stages I and IIA. Overall 5-year survival was 74.9%. Patients who presented with large-sized tumors (HR 3.06; 95% CI 0.4-9.0), higher composite stage (HR 1.91; 0.55-6.58) and undergone mastectomy (HR 2.94; 0.63- 13.62) had a higher risk of mortality than women who had higher levels of education (HR 0.25; 0.05-1.16), although none of these results reached the significant statistical level. We observed 25% better survival compared to other Indian populations. Our results are comparable to those from the European Union and North America, owing to early presentation, equitable access to standardised free healthcare and complete follow-up ensured under the scheme. This emphasises that equitable and affordable delivery of standardised healthcare can translate into early presentation and better survival in India.

  1. The effects of alcoholism and smoking on advanced cancer patients admitted to an acute supportive/palliative care unit.

    Science.gov (United States)

    Mercadante, Sebastiano; Adile, Claudio; Ferrera, Patrizia; Casuccio, Alessandra

    2017-07-01

    The aim of this prospective study was to determine the characteristics and symptom burden of advanced cancer patients with alcoholism problems and smoking, who were referred to an acute palliative/supportive care unit (ASPCU) of a comprehensive cancer center. Patients' characteristics, indications for admission, kind of admission, awareness of prognosis, and anticancer treatments were recorded. The Edmonton Symptom Assessment Scale (ESAS) was used to assess physical and psychological symptoms, and the CAGE questionnaire for the diagnosis of alcoholism. Patients were also divided in three groups: persistent smokers (PS), former smokers (FS), and non-smokers (NS). The Memorial Delirium Assessment Scale (MDAS) was used to assess the cognitive status of patients. Analgesic drugs and their doses at admission and discharge were recorded, as well opioid escalation index during hospital stay. Three hundred fourteen consecutive cancer patients were surveyed. Forty-seven (14.9%), 143 (45.5%), and 124 (39.5%) subjects were PS-patients, FS-patients, and NS-patients, respectively. Sixteen patients were CAGE-positive. Females were more frequently NS, while males were more frequently FS (p = 0.0005). Statistical differences were also observed in disease awareness among the categories of smoking (p = 0.048). No statistical differences were found in ESAS items, except for drowsiness at T0 in NS-patients. Differences were found in OME and OEI, although the large variability of data did not determined a statistical difference. Higher values of nausea (at T0, p = 0.0005), dyspnea (at T0 and TX, p = 0.08 and 0.023, respectively), and well-being (at TX p = 0.003) were reported in CAGE-positive patients. No correlation was found between CAGE-positive patients and smokers. Although smoking and alcoholism have obvious implications in advanced cancer patients, data remain controversial, as present data did provide limited data to confirm risk factors for advanced cancer patients

  2. Coordination of cancer care between family physicians and cancer specialists: Importance of communication.

    Science.gov (United States)

    Easley, Julie; Miedema, Baukje; Carroll, June C; Manca, Donna P; O'Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva

    2016-10-01

    To explore health care provider (HCP) perspectives on the coordination of cancer care between FPs and cancer specialists. Qualitative study using semistructured telephone interviews. Canada. A total of 58 HCPs, comprising 21 FPs, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 GPs in oncology. This qualitative study is nested within a larger mixed-methods program of research, CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum), focused on improving the coordination of cancer care between FPs and cancer specialists. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care. Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location (urban or rural). A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review. Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles. Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still exist. This can lead to serious consequences that affect clinical decision making

  3. Cancer Patient Navigator Tasks across the Cancer Care Continuum

    Science.gov (United States)

    Braun, Kathryn L.; Kagawa-Singer, Marjorie; Holden, Alan E. C.; Burhansstipanov, Linda; Tran, Jacqueline H.; Seals, Brenda F.; Corbie-Smith, Giselle; Tsark, JoAnn U.; Harjo, Lisa; Foo, Mary Anne; Ramirez, Amelie G.

    2011-01-01

    Cancer patient navigation (PN) programs have been shown to increase access to and utilization of cancer care for poor and underserved individuals. Despite mounting evidence of its value, cancer patient navigation is not universally understood or provided. We describe five PN programs and the range of tasks their navigators provide across the cancer care continuum (education and outreach, screening, diagnosis and staging, treatment, survivorship, and end-of-life). Tasks are organized by their potential to make cancer services understandable, available, accessible, affordable, appropriate, and accountable. Although navigators perform similar tasks across the five programs, their specific approaches reflect differences in community culture, context, program setting, and funding. Task lists can inform the development of programs, job descriptions, training, and evaluation. They also may be useful in the move to certify navigators and establish mechanisms for reimbursement for navigation services. PMID:22423178

  4. Peers without fears? Barriers to effective communication among primary care physicians and oncologists about diagnostic delays in cancer.

    Science.gov (United States)

    Lipitz-Snyderman, Allison; Kale, Minal; Robbins, Laura; Pfister, David; Fortier, Elizabeth; Pocus, Valerie; Chimonas, Susan; Weingart, Saul N

    2017-11-01

    Relatively little attention has been devoted to the role of communication between physicians as a mechanism for individual and organisational learning about diagnostic delays. This study's objective was to elicit physicians' perceptions about and experiences with communication among physicians regarding diagnostic delays in cancer. Qualitative analysis based on seven focus groups. Fifty-one physicians affiliated with three New York-based academic medical centres participated, with six to nine subjects per group. We used content analysis to identify commonalities among primary care physicians and specialists (ie, medical and surgical oncologists). Perceptions and experiences with physician-to-physician communication about delays in cancer diagnosis. Our analysis identified five major themes: openness to communication, benefits of communication, fears about giving and receiving feedback, infrastructure barriers to communication and overcoming barriers to communication. Subjects valued communication about cancer diagnostic delays, but they had many concerns and fears about providing and receiving feedback in practice. Subjects expressed reluctance to communicate if there was insufficient information to attribute responsibility, if it would have no direct benefit or if it would jeopardise their existing relationships. They supported sensitive approaches to conveying information, as they feared eliciting or being subject to feelings of incompetence or shame. Subjects also cited organisational barriers. They offered suggestions that might facilitate communication about delays. Addressing the barriers to communication among physicians about diagnostic delays is needed to promote a culture of learning across specialties and institutions. Supporting open and honest discussions about diagnostic delays may help build safer health systems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use

  5. Practical multimodal care for cancer cachexia.

    Science.gov (United States)

    Maddocks, Matthew; Hopkinson, Jane; Conibear, John; Reeves, Annie; Shaw, Clare; Fearon, Ken C H

    2016-12-01

    Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory. Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments. We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.

  6. The hyperprolactinemic breast cancer in radiooncologic care

    International Nuclear Information System (INIS)

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

    1986-01-01

    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. (orig.) [de

  7. Oral care of the cancer patient receiving radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Holtzhausen, T [Medical Univ. of Southern Africa, Pretoria (South Africa). Dept. of Community Dentistry

    1982-07-01

    Radiation therapy is frequently being used for the patient with oral cancer. The survival rate is increasing, due to more effective treatment technique. The question of whether any teeth should be extracted, the mode of therapy and the side effects of radiation like Xerostomia, caries, stomatitis, trismus and osteo-radionecrosis and also post radiation care are discussed.

  8. Assessing Patient-Centered Communication in Cancer Care: Stakeholder Perspectives

    Science.gov (United States)

    Mazor, Kathleen M.; Gaglio, Bridget; Nekhlyudov, Larissa; Alexander, Gwen L.; Stark, Azadeh; Hornbrook, Mark C.; Walsh, Kathleen; Boggs, Jennifer; Lemay, Celeste A.; Firneno, Cassandra; Biggins, Colleen; Blosky, Mary Ann; Arora, Neeraj K.

    2013-01-01

    Purpose: Patient-centered communication is critical to quality cancer care. Effective communication can help patients and family members cope with cancer, make informed decisions, and effectively manage their care; suboptimal communication can contribute to care breakdowns and undermine clinician-patient relationships. The study purpose was to explore stakeholders' views on the feasibility and acceptability of collecting self-reported patient and family perceptions of communication experiences while receiving cancer care. The results were intended to inform the design, development, and implementation of a structured and generalizable patient-level reporting system. Methods: This was a formative, qualitative study that used semistructured interviews with cancer patients, family members, clinicians, and leaders of health care organizations. The constant comparative method was used to identify major themes in the interview transcripts. Results: A total of 106 stakeholders were interviewed. Thematic saturation was achieved. All stakeholders recognized the importance of communication and endorsed efforts to improve communication during cancer care. Patients, clinicians, and leaders expressed concerns about the potential consequences of reports of suboptimal communication experiences, such as damage to the clinician-patient relationship, and the need for effective improvement strategies. Patients and family members would report good communication experiences in order to encourage such practices. Practical and logistic issues were identified. Conclusion: Patient reports of their communication experiences during cancer care could increase understanding of the communication process, stimulate improvements, inform interventions, and provide a basis for evaluating changes in communication practices. This qualitative study provides a foundation for the design and pilot testing of such a patient reporting system. PMID:23943884

  9. Cost Effectiveness Analysis of Different Management Strategies between Best Supportive Care and Second-line Chemotherapy for Platinum-resistant or Refractory Ovarian Cancer.

    Science.gov (United States)

    Luealon, Phanida; Khempech, Nipon; Vasuratna, Apichai; Hanvoravongchai, Piya; Havanond, Piyalamporn

    2016-01-01

    There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All

  10. Site of childhood cancer care in the Netherlands.

    Science.gov (United States)

    Reedijk, A M J; van der Heiden-van der Loo, M; Visser, O; Karim-Kos, H E; Lieverst, J A; de Ridder-Sluiter, J G; Coebergh, J W W; Kremer, L C; Pieters, R

    2017-12-01

    Due to the complexity of diagnosis and treatment, care for children and young adolescents with cancer preferably occurs in specialised paediatric oncology centres with potentially better cure rates and minimal late effects. This study assessed where children with cancer in the Netherlands were treated since 2004. All patients aged under 18 diagnosed with cancer between 2004 and 2013 were selected from the Netherlands Cancer Registry (NCR) and linked with the Dutch Childhood Oncology Group (DCOG) database. Associations between patient and tumour characteristics and site of care were tested statistically with logistic regression analyses. This population-based study of 6021 children diagnosed with cancer showed that 82% of them were treated in a paediatric oncology centre. Ninety-four percent of the patients under 10 years of age, 85% of the patients aged 10-14 and 48% of the patients aged 15-17 were treated in a paediatric oncology centre. All International Classification of Childhood Cancers (ICCC), 3rd edition, ICCC-3 categories, except embryonal tumours, were associated with a higher risk of treatment outside a paediatric oncology centre compared to leukaemia. Multivariable analyses by ICCC-3 category revealed that specific tumour types such as chronic myelogenous leukaemia (CML), embryonal carcinomas, bone tumours other type than osteosarcoma, non-rhabdomyosarcomas, thyroid carcinomas, melanomas and skin carcinomas as well as lower-staged tumours were associated with treatment outside a paediatric oncology centre. The site of childhood cancer care in the Netherlands depends on the age of the cancer patient, type of tumour and stage at diagnosis. Collaboration between paediatric oncology centre(s), other academic units is needed to ensure most up-to-date paediatric cancer care for childhood cancer patients at the short and long term. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Timely and Effective Care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - national data. This data set includes national-level data for measures of heart attack care, heart failure care, pneumonia care,...

  12. Timely and Effective Care - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - state data. This data set includes state-level data for measures of heart attack care, heart failure care, pneumonia care,...

  13. Recommendations for Premature Ovarian Insufficiency Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Report From the International Late Effects of Childhood Cancer Guideline Harmonization Group in Collaboration With the PanCareSurFup Consortium

    Science.gov (United States)

    van Dorp, Wendy; Mulder, Renée L.; Kremer, Leontien C.M.; Hudson, Melissa M.; van den Heuvel-Eibrink, Marry M.; van den Berg, Marleen H.; Levine, Jennifer M.; van Dulmen-den Broeder, Eline; di Iorgi, Natascia; Albanese, Assunta; Armenian, Saro H.; Bhatia, Smita; Constine, Louis S.; Corrias, Andreas; Deans, Rebecca; Dirksen, Uta; Gracia, Clarisa R.; Hjorth, Lars; Kroon, Leah; Lambalk, Cornelis B.; Landier, Wendy; Levitt, Gill; Leiper, Alison; Meacham, Lillian; Mussa, Alesandro; Neggers, Sebastian J.; Oeffinger, Kevin C.; Revelli, Alberto; van Santen, Hanneke M.; Skinner, Roderick; Toogood, Andrew; Haupt, Riccardo

    2016-01-01

    Purpose Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were treated with alkylating agents and/or radiation, with potential exposure of the ovaries, have an increased risk of premature ovarian insufficiency (POI). Clinical practice guidelines can facilitate these survivors’ access to optimal treatment of late effects that may improve health and quality of survival; however, surveillance recommendations vary among the existing long-term follow-up guidelines, which impedes the implementation of screening. Patients and Methods The present guideline was developed by using an evidence-based approach and summarizes harmonized POI surveillance recommendations for female survivors of CAYA cancer who were diagnosed at age < 25 years. The recommendations were formulated by an international multidisciplinary panel and graded according to the strength of the evidence and the potential benefit gained from early detection and intervention. The harmonized POI surveillance recommendations were developed by using a transparent process and are intended to facilitate care for survivors of CAYA cancer. Results and Conclusion The harmonized set of POI surveillance recommendations is intended to be scientifically rigorous, to positively influence health outcomes, and to facilitate the care for female survivors of CAYA cancer. PMID:27458300

  14. Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care.

    Science.gov (United States)

    Berkowitz, Callie; Allen, Deborah H; Tenhover, Jennifer; Zullig, Leah L; Ragsdale, John; Fischer, Jonathan E; Pollak, Kathryn I; Koontz, Bridget F

    2017-07-14

    Long-term care for head and neck cancer (HNC) survivors is complex and requires coordination among multiple providers. Clinical practice guidelines highlight the role of primary care providers (PCPs) in screening for secondary cancer/recurrence, assessment of late/long-term side effects, and referrals for appropriate specialty management of toxicity. However, these responsibilities may be difficult to meet within the scope of primary care practice. We conducted this study to explore preferences, comfort, and knowledge of PCPs in the care of HNC survivors. We piloted a 40-item web-based survey developed with oncologist and PCP input targeted for family medicine and internal medicine providers. Responses were collected within a single university health system over 2 months. PCPs (n = 28; RR = 11.3%) were interested in learning about health promotion after cancer treatment (89%) and generally agree that their current practice patterns address healthy lifestyle behaviors (82%). However, only 32% of PCPs felt confident they could manage late/long-term side effects of chemotherapy, radiation, or surgery. Only 29% felt confident they could provide appropriate cancer screening. Looking at shared care responsibilities with oncology providers, PCPs perceived being responsible for 30% of care in the first year after treatment and 81% of care after 5 years. Seventy-one percent of PCPs agreed that oncologists provided them necessary information, yet 32% of PCPs found it difficult to coordinate with cancer providers. While these PCPs perceive increased care responsibility for long-term survivors, most are uncomfortable screening for recurrence and managing late/long-term side effects. Education and mutual coordination between PCPs and oncology providers may improve survivor care.

  15. Addition of docetaxel and/or zoledronic acid to standard of care for hormone-naive prostate cancer: a cost-effectiveness analysis.

    Science.gov (United States)

    Zhang, Pengfei; Wen, Feng; Fu, Ping; Yang, Yu; Li, Qiu

    2017-07-31

    The effectiveness of the addition of docetaxel and/or zoledronic acid to the standard of care (SOC) for hormone-naive prostate cancer has been evaluated in the STAMPEDE trial. The object of the present analysis was to evaluate the cost-effectiveness of these treatment options in the treatment of advanced hormone-naive prostate cancer in China. A cost-effectiveness analysis using a Markov model was carried out from the Chinese societal perspective. The efficacy data were obtained from the STAMPEDE trial and health utilities were derived from previous studies. Transition probabilities were calculated based on the survival in each group. The primary endpoint in the analysis was the incremental cost-effectiveness ratio (ICER), and model uncertainties were explored by 1-way sensitivity analysis and probabilistic sensitivity analysis. SOC alone generated an effectiveness of 2.65 quality-adjusted life years (QALYs) at a lifetime cost of $20,969.23. At a cost of $25,001.34, SOC plus zoledronic acid was associated with 2.69 QALYs, resulting in an ICER of $100,802.75/QALY compared with SOC alone. SOC plus docetaxel gained an effectiveness of 2.85 QALYs at a cost of $28,764.66, while the effectiveness and cost data in the SOC plus zoledronic acid/docetaxel group were 2.78 QALYs and $32,640.95. Based on the results of the analysis, SOC plus zoledronic acid, SOC plus docetaxel, and SOC plus zoledronic acid/docetaxel are unlikely to be cost-effective options in patients with advanced hormone-naive prostate cancer compared with SOC alone.

  16. 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

  17. Inequity in Cancer Care: A Global Perspective

    International Nuclear Information System (INIS)

    2011-01-01

    The strategies of United Nations system organizations such as the International Atomic Energy Agency (IAEA) and the World Health Organization (WHO) are based on guiding principles, the attainment of health equality being an important one. Therefore, their strategies focus on the needs of low and middle income countries and of vulnerable and marginalized populations. The IAEA is committed to gender equality. In keeping with the United Nations policies and agreements on both gender equality and gender mainstreaming, the IAEA has the responsibility of integrating gender equality into its programmes, as well as for contributing to worldwide gender equality. In addition, the IAEA strongly emphasizes the attainment of the United Nations Millennium Development Goals, of which gender equality is a central tenet. This publication focuses on the issue of inequality (disparity) as it applies to cancer care in general, and access to prevention, screening, palliative and treatment services in particular. The problem of inequality in access to radiation oncology services is addressed in detail. Access to cancer care and radiotherapy services for women and children is specifically considered, reflecting the currently published literature. The report is aimed at radiotherapy professionals, health programme managers and decision makers in the area of cancer control. It was developed to create awareness of the role of socioeconomic inequality in access to cancer care, and to eventually mobilize resources to be equitably allocated to public health programmes in general, and to cancer control and radiotherapy programmes in particular

  18. Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer.

    Science.gov (United States)

    Wiener, Lori; Weaver, Meaghann Shaw; Bell, Cynthia J; Sansom-Daly, Ursula M

    2015-01-09

    Medical providers are trained to investigate, diagnose, and treat cancer. Their primary goal is to maximize the chances of curing the patient, with less training provided on palliative care concepts and the unique developmental needs inherent in this population. Early, systematic integration of palliative care into standard oncology practice represents a valuable, imperative approach to improving the overall cancer experience for adolescents and young adults (AYAs). The importance of competent, confident, and compassionate providers for AYAs warrants the development of effective educational strategies for teaching AYA palliative care. Just as palliative care should be integrated early in the disease trajectory of AYA patients, palliative care training should be integrated early in professional development of trainees. As the AYA age spectrum represents sequential transitions through developmental stages, trainees experience changes in their learning needs during their progression through sequential phases of training. This article reviews unique epidemiologic, developmental, and psychosocial factors that make the provision of palliative care especially challenging in AYAs. A conceptual framework is provided for AYA palliative care education. Critical instructional strategies including experiential learning, group didactic opportunity, shared learning among care disciplines, bereaved family members as educators, and online learning are reviewed. Educational issues for provider training are addressed from the perspective of the trainer, trainee, and AYA. Goals and objectives for an AYA palliative care cancer rotation are presented. Guidance is also provided on ways to support an AYA's quality of life as end of life nears.

  19. Cardiopulmonary resuscitation in palliative care cancer patients.

    Science.gov (United States)

    Kjørstad, Odd Jarle; Haugen, Dagny Faksvåg

    2013-02-19

    The criteria for refraining from cardiopulmonary resuscitation in palliative care cancer patients are based on patients' right to refuse treatment and the duty of the treating personnel not to exacerbate their suffering and not to administer futile treatment. When is cardiopulmonary resuscitation futile in these patients? Systematic literature searches were conducted in PubMed for the period 1989-2010 on the results of in-hospital cardiopulmonary resuscitation in advanced cancer patients and on factors that affected the results of CPR when special mention was made of cancer. The searches yielded 333 hits and 18 included articles: four meta-analyses, eight retrospective clinical studies, and six review articles. Cancer patients had a poorer post-CPR survival than non-cancer patients. Survival declined with increasing extent of the cancer disease. Widespread and therapy-resistant cancer disease coupled with a performance status lower than WHO 2 or a PAM score (Pre-Arrest Morbidity Index) of above 8 was regarded as inconsistent with survival after cardiopulmonary resuscitation. Cardiopulmonary resuscitation is futile for in-hospital cancer patients with widespread incurable disease and poor performance status.

  20. Young adult cancer survivors' follow-up care expectations of oncologists and primary care physicians.

    Science.gov (United States)

    Hugh-Yeun, Kiara; Kumar, Divjot; Moghaddamjou, Ali; Ruan, Jenny Y; Cheung, Winson Y

    2017-06-01

    Young adult cancer survivors face unique challenges associated with their illness. While both oncologists and primary care physicians (PCPs) may be involved in the follow-up care of these cancer survivors, we hypothesized that there is a lack of clarity regarding each physician's roles and responsibilities. A self-administered survey was mailed to young adult cancer survivors in British Columbia, Canada, who were aged 20 to 39 years at the time of diagnosis and alive at 2 to 5 years following the diagnosis to capture their expectations of oncologists and PCPs in various important domains of cancer survivorship care. Multivariate logistic regression models that adjusted for confounders were constructed to examine for predictors of the different expectations. Of 722 young cancer survivors surveyed, 426 (59%) responded. Among them, the majority were White women with breast cancer. Oncologists were expected to follow the patient's most recent cancer and treatment-related side effects while PCPs were expected to manage ongoing and future cancer surveillance as well as general preventative care. Neither physician was perceived to be responsible for addressing the return to daily activities, reintegration to interpersonal relationships, or sexual function. Older survivors were significantly less likely to expect oncologists (p = 0.03) and PCPs (p = 0.01) to discuss family planning when compared to their younger counterparts. Those who were White were significantly more likely to expect PCPs to discuss comorbidities (p = 0.009) and preventative care (p = 0.001). Young adult cancer survivors have different expectations of oncologists and PCPs with respect to their follow-up care. Physicians need to better clarify their roles in order to further improve the survivorship phase of cancer care for young adults. Young adult cancer survivors have different expectations of their oncologists and PCPs. Clarification of the roles of each physician group during follow-up can

  1. Danish cancer patients’ perspective on health care

    DEFF Research Database (Denmark)

    Sandager, Mette; Sperling, Cecilie; Jensen, Henry

    2015-01-01

    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...... 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...... 2010. A total of 4,346 patients (64.7 %) returned a questionnaire and were finally included in the study. The results exposed patient experienced problems with regard to easier access to diagnostics, GP’s responsiveness to patients’ worries, better coordination between different healthcare units...

  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. The effect of pneumonia on short-term outcomes and cost of care after head and neck cancer surgery.

    Science.gov (United States)

    Semenov, Yevgeniy R; Starmer, Heather M; Gourin, Christine G

    2012-09-01

    The Centers for Medicare and Medicaid Services has threatened to discontinue reimbursements for ventilator-associated pneumonia (VAP) as a preventable "never event." We sought to determine the relationship between pneumonia and in-hospital mortality, complications, length of hospitalization and costs in head and neck cancer (HNCA) surgery. Retrospective cross-sectional study. Discharge data from the Nationwide Inpatient Sample for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm from 2003 to 2008 were analyzed using cross-tabulations and multivariate regression modeling. VAP was rarely coded. Infectious pneumonia was significantly associated with chronic pulmonary disease (odds ratio [OR], 1.5; P aspiration pneumonia was associated with dysphagia (OR, 2.0; P 80 years (OR, 2.0; P = .007), comorbidity (OR, 2.3; P aspiration pneumonia (OR, 5.3; P aspiration pneumonia were associated with postoperative medical and surgical complications, increased length of hospitalization, and hospital-related costs. Postoperative pneumonia is associated with increased mortality, complications, length of hospitalization, and hospital-related costs in HNCA surgical patients. Variables associated with an increased risk of pneumonia are inherent comorbidities in HNCA and known risk factors for VAP, making this a high-risk group for this never event. Caution must be used in the institution of reforms that threaten to inadequately reimburse the provision of care to this vulnerable population. Aggressive preoperative identification and treatment of underlying pulmonary disease, weight loss, and dysphagia may reduce morbidity and mortality. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  4. Faecal immunochemical tests to triage patients with lower abdominal symptoms for suspected colorectal cancer referrals in primary care: a systematic review and cost-effectiveness analysis.

    Science.gov (United States)

    Westwood, Marie; Corro Ramos, Isaac; Lang, Shona; Luyendijk, Marianne; Zaim, Remziye; Stirk, Lisa; Al, Maiwenn; Armstrong, Nigel; Kleijnen, Jos

    2017-05-01

    Colorectal cancer (CRC) is the third most common cancer in the UK. Presenting symptoms that can be associated with CRC usually have another explanation. Faecal immunochemical tests (FITs) detect blood that is not visible to the naked eye and may help to select patients who are likely to benefit from further investigation. To assess the effectiveness of FITs [OC-Sensor (Eiken Chemical Co./MAST Diagnostics, Tokyo, Japan), HM-JACKarc (Kyowa Medex/Alpha Laboratories Ltd, Tokyo, Japan), FOB Gold (Sentinel/Sysmex, Sentinel Diagnostics, Milan, Italy), RIDASCREEN Hb or RIDASCREEN Hb/Hp complex (R-Biopharm, Darmstadt, Germany)] for primary care triage of people with low-risk symptoms. Twenty-four resources were searched to March 2016. Review methods followed published guidelines. Summary estimates were calculated using a bivariate model or a random-effects logistic regression model. The cost-effectiveness analysis considered long-term costs and quality-adjusted life-years (QALYs) that were associated with different faecal occult blood tests and direct colonoscopy referral. Modelling comprised a diagnostic decision model, a Markov model for long-term costs and QALYs that were associated with CRC treatment and progression, and a Markov model for QALYs that were associated with no CRC. We included 10 studies. Using a single sample and 10 µg Hb/g faeces threshold, sensitivity estimates for OC-Sensor [92.1%, 95% confidence interval (CI) 86.9% to 95.3%] and HM-JACKarc (100%, 95% CI 71.5% to 100%) indicated that both may be useful to rule out CRC. Specificity estimates were 85.8% (95% CI 78.3% to 91.0%) and 76.6% (95% CI 72.6% to 80.3%). Triage using FITs could rule out CRC and avoid colonoscopy in approximately 75% of symptomatic patients. Data from our systematic review suggest that 22.5-93% of patients with a positive FIT and no CRC have other significant bowel pathologies. The results of the base-case analysis suggested minimal difference in QALYs between all of the

  5. Tumor boards and the quality of cancer care.

    Science.gov (United States)

    Keating, Nancy L; Landrum, Mary Beth; Lamont, Elizabeth B; Bozeman, Samuel R; Shulman, Lawrence N; McNeil, Barbara J

    2013-01-16

    Despite the widespread use of tumor boards, few data on their effects on cancer care exist. We assessed whether the presence of a tumor board, either general or cancer specific, was associated with recommended cancer care, outcomes, or use in the Veterans Affairs (VA) health system. We surveyed 138 VA medical centers about the presence of tumor boards and linked cancer registry and administrative data to assess receipt of stage-specific recommended care, survival, or use for patients with colorectal, lung, prostate, hematologic, and breast cancers diagnosed in the period from 2001 to 2004 and followed through 2005. We used multivariable logistic regression to assess associations of tumor boards with the measures, adjusting for patient sociodemographic and clinical characteristics. All statistical tests were two-sided. Most facilities (75%) had at least one tumor board, and many had several cancer-specific tumor boards. Presence of a tumor board was associated with only seven of 27 measures assessed (all P < .05), and several associations were not in expected directions. Rates of some recommended care (eg, white blood cell growth factors with cyclophosphamide, adriamycin, vincristine, and prednisone in diffuse large B-cell lymphoma) were lower in centers with hematologic-specialized tumor boards (39.4%) than in centers with general tumor boards (61.3%) or no tumor boards (56.4%; P = .002). Only one of 27 measures was statistically significantly associated with tumor boards after applying a Bonferroni correction for multiple comparisons. We observed little association of multidisciplinary tumor boards with measures of use, quality, or survival. This may reflect no effect or an effect that varies by structural and functional components and participants' expertise.

  6. SCORE: Shared care of Colorectal cancer survivors: protocol for a randomised controlled trial

    OpenAIRE

    Jefford, Michael; Emery, Jon; Grunfeld, Eva; Martin, Andrew; Rodger, Paula; Murray, Alexandra M.; De Abreu Lourenco, Richard; Heriot, Alexander; Phipps-Nelson, Jo; Guccione, Lisa; King, Dorothy; Lisy, Karolina; Tebbutt, Niall; Burgess, Adele; Faragher, Ian

    2017-01-01

    Background Colorectal cancer (CRC) is the most common cancer affecting both men and women. Survivors of CRC often experience various physical and psychological effects arising from CRC and its treatment. These effects may last for many years and adversely affect QoL, and they may not be adequately addressed by standard specialist-based follow-up. Optimal management of these effects should harness the expertise of both primary care and specialist care. Shared models of care (involving both the...

  7. 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

    2018-03-01

    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. © 2017 John Wiley & Sons Ltd.

  8. The financial burden of cancer: Estimates from patients undergoing cancer care in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Zaidi Adnan A

    2012-10-01

    Full Text Available Abstract Introduction The emotional burden associated with the diagnosis of cancer is sometimes overshadowed by financial burden sustained by patient and the family. This is especially relevant for a developing country as there is limited state support for cancer treatment. We conducted this study to estimate the cost of cancer care for two major types of cancer and to assess the perception of patients and families regarding the burden of the cost for undergoing cancer treatment at a private tertiary care hospital. Methods This cross-sectional study was conducted at day care and radiotherapy unit of Aga Khan University, Hospital (AKUH Karachi, Pakistan. All adult patients with breast and head & neck cancers diagnosed for 3 months or more were included. Data was collected using a structured questionnaire and analysed using SPSS. Results Sixty seven patients were interviewed during the study period. The mean and median monthly income of these patients was 996.4 USD and 562.5 USD respectively. Comparatively the mean and median monthly cost of cancer care was 1093.13 USD and 946.42 USD respectively. The cost of the treatment either fully or partially was borne by the family in most cases (94%. The financial burden of cancer was perceived as significant by 28 (42% patients and unmanageable by 18 (27% patients. This perceived level of burden was associated significantly with average monthly income (p = Conclusion Our study indicates that the financial burden of cancer care is substantial and can be overwhelming. There is a desperate need for treatment support programs either by the government or other welfare organisations to support individuals and families who are already facing a difficult and challenging situation.

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

    OpenAIRE

    Tracy L Truant; Lynda G Balneaves; Margaret I Fitch

    2015-01-01

    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 CA...

  10. Cancer survivorship: history, quality-of-life issues, and the evolving multidisciplinary approach to implementation of cancer survivorship care plans.

    Science.gov (United States)

    Morgan, Mary Ann

    2009-07-01

    To discuss the history of cancer survivorship, related quality-of-life issues, and cancer survivorship care plans (CSCPs). CINAHL, PubMed, published articles, and Web sites. A cancer survivor is an individual who has been diagnosed with cancer, regardless of when that diagnosis was received, who is still living. Cancer survivorship is complex and involves many aspects of care. Major areas of concern for survivors are recurrence, secondary malignancies, and long-term treatment sequelae that affect quality of life. Four essential components of survivorship care are prevention, surveillance, intervention, and coordination. A CSCP should address the survivor's long-term care, such as type of cancer, treatments received, potential side effects, and recommendations for follow-up. It should include preventive practices, how to maintain health and well-being, information on legal protections regarding employment and health insurance, and psychosocial services in the community. Survivorship care for patients with cancer requires a multidisciplinary effort and team approach. Enhanced knowledge of long-term complications of survivorship is needed for healthcare providers. Further research on evidence-based practice for cancer survivorship care also is necessary. Nurses can review CSCPs with patients, instruct them when to seek treatment, promote recommended surveillance protocols, and encourage behaviors that lead to cancer prevention and promote well-being for cancer survivors.

  11. Deploying Team Science Principles to Optimize Interdisciplinary Lung Cancer Care Delivery: Avoiding the Long and Winding Road to Optimal Care.

    Science.gov (United States)

    Osarogiagbon, Raymond U; Rodriguez, Hector P; Hicks, Danielle; Signore, Raymond S; Roark, Kristi; Kedia, Satish K; Ward, Kenneth D; Lathan, Christopher; Santarella, Scott; Gould, Michael K; Krasna, Mark J

    2016-11-01

    The complexity of lung cancer care mandates interaction between clinicians with different skill sets and practice cultures in the routine delivery of care. Using team science principles and a case-based approach, we exemplify the need for the development of real care teams for patients with lung cancer to foster coordination among the multiple specialists and staff engaged in routine care delivery. Achieving coordinated lung cancer care is a high-priority public health challenge because of the volume of patients, lethality of disease, and well-described disparities in quality and outcomes of care. Coordinating mechanisms need to be cultivated among different types of specialist physicians and care teams, with differing technical expertise and practice cultures, who have traditionally functioned more as coactively working groups than as real teams. Coordinating mechanisms, including shared mental models, high-quality communication, mutual trust, and mutual performance monitoring, highlight the challenge of achieving well-coordinated care and illustrate how team science principles can be used to improve quality and outcomes of lung cancer care. To develop the evidence base to support coordinated lung cancer care, research comparing the effectiveness of a diverse range of multidisciplinary care team approaches and interorganizational coordinating mechanisms should be promoted.

  12. Palliative Care Use Among Patients With Solid Cancer Tumors: A National Cancer Data Base Study.

    Science.gov (United States)

    Osagiede, Osayande; Colibaseanu, Dorin T; Spaulding, Aaron C; Frank, Ryan D; Merchea, Amit; Kelley, Scott R; Uitti, Ryan J; Ailawadhi, Sikander

    2018-01-01

    Palliative care has been increasingly recognized as an important part of cancer care but remains underutilized in patients with solid cancers. There is a current gap in knowledge regarding why palliative care is underutilized nationwide. To identify the factors associated with palliative care use among deceased patients with solid cancer tumors. Using the 2016 National Cancer Data Base, we identified deceased patients (2004-2013) with breast, colon, lung, melanoma, and prostate cancer. Data were described as percentages. Associations between palliative care use and patient, facility, and geographic characteristics were evaluated through multivariate logistic regression. A total of 1 840 111 patients were analyzed; 9.6% received palliative care. Palliative care use was higher in the following patient groups: survival >24 months (17% vs 2%), male (54% vs 46%), higher Charlson-Deyo comorbidity score (16% vs 8%), treatment at designated cancer programs (74% vs 71%), lung cancer (76% vs 28%), higher grade cancer (53% vs 24%), and stage IV cancer (59% vs 13%). Patients who lived in communities with a greater percentage of high school degrees had higher odds of receiving palliative care; Central and Pacific regions of the United States had lower odds of palliative care use than the East Coast. Patients with colon, melanoma, or prostate cancer had lower odds of palliative care than patients with breast cancer, whereas those with lung cancer had higher odds. Palliative care use in solid cancer tumors is variable, with a preference for patients with lung cancer, younger age, known insurance status, and higher educational level.

  13. Improving Symptom Control, QOL, and Quality of Care for Women with Breast Cancer: Developing a Research Program on Neurological Effects via Doctoral Education

    Science.gov (United States)

    2005-05-01

    not complicated by significant neuro-toxicity. European Journal of Cancer 2002;38(387-391. 285. Van Manen Max: Researching Lived Experience: Human...thoracotomy. Journal of Thoracic & Cardiovascular Surgery 1998; 115(4):841-847. 27. Benner Patricia: Interpretive Phenomenology : Embodiment, Caring, and... Phenomenology . Thousand Oaks, CA: Sage, 1995, pp 129-138. 90. Dixon Jane K: Factor Analysis, in Munro B (ed): Statistical methods for health care

  14. Financial Toxicity of Cancer Care: It's Time to Intervene.

    Science.gov (United States)

    Zafar, S Yousuf

    2016-05-01

    Evidence suggests that a considerably large proportion of cancer patients are affected by treatment-related financial harm. As medical debt grows for some with cancer, the downstream effects can be catastrophic, with a recent study suggesting a link between extreme financial distress and worse mortality. At least three factors might explain the relationship between extreme financial distress and greater risk of mortality: 1) overall poorer well-being, 2) impaired health-related quality of life, and 3) sub-par quality of care. While research has described the financial harm associated with cancer treatment, little has been done to effectively intervene on the problem. Long-term solutions must focus on policy changes to reduce unsustainable drug prices and promote innovative insurance models. In the mean time, patients continue to struggle with high out-of-pocket costs. For more immediate solutions, we should look to the oncologist and patient. Oncologists should focus on the value of care delivered, encourage patient engagement on the topic of costs, and be better educated on financial resources available to patients. For their part, patients need improved cost-related health literacy so they are aware of potential costs and resources, and research should focus on how patients define high-value care. With a growing list of financial side effects induced by cancer treatment, the time has come to intervene on the "financial toxicity" of cancer care. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  15. Caregiving and Its Resulting Effects—The Care Study to Evaluate the Effects of Caregiving on Caregivers of Patients with Advanced Cancer in Singapore

    Directory of Open Access Journals (Sweden)

    Cheryl Kai Ting Chua

    2016-11-01

    Full Text Available Informal caregivers (IC are key to enabling home deaths, where preferred, at the end-of-life. Significant morbidity from advanced cancer can make caregiving burdensome. However, knowledge about the nature of the caregiving burden for caregivers in Singapore is limited. Hence, the key objective in this study was to examine the impact of the caregiving burden on quality of life (QOL, mental health and work capacity among local ICs. Eligible English-speaking ICs of hospitalized advanced cancer patients were recruited through non-random sampling. The Zarit Burden Interview (ZBI, Caregiver Quality of Life Index—Cancer (CQOLC, Center for Epidemiologic Studies Depression Scale—Revised (CESD-R, and Work Productivity and Activity Impairment Questionnaire (WPAI were interviewer-administered to eligible ICs. Altogether, 16 ICs were surveyed. The mean age of ICs was 43.8 years. Most were children of patients (43.8%, and eight ICs had high burden (ZBI > 17. Those with ZBI > 17 had lower QOL, higher depression scores as well as greater work and activity impairment. In conclusion, high caregiver burden has adverse effects on QOL, mental health and work productivity. Non-physical elements of caregiving (particularly financial and decision-making and increased number of care roles undertaken by a single IC contribute to high burden. Future interventions for caregiving burden in Singapore should also address the financial and decision-making aspects of caregiving. Outsourcing selected aspects of the caregiving role to community services may reduce the number of caregiving aspects undertaken by a single IC and caregiver burden.

  16. Monitoring the delivery of cancer care: Commission on Cancer and National Cancer Data Base.

    Science.gov (United States)

    Williams, Richelle T; Stewart, Andrew K; Winchester, David P

    2012-07-01

    The primary objective of the Commission on Cancer (CoC) is to ensure the delivery of comprehensive, high-quality care that improves survival while maintaining quality of life for patients with cancer. This article examines the initiatives of the CoC toward achieving this goal, utilizing data from the National Cancer Data Base (NCDB) to monitor treatment patterns and outcomes, to develop quality measures, and to benchmark hospital performance. The article also highlights how these initiatives align with the Institute of Medicine's recommendations for improving the quality of cancer care and briefly explores future projects of the CoC and NCDB. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery

    OpenAIRE

    Trosman, Julia R.; Carlos, Ruth C.; Simon, Melissa A.; Madden, Debra L.; Gradishar, William J.; Benson, Al B.; Rapkin, Bruce D.; Weiss, Elisa S.; Gareen, Ilana F.; Wagner, Lynne I.; Khan, Seema A.; Bunce, Mikele M.; Small, Art; Weldon, Christine B.

    2016-01-01

    Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. W...

  18. Individualized Integrative Cancer Care in Anthroposophic Medicine

    Science.gov (United States)

    Kienle, Gunver S.; Mussler, Milena; Fuchs, Dieter; Kiene, Helmut

    2016-01-01

    Background. Cancer patients widely seek integrative oncology which embraces a wide variety of treatments and system approaches. Objective. To investigate the concepts, therapeutic goals, procedures, and working conditions of integrative oncology doctors in the field of anthroposophic medicine. Methods. This qualitative study was based on in-depth interviews with 35 highly experienced doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Results. The doctors integrated conventional and holistic cancer concepts. Their treatments aimed at both tumor and symptom control and at strengthening the patient on different levels: living with the disease, overcoming the disease, enabling emotional and cognitive development, and addressing spiritual or transcendental issues according to the patient’s wishes and initiatives. Therapeutic procedures were conventional anticancer and symptom-relieving treatments, herbal and mineral remedies, mistletoe therapy, art therapies, massages and other external applications, nutrition and lifestyle advice, psychological support, and multiple forms of empowerment. The approach emphasised good patient-doctor relationships and sufficient time for patient encounters and decision-making. Individualization appeared in several dimensions and was interwoven with standards and mindlines. The doctors often worked in teams and cooperated with other cancer care–related specialists. Conclusion. Integrative cancer care pursues an individualized and patient-centered approach, encompassing conventional and multimodal complementary interventions, and addressing, along with physical and functional needs, the emotional and spiritual needs of patients. This seems to be important for tumor and symptom control, and addresses major challenges and important goals of modern cancer care. PMID:27151589

  19. Effects of irradiation for cervical cancer on subsequent breast cancer

    International Nuclear Information System (INIS)

    Harlan, L.C.M.

    1985-01-01

    Previous research suggests that cervical cancer patients have a lower risk of breast cancer than women in the general population. Possible explanations include opposing risk factors for cervical cancer and breast cancer, the effect of irradiation used to treat cervical cancer, or both. The purpose of this study was to explore the relationship between irradiation for cervical cancer and the subsequent development of breast cancer. There was no statistically significant relationship between radiation to the ovarian area and the risk of breast cancer in this study. However, the results were consistent with a 19% reduction in risk for women irradiated for cervical cancer when compared to nonirradiated women. In a dose-response analysis, there was a nonsignificant trend of decreased risk of breast cancer with increased radiation up to 1800 rad. There was no consistent pattern for higher doses. The trend, although nonsignificant, differed by age. Women <60 years of age at irradiation were generally at a lower risk of breast cancer than nonirradiated women. Women over 59 years were at an increased risk. There are some potentially important findings from this study which might influence medical care. These should be examined in the larger International Radiation Study

  20. 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.

  1. Ovarian cancer treatment in the Netherlands : the effect of care provider on the outcomes of treatment between 1996-2003

    NARCIS (Netherlands)

    Vernooij, F.

    2008-01-01

    Ovarian cancer has a very poor prognosis. Symptoms develop late in the disease and therefore it is usually diagnosed in an advanced stage. Attempts to detect the disease at an earlier stage have not been successful thus far. Therefore, optimal treatment seems to be the most efficient means at the

  2. 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

  3. Comparison of the effect of individual dietary counselling and of standard nutritional care on weight loss in patients with head and neck cancer undergoing radiotherapy

    NARCIS (Netherlands)

    Berg, van den M.G.A.; Rasmussen-Conrad, E.L.; Wei, K.H.; Lintz-Luidens, H.; Kaanders, J.H.A.M.; Merkx, M.A.W.

    2010-01-01

    Clinical research shows that nutritional intervention is necessary to prevent malnutrition in head and neck cancer patients undergoing radiotherapy. The objective of the present study was to assess the value of individually adjusted counselling by a dietitian compared to standard nutritional care

  4. Shared Care of Childhood Cancer Survivors: A Telemedicine Feasibility Study.

    Science.gov (United States)

    Costello, Aimee G; Nugent, Bethany D; Conover, Noelle; Moore, Amanda; Dempsey, Kathleen; Tersak, Jean M

    2017-12-01

    With an increasing number of childhood cancer survivors (CCSs), determining the best model of survivorship transition care is becoming a growing priority. Shared care between pediatric oncology and adult primary care is often necessary, making survivorship a time of transition, but effective standard models are lacking. We sought to provide a more integrated approach to transition using telemedicine. Recruited primary care provider/CCS dyads were instructed to log-in to a password-protected virtual meeting room using telemedicine equipment at the time or a regularly scheduled office visit. Dyads were joined by a pediatric survivorship clinic team member who conducted the telemedicine portion of the transition visit, which consisted of the review of an individualized treatment summary and care plan. Postquestionnaires were developed to evaluate key points such as fund of knowledge, satisfaction with the visit, and effectiveness of this electronic tool. There were 19 transition visits conducted, 13 of which used the telemedicine equipment as planned. Those that did not use the equipment were primarily unable to due to technical difficulties. Postquestionnaires were overall positive, confirming increased knowledge, comfort and abilities, and patient satisfaction in survivorship care. Negative comments were primarily related to equipment difficulties. A gap still remains in helping CCSs transition from oncology to primary care and this pilot study offered insights into how we might better bridge that gap through the use of telemedicine. Further research is needed to refine the transition process for CCSs, including evaluation and testing models for standard of care.

  5. 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....

  6. Can we overcome the effect of conflicts in rendering palliative care? An introduction to the Middle Eastern Cancer Consortium (MECC).

    Science.gov (United States)

    Silbermann, Michael; Khleif, Amal; Tuncer, Murat; Pitsillides, Barbara; Shad, Aziza; Oberman, Amitai; Elshami, Mohammad; Gultekin, Murat; Daher, Michel; Tarawneh, Mohammed; Harford, Joe

    2011-08-01

    The Middle East has been experiencing an ongoing political conflict for the past several decades. This situation has been characterized by hostility often leading to violence of all sources. At times, such a conflict led to the outbreak of a military war, which was followed by an enmity between religious, ethnic, cultural, and national populations. In such environmental situations, palliative care professionals often confront major challenges including bias, mistrust, and mutual suspicion between patients and their treating clinicians. In order to overcome such obstacles, while rendering palliative care services, all professionals involved need careful planning and execution of their treatment plans. The latter is however possible, and sometimes successful even across lines of conflict, thereby promoting understanding, mutual respect, and tolerance between the involved communities and individuals.

  7. Follow-up Medical Care After Cancer Treatment

    Science.gov (United States)

    ... Data Conducting Clinical Trials Statistical Tools and Data Terminology Resources NCI Data Catalog Cryo-EM NCI's Role ... Questions to Ask About Cancer Research Follow-Up Medical Care Once you’re done with cancer treatment, ...

  8. Effectiveness of the HuCare Quality Improvement Strategy on health-related quality of life in patients with cancer: study protocol of a stepped-wedge cluster randomised controlled trial (HuCare2 study).

    Science.gov (United States)

    Caminiti, Caterina; Iezzi, Elisa; Passalacqua, Rodolfo

    2017-10-06

    Our group previously demonstrated the feasibility of the HuCare Quality Improvement Strategy (HQIS), aimed at integrating into practice six psychosocial interventions recommended by international guidelines. This trial will assess whether the introduction of the strategy in oncology wards improves patient's health-related quality of life (HRQoL). Multicentre, incomplete stepped-wedge cluster randomised controlled trial, conducted in three clusters of five centres each, in three equally spaced time epochs. The study also includes an initial epoch when none of the centres are exposed to the intervention, and a final epoch when all centres will have implemented the strategy. The intervention is applied at a cluster level, and assessed at an individual level with cross-sectional model. A total of 720 patients who received a cancer diagnosis in the previous 2 months and about to start medical treatment will be enrolled. The primary aim is to evaluate the effectiveness of the HQIS versus standard care in terms of improvement of at least one of two domains (emotional and social functions) of HRQoL using the EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 items) questionnaire, at baseline and at 3 months. This outcome was chosen because patients with cancer generally exhibit low HRQoL, particularly at certain stages of care, and because it allows to assess the strategy's impact as perceived by patients themselves. The HQIS comprises three phases: (1) clinician training-to improve communication-relational skills and instruct on the project; (2) centre support-four on-site visits by experts of the project team, aimed to boost motivation, help with context analysis and identification of solutions; (3) implementation of Evidence-Based Medicine (EBM) recommendations at the centre. Ethics committee review approval has been obtained from the Ethics Committee of Parma. Results will be disseminated at conferences, and

  9. Implementing exercise in cancer care: study protocol to evaluate a community-based exercise program for people with cancer

    OpenAIRE

    Cormie, Prue; Lamb, Stephanie; Newton, Robert U.; Valentine, Lani; McKiernan, Sandy; Spry, Nigel; Joseph, David; Taaffe, Dennis R.; Doran, Christopher M.; Galv?o, Daniel A.

    2017-01-01

    Background Clinical research has established the efficacy of exercise in reducing treatment-related side-effects and increasing wellbeing in people with cancer. Major oncology organisations have identified the importance of incorporating exercise in comprehensive cancer care but information regarding effective approaches to translating evidence into practice is lacking. This paper describes the implementation of a community-based exercise program for people with cancer and the protocol for pr...

  10. Communication about Sexuality and Intimacy in Couples Affected by Lung Cancer and their Clinical Care Providers

    Science.gov (United States)

    Lindau, Stacy Tessler; Surawska, Hanna; Paice, Judith; Baron, Shirley R.

    2012-01-01

    OBJECTIVE Little is known about the effects of lung cancer on intimate and sexual relationships. This study explores health care provider, patient, and partner perspectives on: 1) the effects of lung cancer on physical and emotional intimacy, 2) the ways in which intimacy affects the experience of living with lung cancer, and 3) communication about intimacy and sexuality in the context of lung cancer. METHODS Qualitative, in-depth interviews with 8 cancer care providers and 13 married couples (ages 43–79) affected by lung cancer were conducted and audiotaped in the clinical setting. Interviews were transcribed, iteratively analyzed, and coded according to the above domains. Coding was performed independently by members of an interdisciplinary team; inter-rater reliability was assessed using the kappa statistic; and analyses were summarized by domain. RESULTS Most cancer care providers and couples affected by lung cancer believed intimacy and sexuality issues were salient, yet few reported discussing these. Couples described negative and positive effects of cancer on intimacy. Negative effects were driven by cancer or its treatment, including physical and psychological effects. Positive effects included an increase in non-coital physical closeness and appreciation of the spouse. Age was perceived as an important factor influencing the relationship between lung cancer and intimacy. CONCLUSIONS Emotional intimacy and sexuality are important concerns for couples affected by lung cancer. The findings suggest previously unrecognized positive effects of lung cancer on emotional and physical intimacy. Couples affected by lung cancer and providers believe these issues are relevant for lung cancer care. PMID:20540168

  11. PROGRAM OF PALLIATIVE CANCER CARE – OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Iva Slánská

    2013-01-01

    Full Text Available Introduction: Annually more than 27,000 persons die of cancer in the Czech Republic and the overall incidence of malignancies is still increasing. These data shows the need for affordable and good follow-up care especially for patients without any cancer treatment due to irreversible progression of tumor. Currently the outpatient palliative cancer care gets more into the forefront. Prerequisite for a well working outpatient palliative care is cooperation with general practitioners and home health care agencies. The purpose of the so called program of palliative cancer care is to guide a patient in palliative cancer care and to improve the cooperation among health care providers. Methods: During the period from January 2008 to October 2010 we evaluated in patient without any oncology treatment due to irreversible progression of tumor. Results: In palliative outpatient clinic we treated 446 patients, 119 of them received home care services with average length of 27.8 days. 77 patients died at home, 51 in health facilities and 41 in inpatient hospice care. Conclusion: We present pilot study focusing on outpatient palliative cancer care which shows the real benefit from early indication of palliative cancer care. This type of care allows patients to stay as long as possible at home among their close relatives.

  12. 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.

  13. 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.

    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

  14. 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, 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

  15. 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.

  16. Cancer Care and Control as a Human Right: Recognizing Global Oncology as an Academic Field.

    Science.gov (United States)

    Eniu, Alexandru E; Martei, Yehoda M; Trimble, Edward L; Shulman, Lawrence N

    2017-01-01

    The global burden of cancer incidence and mortality is on the rise. There are major differences in cancer fatality rates due to profound disparities in the burden and resource allocation for cancer care and control in developed compared with developing countries. The right to cancer care and control should be a human right accessible to all patients with cancer, regardless of geographic or economic region, to avoid unnecessary deaths and suffering from cancer. National cancer planning should include an integrated approach that incorporates a continuum of education, prevention, cancer diagnostics, treatment, survivorship, and palliative care. Global oncology as an academic field should offer the knowledge and skills needed to efficiently assess situations and work on solutions, in close partnership. We need medical oncologists, surgical oncologists, pediatric oncologists, gynecologic oncologists, radiologists, and pathologists trained to think about well-tailored resource-stratified solutions to cancer care in the developing world. Moreover, the multidisciplinary fundamental team approach needed to treat most neoplastic diseases requires coordinated investment in several areas. Current innovative approaches have relied on partnerships between academic institutions in developed countries and local governments and ministries of health in developing countries to provide the expertise needed to implement effective cancer control programs. Global oncology is a viable and necessary field that needs to be emphasized because of its critical role in proposing not only solutions in developing countries, but also solutions that can be applied to similar challenges of access to cancer care and control faced by underserved populations in developed countries.

  17. Role of Bhabhatron in rural cancer care

    International Nuclear Information System (INIS)

    Singh, Manjit

    2009-01-01

    Radiotherapy, using cobalt-60 is the most cost-effective and the most relevant method of cancer treatment in India. However, there is acute shortage of radiotherapy machines in the country, due the high cost of imported machines. As most of the radiotherapy machines in the country are located in urban areas, patients from rural areas have to travel a long distance and stay there to get treatment. BARC has developed Bhabhatron to meet the demand for affordable telecobalt machines. Compared to any imported unit, the indigenous machine is cheaper, superior in features and more suitable for rural use. Bhabhatrons are installed in many cancer hospitals in the country. (author)

  18. Spiritual issues and quality of life assessment in cancer care.

    Science.gov (United States)

    Efficace, Fabio; Marrone, Robert

    2002-11-01

    Being diagnosed with cancer forces most human beings to face their own death. The comfortable sense of both invulnerability and immortality is shattered, making the patient thoroughly aware that life is finite and limited. Approaching death, cancer patients commonly embark on an inner journey involving a search for meaning as well as a reordering of priorities involving physical, psychological, social, and spiritual needs. Although interest in the role of spirituality, relating to both adjustment to cancer and the overall quality of life of cancer patients, has increased in recent years, most of the commonly used quality of life (QOL) instruments in oncology typically do not include spiritual issues. In this article, it is argued that assessing QOL effectively should involve all aspects of the personality, including mind, body, and spirit as well. This article also reviews recent studies, which have shown that spiritual well-being, although a many-sided and difficult construct to define, is closely related to the QOL of cancer patients. It is also suggested that further research is needed to understand how the new focus on spirituality can contribute to a more comprehensive assessment of patient's QOL in cancer care.

  19. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... with Cancer Reports, Research, and Literature Cancers by Body Location/System Childhood Cancers Late Effects of Childhood Cancer Treatment Pediatric Supportive Care Unusual ...

  20. The effects of community-wide dissemination of information on perceptions of palliative care, knowledge about opioids, and sense of security among cancer patients, their families, and the general public.

    Science.gov (United States)

    Akiyama, Miki; Hirai, Kei; Takebayashi, Toru; Morita, Tatsuya; Miyashita, Mitsunori; Takeuchi, Ayano; Yamagishi, Akemi; Kinoshita, Hiroya; Shirahige, Yutaka; Eguchi, Kenji

    2016-01-01

    Prejudices against palliative care are a potential barrier to quality end-of-life care. There have been few large-scale community-wide interventions to distribute appropriate information about palliative care, and no studies have investigated their impact on cancer patients, their families, and the general public. Thus, we conducted a 3-year community intervention and evaluated the effects of distributing such information at the community level, and explored associations among levels of exposure, perceptions, knowledge, and the sense of security achieved. Over a period of 3 years, we provided flyers, booklets, posters, and public lectures about palliative care in four regions of Japan, and carried out pre- and post-intervention surveys with repeated cross-sectional samplings of cancer patients (pre 859, post 857), bereaved family members (1110, 1137), and the general public (3984, 1435). The levels of exposure to the provided information were measured by a multiple-choice questionnaire after intervention. Multiple logistic regression analyses were used to estimate multivariable-adjusted odds ratios (ORs) for perceptions of palliative care, knowledge about opioids, and sense of security among the exposure groups. Overall perceptions of palliative care, opioids, and receiving care at home improved significantly among the general public and families, but not among the patients at the community level. However, multiple regression revealed that patients of extensive exposure category had significantly more positive perceptions of palliative care to those of non-exposure category (p = 0.02). The sense of security regarding cancer care of all patients, family members, and the general public improved. Among others, the respondents who reported extensive exposure in the general public and family members scored significantly higher sense of security. Our findings indicate that providing palliative care information via small media and lectures in the community is

  1. Improving Symptom Control, QOL, and Quality of Care for Women with Breast Cancer: Developing a Research Program on Neurological Effects via Doctoral Education

    National Research Council Canada - National Science Library

    Bakitas, Marie; Ahles, Tim A

    2006-01-01

    ... on the Cognitive Effects of Chemotherapy. The scope of the program was to support the trainee's doctoral education with an ultimate career goal of becoming a Clinical Breast Cancer Research Scientist through a mentored research experience. Ms...

  2. Racial disparities in cancer care in the Veterans Affairs health care system and the role of site of care.

    Science.gov (United States)

    Samuel, Cleo A; Landrum, Mary Beth; McNeil, Barbara J; Bozeman, Samuel R; Williams, Christina D; Keating, Nancy L

    2014-09-01

    We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12,897), lung (n = 25,608), or prostate (n = 38,202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between- or within-hospital differences. Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10). Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.

  3. Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial.

    Science.gov (United States)

    Hui, David; Frisbee-Hume, Susan; Wilson, Annie; Dibaj, Seyedeh S; Nguyen, Thuc; De La Cruz, Maxine; Walker, Paul; Zhukovsky, Donna S; Delgado-Guay, Marvin; Vidal, Marieberta; Epner, Daniel; Reddy, Akhila; Tanco, Kimerson; Williams, Janet; Hall, Stacy; Liu, Diane; Hess, Kenneth; Amin, Sapna; Breitbart, William; Bruera, Eduardo

    2017-09-19

    The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. Single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016. Lorazepam (3 mg) intravenously (n = 47) or placebo (n = 43) in addition to haloperidol (2 mg) intravenously upon the onset of an agitation episode. The primary outcome was change in Richmond Agitation-Sedation Scale (RASS) score (range, -5 [unarousable] to 4 [very agitated or combative]) from baseline to 8 hours after treatment administration. Secondary end points were rescue neuroleptic use, delirium recall, comfort (perceived by caregivers and nurses), communication capacity, delirium severity, adverse effects, discharge outcomes, and overall survival. Among 90 randomized patients (mean age, 62 years; women, 42 [47%]), 58 (64%) received the study medication and 52 (90%) completed the trial. Lorazepam + haloperidol resulted in a significantly greater reduction of RASS score at 8 hours (-4.1 points) than placebo + haloperidol (-2.3 points) (mean difference, -1.9 points [95% CI, -2.8 to -0.9]; P haloperidol group required less median rescue neuroleptics (2.0 mg) than the placebo + haloperidol group (4.0 mg) (median difference, -1.0 mg [95% CI, -2.0 to 0]; P = .009) and was perceived to be more comfortable by both blinded caregivers and nurses (caregivers: 84% for the lorazepam + haloperidol group vs 37% for the placebo + haloperidol group; mean difference, 47% [95% CI, 14% to 73%], P = .007; nurses: 77% for the lorazepam

  4. 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....

  5. Public perception of cancer care in Poland and Austria.

    Science.gov (United States)

    Jȩdrzejewski, Mariusz; Thallinger, Christiane; Mrozik, Magda; Kornek, Gabriela; Zielinski, Christoph; Jassem, Jacek

    2015-01-01

    We compared the public perception of cancer care in Poland and Austria. Both countries are members of the European Union (EU) but reflect two extremes in health-related per capita spending. Recently, the EUROCARE-5 study reported on very discrepant cancer outcomes between the two countries. A one-time survey was conducted to compare the public perception of cancer treatment in Poland and Austria. In total, 3,649 subjects, representing the general population, cancer patients, and cancer patients' family members, were surveyed. In both countries, cancer was considered the most challenging problem of the health care system, and health care was indicated as the most important issue influencing political election decisions. Polish compared with Austrian cancer patients gave a significantly lower positive assessment of overall cancer treatment efficacy and detection methods. Cancer cure rates estimated by Polish and Austrian citizens were 29% and 44%, respectively. The majority of all citizens interviewed thought that cancer patients should have access to all available registered cancer drugs. However, only 18% of Poles versus 62% of Austrians agreed with the notion that the available cancer treatment in their countries is of a standard comparable to that of other EU countries. Consequently, 24% of Poles and 7% of Austrians identified financial status, age, gender, and residence as factors influencing the availability of cancer treatments. In both countries, cancer is considered the most challenging problem of the health care system, and health care issues may strongly influence decisions for political elections. Vast differences in the two populations' perceptions of cancer care reflect actual cancer outcomes and the national per capita spending on health-related issues. ©AlphaMed Press.

  6. Cancer - the delivery of nursing care

    International Nuclear Information System (INIS)

    Cox, S.; Wark, E.

    1978-01-01

    This and the preceding article (Nursing Mirror, Sept. 1, 1978) form a slightly shortened version of Chap. 5 from Vol. 2 of the book 'Oncology for Nurses and Health Care Professionals', ed. R. Tiffany, (Allen and Unwin, Oct. 1978). Teletherapy was dealt with in part 1. Part 2 is concerned with radiotherapy using radioisotope implants and applicators and unsealed sources, and with surgery and chemotherapy, including side effects of anti-tumour drugs. The physical and psychological effects on the patient of these forms of treatment are discussed, and nursing care and radiological safety precautions for both patients and nursing staff are described. (author)

  7. Health care use after diagnosis of cancer in children.

    NARCIS (Netherlands)

    Heins, M.J.; Lorenzi, M.F.; Korevaar, J.C.; McBride, M.L.

    2014-01-01

    Purpose: Young patients with cancer often require extensive care during and shortly after cancer treatment for medical, psychosocial and educational problems. Approximately 85% are treated by an oncologist; however, their additional health care in this phase has barely been studied. The role of the

  8. Original Research Characterising cancer burden and quality of care ...

    African Journals Online (AJOL)

    Cancer burden at two palliative care clinics in Malawi 130 ... Cancer is a leading cause of mortality and morbidity worldwide. ... Health Organization (WHO) defines palliative care as an .... period, patients aged 15 years ..... GLOBOCAN 2012 ... Young People: A Case Series of 109 Cases and Review of the Literature.

  9. 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.

  10. 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.

  11. "EXHALE": exercise as a strategy for rehabilitation in advanced stage lung cancer patients: a randomized clinical trial comparing the effects of 12 weeks supervised exercise intervention versus usual care for advanced stage lung cancer patients

    DEFF Research Database (Denmark)

    Quist, Morten; Langer, SW; Rørth, Mikael

    2013-01-01

    BACKGROUND: Lung cancer is the leading cause of cancer death in North America and Western Europe. Patients with lung cancer in general have reduced physical capacity, functional capacity, poor quality of life and increased levels of anxiety and depression. Intervention studies indicate that physi......BACKGROUND: Lung cancer is the leading cause of cancer death in North America and Western Europe. Patients with lung cancer in general have reduced physical capacity, functional capacity, poor quality of life and increased levels of anxiety and depression. Intervention studies indicate...... that physical training can address these issues. However, there is a lack of decisive evidence regarding the effect of physical exercise in patients with advanced lung cancer. The aim of this study is to evaluate the effects of a twelve weeks, twice weekly program consisting of: supervised, structured training...... in a group of advanced lung cancer patients (cardiovascular and strength training, relaxation). METHODS/DESIGN: A randomized controlled trial will test the effects of the exercise intervention in 216 patients with advanced lung cancer (non-small cell lung cancer (NSCLC) stage IIIb-IV and small cell lung...

  12. Collaboration and communication in colorectal cancer care: a qualitative study of the challenges experienced by patients and health care professionals

    Science.gov (United States)

    Kamradt, Martina; Baudendistel, Ines; Längst, Gerda; Kiel, Marion; Eckrich, Felicitas; Winkler, Eva; Szecsenyi, Joachim; Ose, Dominik

    2015-01-01

    Background. Colorectal cancer is becoming a chronic condition. This has significant implications for the delivery of health care and implies the involvement of a range of health care professionals (HCPs) from different settings to ensure the needed quality and continuity of care. Objectives. To explore the challenges that patients and HCPs experience in the course of colorectal cancer care and the perceived consequences caused by these challenges. Methods. Ten semi-structured focus groups were conducted including patients receiving treatment for colorectal cancer, representatives of patient support groups, physicians and other non-physician HCPs from different health care settings. Participants were asked to share their experiences regarding colorectal cancer care. All data were audio- and videotaped, transcribed verbatim and thematically analysed using qualitative content analysis. Results. Patients and HCPs (total N = 47) experienced collaboration and communication as well as exchange of information between HCPs as challenging. Particularly communication and information exchange with GPs appeared to be lacking. The difficulties identified restricted a well-working coordination of care and seemed to cause inappropriate health care. Conclusion. Colorectal cancer care seems to require an effective, well-working collaboration and communication between the different HCPs involved ensuring the best possible care to suit patients’ individual needs. However, the perceived challenges and consequences of our participants seem to restrict the delivery of the needed quality of care. Therefore, it seems crucial (i) to include all HCPs involved, especially the GP, (ii) to support an efficient and standardized exchange of health-related information and (iii) to focus on the patients’ entire pathway of care. PMID:26311705

  13. A Primary Care Initiative for Cancer Survivorship: A Case Study of Cancer in Obese Men

    Directory of Open Access Journals (Sweden)

    Mamdouh M. Shubair

    2017-01-01

    Full Text Available Background: Men in rural and northern areas of Canada experience considerable challenges in health care access for chronic conditions such as obesity, type 2 diabetes (T2D, and cancer. Obese men (body mass index/BMI ≥ 30 kg/m2 in rural/remote northern British Columbia (BC experience poorer health outcomes due to cancer risk compared to other men elsewhere in urban Canada. Context: Challenges faced by men who develop cancer as a complication of being obese are paramount in terms of primary care treatment of their cancers. Oftentimes cancer treatment is multi-modal and complex. Models of shared care have been proposed to provide coordinated survivorship care to the growing population of rural male cancer patients suffering from obesity and the Metabolic Syndrome (MetS. Methods: Objectives: The main objective of the study was to examine the type of cancer care programs that may have focused on men with cancer in northern British Columbia (BC. A secondary objective is to identify challenges in care experienced by men with cancer during their transition from in-hospital care back to their home communities. Population: We conducted a comprehensive literature review and a qualitative focus group interview with primary care physicians (PCPs, oncologists (n=8, and a convenience sample of male cancer patients (n=6 who have underlying obesity and Metabolic Syndrome (MetS. We examined the types of cancer care programs that may have targeted such men. We further identified challenges experienced by male cancer patients while transitioning back to their home communities. Results: The focus group results outlined themes speaking to a comprehensive shared care model that goes beyond surveillance of cancer recurrence in men with obesity. Conclusion: A shared survivorship care plan or model integrates collaboration among specialists in clinical decision making and best practice for treatment of cancer in obese men.

  14. Care managers' views on death and caring for older cancer patients in Japan.

    Science.gov (United States)

    Matsui, Miho; Kanai, Emi; Kitagawa, Akiko; Hattori, Keiko

    2013-12-01

    Care managers (CMs) have an important role in coordinating care for cancer patients who are in the end-of-life stage; however, little is known about their views of death and their experiences while caring for older cancer patients. This study was conducted to examine CMs' views of death and caring for older cancer patients in a home care setting in Japan. Convenience sampling was undertaken, and 35 offices from 43 approached services agreed to participate. The final valid sample included responses from 136 CMs (90.7%). Most CMs, including nurses, care workers, home helpers, and social workers in home care settings, experienced difficulty in managing the care of cancer patients in the end-of-life stage. Respondents reported a wide array of experiences with end-of-life care, care management, and seminar attendance, and their ages and Frommelt Attitude Toward Care of the Dying (FATCOD) scores were associated factors. Moreover, multiple regression analysis indicated that better attitudes toward caring for the dying were positively associated with seminar attendance. These results suggest that CMs need education about palliative and end-of-life care in order to promote good home care for cancer patients.

  15. Cancer care coordinators in stage III colon cancer: a cost-utility analysis.

    Science.gov (United States)

    Blakely, Tony; Collinson, Lucie; Kvizhinadze, Giorgi; Nair, Nisha; Foster, Rachel; Dennett, Elizabeth; Sarfati, Diana

    2015-08-05

    There is momentum internationally to improve coordination of complex care pathways. Robust evaluations of such interventions are scarce. This paper evaluates the cost-utility of cancer care coordinators for stage III colon cancer patients, who generally require surgery followed by chemotherapy. We compared a hospital-based nurse cancer care coordinator (CCC) with 'business-as-usual' (no dedicated coordination service) in stage III colon cancer patients in New Zealand. A discrete event microsimulation model was constructed to estimate quality-adjusted life-years (QALYs) and costs from a health system perspective. We used New Zealand data on colon cancer incidence, survival, and mortality as baseline input parameters for the model. We specified intervention input parameters using available literature and expert estimates. For example, that a CCC would improve the coverage of chemotherapy by 33% (ranging from 9 to 65%), reduce the time to surgery by 20% (3 to 48%), reduce the time to chemotherapy by 20% (3 to 48%), and reduce patient anxiety (reduction in disability weight of 33%, ranging from 0 to 55%). Much of the direct cost of a nurse CCC was balanced by savings in business-as-usual care coordination. Much of the health gain was through increased coverage of chemotherapy with a CCC (especially older patients), and reduced time to chemotherapy. Compared to 'business-as-usual', the cost per QALY of the CCC programme was $NZ 18,900 (≈ $US 15,600; 95% UI: $NZ 13,400 to 24,600). By age, the CCC intervention was more cost-effective for colon cancer patients costs, meaning the cost-effectiveness was roughly comparable between ethnic groups. Such a nurse-led CCC intervention in New Zealand has acceptable cost-effectiveness for stage III colon cancer, meaning it probably merits funding. Each CCC programme will differ in its likely health gains and costs, making generalisation from this evaluation to other CCC interventions difficult. However, this evaluation suggests

  16. Diet and Nutrition in Cancer Survivorship and Palliative Care

    OpenAIRE

    Anthony J. Bazzan; Andrew B. Newberg; William C. Cho; Daniel A. Monti

    2013-01-01

    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 ...

  17. 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.

  18. Psychological factors impacting transition from paediatric to adult care by childhood cancer survivors.

    Science.gov (United States)

    Granek, Leeat; Nathan, Paul C; Rosenberg-Yunger, Zahava R S; D'Agostino, Norma; Amin, Leila; Barr, Ronald D; Greenberg, Mark L; Hodgson, David; Boydell, Katherine; Klassen, Anne F

    2012-09-01

    Childhood cancer survivors require life-long care focused on the specific late effects that may arise from their cancer and its treatment. In many centers, survivors are required to transition from follow-up care in a paediatric cancer center, to care provided in an adult care setting. The purpose of this study was to identify the psychological factors involved in this transition to adult care long-term follow-up clinics. Qualitative interviews were conducted with ten paediatric survivors still in paediatric care, as well as 28 adult survivors of whom 11 had transitioned successfully to adult care (attended three long-term follow-up (LTFU) appointments consecutively); ten who failed to transition (attended at least one LTFU appointment as an adult, but were inconsistent with subsequent attendance); and seven who had never transitioned (did not attend any LTFU care as an adult). Line-by-line coding was used to establish categories and themes. Constant comparison was used to examine relationships within and across codes and categories. Two overall categories and four subthemes were identified: (1) Identification with being a cancer survivor included the subthemes of 'cancer identity' and 'cancer a thing of the past' and; (2) Emotional components included the subthemes of 'fear and anxiety' and 'gratitude and gaining perspective'. The analysis revealed that the same factor could act as either a motivator or a hindrance to successful transition in different survivors (e.g., fear of recurrence of cancer might be a barrier or a facilitator depending on the survivor's life experience). Psychological factors are an important consideration when preparing cancer survivors for transition to adult long-term follow-up care. Identifying and addressing the individual psychological needs of childhood cancer survivors may improve the likelihood of their successful transition to adult care.

  19. 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.

  20. Cancer Trends: Influencing Care and Research Priorities

    Science.gov (United States)

    Many of the trends being seen in cancer are changing how we view cancer and how we address it, from prompting research to identify the underlying causes of cancers increasing in incidence to informing research on treatment and prevention.

  1. Bring about benefit, forestall harm: what communication studies say about spirituality and cancer care.

    Science.gov (United States)

    Tullis, Jillian A

    2010-01-01

    they are spiritually, emotionally, and socially and offer effective care that is culturally situated. For many in Muslim societies, a cancer diagnosis is Divine fate. Understanding a cancer diagnosis as destiny offers comfort to some, yet cancer patients and their family members may experience isolation because of the stigmas associated with the disease. This double-bind can lead to spiritual or existential crises, which draws further attention to the need for effective spiritual care that ultimately fosters patient and family healing whether or not a cure is possible. Bringing together various approaches to communicating about diverse spiritual and religious ideas may allow for enhanced comprehensive cancer care.

  2. The effects of a multimodal training program on burnout syndrome in gynecologic oncology nurses and on the multidisciplinary psychosocial care of gynecologic cancer patients: an Italian experience.

    Science.gov (United States)

    Lupo, F N; Arnaboldi, Paola; Santoro, L; D'Anna, E; Beltrami, C; Mazzoleni, E M; Veronesi, P; Maggioni, A; Didier, F

    2013-06-01

    In cancer care, the burden of psycho-emotional elements involved on the patient-healthcare provider relationship cannot be ignored. The aim of this work is to have an impact on the level of burnout experienced by European Institute of Oncology (IEO) gynecologic oncology nurses (N = 14) and on quality of multidisciplinary team work. We designed a 12 session multimodal training program consisting of a 1.5 hour theoretical lesson on a specific issue related to gynecologic cancer patient care, 20 minute projection of a short film, and 1.75 hours of role-playing exercises and experiential exchanges. The Link Burnout Questionnaire (Santinello, 2007) was administered before and after the completion of the intervention. We also monitored the number of patients referred to the Psycho-oncology Service as an indicator of the efficacy of the multidisciplinary approach. After the completion of the program, the general level of burnout significantly diminished (p = 0.02); in particular, a significant decrease was observed in the "personal inefficacy" subscale (p = 0.01). The number of patients referred to the Psycho-oncology Service increased by 50%. Nurses are in the first line of those seeing patients through the entire course of the disease. For this reason, they are at a particularly high risk of developing work-related distress. Structured training programs can be a valid answer to work-related distress, and feeling part of a multidisciplinary team helps in providing patients with better psychosocial care.

  3. Dedicated researcher brings cancer care to rural communities

    Directory of Open Access Journals (Sweden)

    Sharan Bhuller

    2016-10-01

    . Dr. Asthana has also ventured into various other new areas that are currently lacking presence in India and other low- and middle-income countries. One such area is palliative care, where she has undergone specialized training in palliative care from the Indian Association of Palliative Care. Additionally, Dr. Asthana is working on a global systematic review project that studies smokeless tobacco attributable risk for oral cancer. She further adds, “As an officer in the district technical support team and in collaboration with World Health Organization, I have devoted quite some time in serving the rural community for leprosy monitoring.”When asked for her opinion about the future of cancer research, Dr. Asthana believes that targeted therapy is the future of cancer therapy, as it kills only cancer cells and not normal cells, which leads to lesser side effects. “However, the major concern is the cost of it,” she says, “and it doesn’t appear to be affordable in the near future.” Hence, “developing countries like India should focus on the prevention of cancer through the modification of risk factors and adopting healthy lifestyles,” she concludes.

  4. 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.

  5. Relatives' level of satisfaction with advanced cancer care in Greenland

    DEFF Research Database (Denmark)

    Augustussen, Mikaela; Hounsgaard, Lise; Pedersen, Michael Lynge

    2017-01-01

    Palliative cancer care in Greenland is provided by health professionals at local level, the national Queen Ingrid's Hospital and at Rigshospitalet in Denmark. To improve and develop care for relatives of patients with advanced cancer, we conducted a mixed method study examining relatives' level...... of satisfaction with care and treatment and their current main concerns. The aim was to investigate relatives' level of satisfaction with advanced cancer care and bring to light their current main concerns. The FAMCARE-20 questionnaire was translated to Greenlandic and pilot tested. The questionnaire...... (66%) and relatives were the most dissatisfied with the lack of inclusion in decision making related to treatment and care (71%) and the length of time required to diagnose cancer (70%). Responses to the open-ended questions revealed that relatives faced challenges in gaining access to information...

  6. Proactive cancer care in primary care: a mixed-methods study.

    Science.gov (United States)

    Kendall, Marilyn; Mason, Bruce; Momen, Natalie; Barclay, Stephen; Munday, Dan; Lovick, Roberta; Macpherson, Stella; Paterson, Euan; Baughan, Paul; Cormie, Paul; Kiehlmann, Peter; Free, Amanda; Murray, Scott A

    2013-06-01

    Current models of post-treatment cancer care are based on traditional practices and clinician preference rather than evidence of benefit. To assess the feasibility of using a structured template to provide holistic follow-up of patients in primary care from cancer diagnosis onwards. A two-phase mixed methods action research project. An electronic cancer ongoing review document (CORD) was first developed with patients and general practitioners, and used with patients with a new diagnosis of cancer. This was evaluated through documentary analysis of the CORDs, qualitative interviews with patients, family carers and health professionals and record reviews. The records of 107 patients from 13 primary care teams were examined and 45 interviews conducted. The document was started in 54% of people with newly diagnosed cancer, and prompted clear documentation of multidimension needs and understanding. General practitioners found using the document helped to structure consultations and cover psychosocial areas, but they reported it needed to be better integrated in their medical records with computerized prompts in place. Few clinicians discussed the review openly with patients, and the template was often completed afterwards. Anticipatory cancer care from diagnosis to cure or death, 'in primary care', is feasible in the U.K. and acceptable to patients, although there are barriers. The process promoted continuity of care and holism. A reliable system for proactive cancer care in general practice supported by hospital specialists may allow more survivorship care to be delivered in primary care, as in other long-term conditions.

  7. 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.

  8. Cancer survivorship care-planning: Practice, research, and policy implications for social work.

    Science.gov (United States)

    Wagner, Richard W; Pritzker, Suzanne

    2016-01-01

    Increasing numbers of cancer survivors are living longer than 5 years from their diagnosis date. This has resulted in a growing population of cancer survivors, expected to reach 19 million by 2024. Survivors frequently experience late effects caused by cancer and its treatment, reducing survivors' quality of life in multiple domains. Survivorship care-plans may aid the many physical, psychosocial, and financial needs that emerge posttreatment. However, the lack of reimbursement mechanisms, the limited amount of effectiveness research, and minimal guidelines for content and delivery are barriers to the widespread provision of survivorship care-plans. Challenges and opportunities for social work practice, research, and policy are identified and discussed.

  9. Integrated Care Planning for Cancer Patients: A Scoping Review

    Directory of Open Access Journals (Sweden)

    Anum Irfan Khan

    2017-11-01

    Full Text Available Introduction: There has been a growing emphasis on the use of integrated care plans to deliver cancer care. However little is known about how integrated care plans for cancer patients are developed including featured core activities, facilitators for uptake and indicators for assessing impact. Methods: Given limited consensus around what constitutes an integrated care plan for cancer patients, a scoping review was conducted to explore the components of integrated care plans and contextual factors that influence design and uptake. Results: Five types of integrated care plans based on the stage of cancer care: surgical, systemic, survivorship, palliative and comprehensive (involving a transition between stages are described in current literature. Breast, esophageal and colorectal cancers were common disease sites. Multi-disciplinary teams, patient needs assessment and transitional planning emerged as key features. Provider buy-in and training alongside informational technology support served as important facilitators for plan uptake. Provider-level measurement was considerably less robust compared to patient and system-level indicators. Conclusions: Similarities in design features, components and facilitators across the various types of integrated care plans indicates opportunities to leverage shared features and enable a management lens that spans the trajectory of a patient’s journey rather than a phase-specific silo approach to care.

  10. Improving access to supportive cancer care through an eHealth application: a qualitative needs assessment among cancer survivors.

    Science.gov (United States)

    Lubberding, Sanne; van Uden-Kraan, Cornelia F; Te Velde, Elisabeth A; Cuijpers, Pim; Leemans, C René; Verdonck-de Leeuw, Irma M

    2015-05-01

    To gain insight into cancer survivors' needs towards an eHealth application monitoring quality of life and targeting personalised access to supportive care. Supportive care in cancer addresses survivors' concerns and needs. However, many survivors are not taking advantage of supportive care provided. To enable cancer survivors to benefit, survivors' needs must be identified timely and effectively. An eHealth application could be a solution to meet patients' individual supportive care needs. A qualitative approach. Thirty cancer survivors (15 head and neck and 15 breast cancer survivors) participated. The majority were female (n = 20·67%). The mean age was 60 (SD 8·8) years. Mean time interval since treatment was 13·5 months (SD 10·5). All interviews were audio-recorded and transcribed verbatim. During the interviews, participants were asked about their unmet needs during follow-up care and a potential eHealth application. Data were analyzed independently by two coders and coded into key issues and themes. Cancer survivors commented that they felt unprepared for the post-treatment period and that their symptoms often remained unknown to care providers. Survivors also mentioned a suboptimal referral pattern to supportive care services. Mentioned advantages of an eHealth application were as follows: insight into the course of symptoms by monitoring, availability of information among follow-up appointments, receiving personalised advice and tailored supportive care. Cancer survivors identified several unmet needs during follow-up care. Most survivors were positive towards the proposed eHealth application and expressed that it could be a valuable addition to follow-up cancer care. Study results provide care providers with insight into barriers that impede survivors from obtaining optimal supportive care. This study also provides insight into the characteristics needed to design, build and implement an eHealth application targeting personalised access to supportive

  11. 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.

  12. Timely and Effective Care - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of cataract surgery outcome, colonoscopy follow-up, heart...

  13. Timely and Effective Care - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes state-level data for measures of cataract surgery outcome, colonoscopy follow-up, heart...

  14. Timely and Effective Care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes national-level data for measures of cataract surgery outcome, colonoscopy follow-up, heart...

  15. A Randomized Controlled Trial of a Nurse-Led Supportive Care Package (SurvivorCare) for Survivors of Colorectal Cancer.

    Science.gov (United States)

    Jefford, Michael; Gough, Karla; Drosdowsky, Allison; Russell, Lahiru; Aranda, Sanchia; Butow, Phyllis; Phipps-Nelson, Jo; Young, Jane; Krishnasamy, Mei; Ugalde, Anna; King, Dorothy; Strickland, Andrew; Franco, Michael; Blum, Robert; Johnson, Catherine; Ganju, Vinod; Shapiro, Jeremy; Chong, Geoffrey; Charlton, Julie; Haydon, Andrew; Schofield, Penelope

    2016-08-01

    Colorectal cancer (CRC) and its treatments can cause distressing sequelae. We conducted a multicenter randomized controlled trial aiming to improve psychological distress, supportive care needs (SCNs), and quality of life (QOL) of patients with CRC. The intervention, called SurvivorCare (SC), comprised educational materials, needs assessment, survivorship care plan, end-of-treatment session, and three follow-up telephone calls. At the end of treatment for stage I-III CRC, eligible patients were randomized 1:1 to usual care (UC) or to UC plus SC. Distress (Brief Symptom Inventory 18), SCNs (Cancer Survivors' Unmet Needs measure), and QOL (European Organization for Research and Treatment of Cancer [EORTC] QOL questionnaires C30 and EORTC CRC module CR29) were assessed at baseline and at 2 and 6 months (follow-up 1 [FU1] and FU2, respectively). The primary hypothesis was that SC would have a beneficial effect on distress at FU1. The secondary hypotheses were that SC would have a beneficial effect on (a) SCN and QOL at FU1 and on (b) distress, SCNs, and QOL at FU2. A total of 15 items assessed experience of care. Of 221 patients randomly assigned, 4 were ineligible for the study and 1 was lost to FU, leaving 110 in the UC group and 106 in the SC group. Patients' characteristics included the following: median age, 64 years; men, 52%; colon cancer, 56%; rectal cancer, 35%; overlapping sites of disease, 10%; stage I disease, 7%; stage II, 22%; stage III, 71%. Baseline distress and QOL scores were similar to population norms. Between-group differences in distress at FU1 (primary outcome) and at FU2, and SCNs and QOL at FU1 and FU2 were small and nonsignificant. Patients in the SC group were more satisfied with survivorship care than those in the UC group (significant differences on 10 of 15 items). The addition of SC to UC did not have a beneficial effect on distress, SCNs, or QOL outcomes, but patients in the SC group were more satisfied with care. Some survivors of

  16. 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

  17. 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.

  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

    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...... that is vital to further improve palliative care in the primary sector.AIM. The aim of the study was to analyse the quality of palliative home care with focus on the GP's role based on evaluations by relatives of recently deceased cancer patients and professionals from both the primary and secondary health care...... 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. 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. Prioritizing medication safety in care of people with cancer: clinicians’ views on main problems and solutions

    Science.gov (United States)

    Car, Lorainne Tudor; Papachristou, Nikolaos; Urch, Catherine; Majeed, Azeem; Atun, Rifat; Car, Josip; Vincent, Charles

    2017-01-01

    Background Cancer care is liable to medication errors due to the complex nature of cancer treatment, the common presence of comorbidities and the involvement of a number of clinicians in cancer care. While the frequency of medication errors in cancer care has been reported, little is known about their causal factors and effective prevention strategies. With a unique insight into the main safety issues in cancer treatment, frontline staff can help close this gap. In this study, we aimed to identify medication safety priorities in cancer patient care according to clinicians in North West London using PRIORITIZE, a novel priority–setting approach. Methods The project steering group determined the scope, the context and the criteria for prioritization. We then invited North West London cancer care clinicians to identify and prioritize main causes for, and solutions to, medication errors in cancer care. Forty cancer care providers submitted their suggestions which were thematically synthesized into a composite list of 20 distinct problems and 22 solutions. A group of 26 clinicians from the initial cohort ranked the composite list of suggestions using predetermined criteria. Results The top ranked problems focused on patients’ poor understanding of treatments due to language or education difficulties, clinicians’ insufficient attention to patients’ psychological distress, and inadequate information sharing among health care providers. The top ranked solutions were provision of guidance to patients and their carers on what to do when unwell, pre–chemotherapy work–up for all patients and better staff training. Overall, clinicians considered improved communication between health care providers, quality assurance procedures (during prescription and monitoring stages) and patient education as key strategies for improving cancer medication safety. Prescribing stage was identified as the most vulnerable to medication safety threats. The highest ranked suggestions

  1. Massage Therapy in Outpatient Cancer Care: A Metropolitan Area Analysis

    Science.gov (United States)

    Miccio, Robin Streit; Parikh, Bijal

    2017-01-01

    Massage offers cancer patients general quality of life benefits as well as alleviation of cancer-related symptoms/cancer-treatment–related symptoms including pain, anxiety, and fatigue. Little is known about whether massage is accessible to cancer patients who receive treatment in the outpatient setting and how massage is incorporated into the overall cancer treatment plan. Outpatient cancer centers (n = 78) in a single metropolitan area were included this mixed-methods project that included a systematic analysis of website information and a telephone survey. Massage was offered at only 40 centers (51.3% of total). A range of massage modalities were represented, with energy-based therapies (Reiki and Therapeutic Touch) most frequently provided. Although massage therapists are licensed health care providers in the states included in this analysis, massage was also provided by nurses, physical therapists, and other health care professionals. PMID:28845677

  2. Massage Therapy in Outpatient Cancer Care: A Metropolitan Area Analysis.

    Science.gov (United States)

    Cowen, Virginia S; Miccio, Robin Streit; Parikh, Bijal

    2017-10-01

    Massage offers cancer patients general quality of life benefits as well as alleviation of cancer-related symptoms/cancer-treatment-related symptoms including pain, anxiety, and fatigue. Little is known about whether massage is accessible to cancer patients who receive treatment in the outpatient setting and how massage is incorporated into the overall cancer treatment plan. Outpatient cancer centers (n = 78) in a single metropolitan area were included this mixed-methods project that included a systematic analysis of website information and a telephone survey. Massage was offered at only 40 centers (51.3% of total). A range of massage modalities were represented, with energy-based therapies (Reiki and Therapeutic Touch) most frequently provided. Although massage therapists are licensed health care providers in the states included in this analysis, massage was also provided by nurses, physical therapists, and other health care professionals.

  3. Nursing workload for cancer patients under palliative care

    OpenAIRE

    Fuly, Patrícia dos Santos Claro; Pires, Livia Márcia Vidal; Souza, Claudia Quinto Santos de; Oliveira, Beatriz Guitton Renaud Baptista de; Padilha, Katia Grillo

    2016-01-01

    Abstract OBJECTIVE To verify the nursing workload required by cancer patients undergoing palliative care and possible associations between the demographic and clinical characteristics of the patients and the nursing workload. METHOD This is a quantitative, cross-sectional, prospective study developed in the Connective Bone Tissue (TOC) clinics of Unit II of the Brazilian National Cancer Institute José Alencar Gomes da Silva with patients undergoing palliative care. RESULTS Analysis of 197 ...

  4. African Americans' and Hispanics' information needs about cancer care.

    Science.gov (United States)

    Muñoz-Antonia, Teresita; Ung, Danielle; Montiel-Ishino, F Alejandro; Nelson, Alison; Canales, Jorge; Quinn, Gwendolyn P

    2015-06-01

    Few studies have reported on African American and Hispanic (AA and H) populations' informational needs when seeking cancer care at an institution that offers clinical trials. Moffitt Cancer Center (MCC) sought to identify and examine the decision making process, the perceptions, and the preferred channels of communication about cancer care services for AA and H communities in order to develop a list of marketing recommendations. Five focus groups (N = 45) consisting of two AA and three H were conducted in four counties of the MCC catchment area in Tampa, FL. Participants were asked about their perceptions, knowledge, attitudes, and beliefs about cancer care and MCC. Focus groups were audio-recorded and verbatim transcripts were analyzed using content analysis. Similarities in responses were found between AA and H participants. Participants received general health and cancer information from media sources and word of mouth and preferred to hear patient testimonials. There were concerns about costs, insurance coverage, and the actual geographic location of the cancer center. In general, H participants were not opposed to participating in cancer clinical trials/research, whereas, AA participants were more hesitant. A majority of participants highly favored an institution that offered standard care and clinical trials. AA and H participants shared similar concerns and preferences in communication channels, but each group had specific informational needs. The perceptions and preferences of AA and H must be explored in order to successfully and efficiently increase cancer clinical trial participation.

  5. 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.

  6. Advance Care Planning: Experience of Women With Breast Cancer

    Science.gov (United States)

    2006-07-01

    recorded along with other characteristics. Inclusion criteria for the primary studies required that women with breast cancer be at least 21 years of age; cog ...W81XWH-04-1-0469 TITLE: Advance Care Planning: Experience of Women with Breast Cancer PRINCIPAL INVESTIGATOR: Ardith Z. Doorenbos...with Breast Cancer 5b. GRANT NUMBER W81XWH-04-1-0469 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Ardith Z. Doorenbos, Ph.D

  7. A randomized, controlled trial to increase discussion of breast cancer in primary care.

    Science.gov (United States)

    Kaplan, Celia P; Livaudais-Toman, Jennifer; Tice, Jeffrey A; Kerlikowske, Karla; Gregorich, Steven E; Pérez-Stable, Eliseo J; Pasick, Rena J; Chen, Alice; Quinn, Jessica; Karliner, Leah S

    2014-07-01

    Assessment and discussion of individual risk for breast cancer within the primary care setting are crucial to discussion of risk reduction and timely referral. We conducted a randomized controlled trial of a multiethnic, multilingual sample of women ages 40 to 74 years from two primary care practices (one academic, one safety net) to test a breast cancer risk assessment and education intervention. Patients were randomly assigned to control or intervention group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room before visit for intervention). Intervention (BreastCARE) patients and their physicians received an individualized risk report to discuss during the visit. One-week follow-up telephone surveys with all patients assessed patient-physician discussion of family cancer history, personal breast cancer risk, high-risk clinics, and genetic counseling/testing. A total of 655 control and 580 intervention women completed the risk assessment and follow-up interview; 25% were high-risk by family history, Gail, or Breast Cancer Surveillance Consortium risk models. BreastCARE increased discussions of family cancer history [OR, 1.54; 95% confidence interval (CI), 1.25-1.91], personal breast cancer risk (OR, 4.15; 95% CI, 3.02-5.70), high-risk clinics (OR, 3.84; 95% CI, 2.13-6.95), and genetic counseling/testing (OR, 2.22; 95% CI, 1.34-3.68). Among high-risk women, all intervention effects were stronger. An intervention combining an easy-to-use, quick risk assessment tool with patient-centered risk reports at the point of care can successfully promote discussion of breast cancer risk reduction between patients and primary care physicians, particularly for high-risk women. Next steps include scaling and dissemination of BreastCARE with integration into electronic medical record systems. ©2014 American Association for Cancer Research.

  8. 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

    2017-07-01

    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. © 2017 John Wiley & Sons Ltd.

  9. 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

  10. Delivering affordable cancer care in high-income countries.

    Science.gov (United States)

    Sullivan, Richard; Peppercorn, Jeffrey; Sikora, Karol; Zalcberg, John; Meropol, Neal J; Amir, Eitan; Khayat, David; Boyle, Peter; Autier, Philippe; Tannock, Ian F; Fojo, Tito; Siderov, Jim; Williamson, Steve; Camporesi, Silvia; McVie, J Gordon; Purushotham, Arnie D; Naredi, Peter; Eggermont, Alexander; Brennan, Murray F; Steinberg, Michael L; De Ridder, Mark; McCloskey, Susan A; Verellen, Dirk; Roberts, Terence; Storme, Guy; Hicks, Rodney J; Ell, Peter J; Hirsch, Bradford R; Carbone, David P; Schulman, Kevin A; Catchpole, Paul; Taylor, David; Geissler, Jan; Brinker, Nancy G; Meltzer, David; Kerr, David; Aapro, Matti

    2011-09-01

    The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies

  11. Key elements of communication in cancer care.

    Science.gov (United States)

    Maex, E; De Valck, C

    2006-01-01

    In this chapter the "communication compass" is introduced. It defines the key elements of communication and provides a language with which to communicate about communication in cancer care. The communication compass consists of two axes. One axis defines the associated perspectives of the clinician and the patient, the other axis the content of information and emotional experience. "Two lovers sat on a park bench with their bodies touching each other, holding hands in the moonlight. There was silence between them. So profound was their love for each other, they needed no words to express it." (Samuel Johnson). Sometimes communication just flows. There are these special moments, as fleeting as they are intense. Often communication is stuck. It is as if we speak another language and never manage to understand one another. The lovers on the park bench need no words to express what they feel, neither do they need words to speak about communication. Where communication gets stuck, we need a suitable language to speak about communication. Professional communication cannot be learned from a cookbook. Most of all it implies a readiness to communicate, which means openness to the other. The old adage that it is impossible not to communicate is only true if no criterion of quality is applied. As soon as some mutual understanding is implied in the definition of communication, the fact that it is at all possible to communicate becomes a miracle. Since there is an important gap between theory and practice, we created a tool that aims to bridge that gap. We call it the communication compass. It does not propose a model of "ideal communication," but provides a language with which to examine and analyze specific situations and to determine what the pitfalls and possibilities are. It is useful as a tool for identifying communicational difficulties in daily clinical practice and it can serve as a model for training basic communication skills.

  12. The intelligent clinical laboratory as a tool to increase cancer care management productivity.

    Science.gov (United States)

    Mohammadzadeh, Niloofar; Safdari, Reza

    2014-01-01

    Studies of the causes of cancer, early detection, prevention or treatment need accurate, comprehensive, and timely cancer data. The clinical laboratory provides important cancer information needed for physicians which influence clinical decisions regarding treatment, diagnosis and patient monitoring. Poor communication between health care providers and clinical laboratory personnel can lead to medical errors and wrong decisions in providing cancer care. Because of the key impact of laboratory information on cancer diagnosis and treatment the quality of the tests, lab reports, and appropriate lab management are very important. A laboratory information management system (LIMS) can have an important role in diagnosis, fast and effective access to cancer data, decrease redundancy and costs, and facilitate the integration and collection of data from different types of instruments and systems. In spite of significant advantages LIMS is limited by factors such as problems in adaption to new instruments that may change existing work processes. Applications of intelligent software simultaneously with existing information systems, in addition to remove these restrictions, have important benefits including adding additional non-laboratory-generated information to the reports, facilitating decision making, and improving quality and productivity of cancer care services. Laboratory systems must have flexibility to change and have the capability to develop and benefit from intelligent devices. Intelligent laboratory information management systems need to benefit from informatics tools and latest technologies like open sources. The aim of this commentary is to survey application, opportunities and necessity of intelligent clinical laboratory as a tool to increase cancer care management productivity.

  13. Patient Care Coordinator | Center for Cancer Research

    Science.gov (United States)

    blood diseases and conditions; parasitic infections; rheumatic and inflammatory diseases; and rare and neglected diseases. CMRP’s collaborative approach to clinical research and the expertise and dedication of staff to the continuation and success of the program’s mission has contributed to improving the overall standards of public health on a global scale. The Clinical Monitoring Research Program (CMRP) provides comprehensive, dedicated clinical research, study coordination, and administrative support to the National Cancer Institute’s (NCI’s), Center for Cancer Research (CCR), Urologic Oncology Branch (UOB) located at the National Institutes of Health (NIH) in Bethesda, Maryland. KEY ROLES/RESPONSIBILITIES - THIS POSITION IS CONTINGENT UPON FUNDING APPROVAL The Patient Care Coordinator III (PCC III) provides administrative services, as well as patient care coordination. Responsibilities will include: Communicates with various clinical administrative support offices/clinics/diagnostic centers concerning scheduling of patient appointments, new and existing work scopes and clinical protocols (Surgery, X-ray, etc.). Consults with the patient, chooses the appropriate appointment, and enters ID and demographic data supplied by patient to secure an appointment in order to update clinic and physician schedules. Composes correspondence on various administrative issues including patient letters and notices to the patient’s home and physicians. Provides patients with information about their appointments, including medical materials the patient will need to bring, dates and times, clinic information, hospital maps and appropriate travel and hotel information. Arranges Admission Travel Voucher (ATV) travel, including lodging, meals and direct bill requests and enters data in the ATV system daily. Obtains up-to-date patient records and other pertinent information prior to patient appointments or admission. Maintains a roster of all patients and tracks their appointments

  14. Expected effect of vaccination using bivalent vaccine on incidence of cervical dysplasia and cervical cancer in terms of health care system in Slovak Republic

    International Nuclear Information System (INIS)

    Bielik, J.; Marusakova, E.; Masak, L.

    2011-01-01

    Purpose: Human papillomavirus is a dominant cause of cervical dysplasia with possible transition to cervical cancer. The main purpose of the study was to make a qualified forecast of the potential of vaccination using a bivalent vaccine on the incidence of cervical dysplasia and cervical cancer as well as disease-related mortality in the Slovak Republic. Methods: The method of evaluation was the use of the Markov model that is strictly based on either epidemiological data from official institutions such as the National Oncology Register of the Slovak Republic, Statistic Office of the Slovak Republic, or the data from health insurance companies and the opinion of the experts´ panel of the Society of Gynaecology and Obstetrics. Results: Results obtained by modelling suggest that the introduction of HPV vaccination into the national immunization programme would result in a reduction of at least 84 deaths of women during the monitored period. Every cervical cancer death averted means 31 life years saved on average. Depending on the vaccination coverage in the cohort, HPV vaccination would cause a reduction of registered cervical dysplasia by 26,900 to 131,808 cases, a reduction of registered carcinoma in situ by 1,371 to 6,714 cases, and a decrease of registered invasive cervical carcinoma by 1,645 to 8,058 cases. Conclusion: The results of the analysis confirmed that HPV vaccination in 12-year old girls has the potential to significantly reduce both the incidence of cervical dysplasia and cervical cancer and mortality due to cervical cancer, whereby this form of primary intervention is also cost-effective. Vaccination also enhances the effect of standard secondary prevention realized by age dependant screening. (author)

  15. Evaluating beauty care provided by the hospital to women suffering from breast cancer: qualitative aspects.

    Science.gov (United States)

    Amiel, Philippe; Dauchy, Sarah; Bodin, Julie; Cerf, Céline; Zenasni, Franck; Pezant, Elisabeth; Teller, Anne-Marie; André, Fabrice; DiPalma, Mario

    2009-07-01

    Cancer patients are offered more and more access to beauty care during their stay in the hospital. This kind of intervention has not been evaluated yet. Primary objective of our research was to determine what type of evaluation strategy to be implemented (as a supportive care with quality of life and/or medical benefits; as a service providing immediate comfort); intermediate objective was to investigate in scientific terms (psychological, sociological) the experience of beauty care by patients. Sixty patients (all users of beauty care provided by hospital, 58 female, most of them treated for breast cancer, two male, mean age 53 years) and 11 nurses and physicians, from four French cancer centres were included. We used direct observation and semi-structured interviews, conducted by a sociologist and a psychologist; different types of beauty care were concerned. All the interviewed patients were satisfied. Patients appreciated acquiring savoir-faire on how to use make-up and on personal image enhancement. Psychological and social well-being benefits were mentioned. The beauty care was not alleged to be reducing the side effects of the treatments, but it had helped patients to accept or bear the burden of them. Providing care beyond that which is directly curative was appreciated by the patients as a sign that they were treated as a "whole" person. The survey brings valuable clues concerning beauty care experience by cancer patients; it suggests the relevance of quantitative evaluation of the immediate and long-term effects on the quality of life.

  16. Effects of screening for psychological distress on patient outcomes in cancer : A systematic review

    NARCIS (Netherlands)

    Meijer, Anna; Roseman, Michelle; Delisle, Vanessa C.; Milette, Katherine; Levis, Brooke; Syamchandra, Achyuth; Stefanek, Michael E.; Stewart, Donna E.; de Jonge, Peter; Coyne, James C.; Thombs, Brett D.

    Objective: Several practice guidelines recommend routine screening for psychological distress in cancer care. The objective was to evaluate the effect of screening cancer patients for psychological distress by assessing the (1) effectiveness of interventions to reduce distress among patients

  17. 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.

  18. The Prostate Cancer Registry: monitoring patterns and quality of care for men diagnosed with prostate cancer.

    Science.gov (United States)

    Evans, Sue M; Millar, Jeremy L; Wood, Julie M; Davis, Ian D; Bolton, Damien; Giles, Graham G; Frydenberg, Mark; Frauman, Albert; Costello, Antony; McNeil, John J

    2013-04-01

    To establish a pilot population-based clinical registry with the aim of monitoring the quality of care provided to men diagnosed with prostate cancer. All men aged >18 years from the contributing hospitals in Victoria, Australia, who have a diagnosis of prostate cancer confirmed by histopathology report notified to the Victorian Cancer Registry are eligible for inclusion in the Prostate Cancer Registry (PCR). A literature review was undertaken aiming to identify existing quality indicators and source evidence-based guidelines from both Australia and internationally. A Steering Committee was established to determine the minimum dataset, select quality indicators to be reported back to clinicians, identify the most effective recruitment strategy, and provide a governance structure for data requests; collection, analysis and reporting of data; and managing outliers. A minimum dataset comprising 72 data items is collected by the PCR, enabling ten quality indicators to be collected and reported. Outcome measures are risk adjusted according to the established National Comprehensive Cancer Network and Cancer of the Prostate Risk Assessment Score (surgery only) risk stratification model. Recruitment to the PCR occurs concurrently with mandatory notification to the state-based Cancer Registry. The PCR adopts an opt-out consent process to maximize recruitment. The data collection approach is standardized, using a hybrid of data linkage and manual collection, and data collection forms are electronically scanned into the PCR. A data access policy and escalation policy for mortality outliers has been developed. The PCR provides potential for high-quality population-based data to be collected and managed within a clinician-led governance framework. This approach satisfies the requirement for health services to establish quality assessment, at the same time as providing clinically credible data to clinicians to drive practice improvement. © 2012 THE AUTHORS. BJU INTERNATIONAL

  19. Patients' and family members' views on patient-centered communication during cancer care.

    Science.gov (United States)

    Mazor, Kathleen M; Beard, Reneé L; Alexander, Gwen L; Arora, Neeraj K; Firneno, Cassandra; Gaglio, Bridget; Greene, Sarah M; Lemay, Celeste A; Robinson, Brandi E; Roblin, Douglas W; Walsh, Kathleen; Street, Richard L; Gallagher, Thomas H

    2013-11-01

    To explore patients' and family members' views on communication during cancer care and to identify those aspects of clinician-patient communication which were most important to patients and family members. We conducted a secondary data analysis of qualitative data from 137 patients with cancer and family members of patients with cancer. We used a modified version of the constant comparative method and coding paradigm of grounded theory. Patients want sensitive, caring clinicians who provide information that they need, when they need it, in a way that they can understand; who listen and respond to questions and concerns, and who attempt to understand the patient's experience. Effective information exchange and a positive interpersonal relationship with the clinician were of fundamental importance to patients and family members. These were interrelated; for instance, failure to provide information a patient needed could damage the relationship, whereas excellent listening could foster the relationship. Information exchange and relationship were also integral to decision-making, managing uncertainty, responding to emotions, and self-management. Clinicians who were responsive to patients' needs beyond the immediate medical encounter were valued. The complexity of cancer care today suggests that efforts to improve communication must be multilevel, acknowledging and addressing patient, clinician, organizational and policy barriers, and facilitators. Measurement tools are needed to assess cancer patients' and family members' experiences with communication over the course of cancer care to provide meaningful, actionable feedback to those seeking to optimize their effectiveness in communicating with patients with cancer. Copyright © 2013 John Wiley & Sons, Ltd.

  20. Point-of-care rare cell cancer diagnostics.

    Science.gov (United States)

    Issadore, David

    2015-01-01

    The sparse cells that are shed from tumors into peripheral circulation are an increasingly promising resource for noninvasive monitoring of cancer progression, early diagnosis of disease, and serve as a tool for improving our understanding of cancer metastasis. However, the extremely sparse concentration of circulating tumor cells (CTCs) in blood (~1-100 CTC in 7.5 mL of blood) as well as their heterogeneous biomarker expression has limited their detection using conventional laboratory techniques. To overcome these challenges, we have developed a microfluidic chip-based micro-Hall detector (μHD), which can directly measure single, immunomagnetically tagged cells in whole blood. The μHD can detect individual cells even in the presence of vast numbers of blood cells and unbound reactants, and does not require any washing or purification steps. Furthermore, this cost-effective, single-cell analytical technique is well suited for miniaturization into a mobile platform for low-cost point-of-care use. In this chapter, we describe the methodology used to design, fabricate, and apply these chips to cancer diagnostics.

  1. Japanese structure survey of radiation oncology in 2007 with special reference to designated cancer care hospitals

    International Nuclear Information System (INIS)

    Numasaki, Hodaka; Shibuya, Hitoshi; Nishio, Masamichi

    2011-01-01

    Background and Purpose: The structure of radiation oncology in designated cancer care hospitals in Japan was investigated in terms of equipment, personnel, patient load, and geographic distribution. The effect of changes in the health care policy in Japan on radiotherapy structure was also examined. Material and Methods: The Japanese Society of Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2007. The structures of 349 designated cancer care hospitals and 372 other radiotherapy facilities were compared. Results: Respective findings for equipment and personnel at designated cancer care hospitals and other facilities included the following: linear accelerators/facility: 1.3 and 1.0; annual patients/linear accelerator: 296.5 and 175.0; and annual patient load/full-time equivalent radiation oncologist was 237.0 and 273.3, respectively. Geographically, the number of designated cancer care hospitals was associated with population size. Conclusion: The structure of radiation oncology in Japan in terms of equipment, especially for designated cancer care hospitals, was as mature as that in European countries and the United States, even though the medical costs in relation to GDP in Japan are lower. There is still a shortage of manpower. The survey data proved to be important to fully understand the radiation oncology medical care system in Japan. (orig.)

  2. 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...... children and 43 parents in the home care group, and 47 children and 66 parents receiving standard hospital care. RESULTS: All parents in the HBHC program were satisfied and preferred home care. There were no serious adverse events associated with HBHC, and costs did not increase. When adjusting for age......, gender, diagnosis and time since diagnosis, we found significant higher HRQOL scores in parent-reported physical health (P = 0.04; 95% confidence interval (CI): -0.2-19.5) and worry (P = 0.04; 95% CI: -0.4-20.6) in the home-care group indicating better physical health and less worry for children...

  3. Relatives' level of satisfaction with advanced cancer care in Greenland

    DEFF Research Database (Denmark)

    Augustussen, Mikaela; Hounsgaard, Lise; Pedersen, Michael Lynge

    2017-01-01

    from health professionals. They experienced a lack of security, worries about the future and a lack of support at home. The study showed a substantial level of dissatisfaction among relatives of patients with advanced cancer. We strongly recommend a focus on psychosocial care, more access......Palliative cancer care in Greenland is provided by health professionals at local level, the national Queen Ingrid's Hospital and at Rigshospitalet in Denmark. To improve and develop care for relatives of patients with advanced cancer, we conducted a mixed method study examining relatives' level...... was supplemented by open-ended questions about relative's current main concerns and analyzed with a phenomenological hermeneutical approach. Greenlandic patients with advanced cancer who were previously participating in a prospective study were asked if their closest adult relative would participate in the study...

  4. Effects of yoga on cancer-related fatigue and global side-effect burden in older cancer survivors.

    Science.gov (United States)

    Sprod, Lisa K; Fernandez, Isabel D; Janelsins, Michelle C; Peppone, Luke J; Atkins, James N; Giguere, Jeffrey; Block, Robert; Mustian, Karen M

    2015-01-01

    Sixty percent of cancer survivors are 65years of age or older. Cancer and its treatments lead to cancer-related fatigue and many other side effects, in turn, creating substantial global side-effect burden (total burden from all side effects) which, ultimately, compromises functional independence and quality of life. Various modes of exercise, such as yoga, reduce cancer-related fatigue and global side-effect burden in younger cancer survivors, but no studies have specifically examined the effects of yoga on older cancer survivors. The purpose of this study was to assess the effects of a 4-week yoga intervention (Yoga for Cancer Survivors: YOCAS©®) on overall cancer-related fatigue, and due to its multidimensional nature, the subdomains of cancer-related fatigue (general, physical, emotional, and mental) and global side-effect burden in older cancer survivors. We conducted a secondary analysis on data from a multicenter phase III randomized controlled clinical trial with 2 arms (standard care and standard care plus a 4-week YOCAS©® intervention). The sample for this secondary analysis was 97 older cancer survivors (≥60years of age), between 2months and 2years post-treatment, who participated in the original trial. Participants in the YOCAS©® intervention arm reported significantly lower cancer-related fatigue, physical fatigue, mental fatigue, and global side-effect burden than participants in the standard care arm following the 4-week intervention period (peffective standardized yoga intervention for reducing cancer-related fatigue, physical fatigue, mental fatigue, and global side-effect burden among older cancer survivors. Copyright © 2014 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2002-01-01

    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......-based study of symptomatology in consecutive cancer patients in palliative care, achieving rather complete data from the participants. The symptomatology in these patients was very pronounced. The questionnaires were able to detect clinically important differences between places of service....

  6. 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.

  7. 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.

  8. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

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

    2012-01-01

    , as it decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. According to family members of children with cancer, hospital-based home care support enhanced their quality of life during the child's cancer trajectory......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...

  9. Clarifying perspectives: Ethics case reflection sessions in childhood cancer care.

    Science.gov (United States)

    Bartholdson, Cecilia; Lützén, Kim; Blomgren, Klas; Pergert, Pernilla

    2016-06-01

    Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child's growing autonomy are known ethical concerns that involve the whole professional team around the child's care. The purpose of this study was to explore healthcare professionals' experiences of participating in ethics case reflection sessions in childhood cancer care. Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology. Healthcare professionals working at a publicly funded children's hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on. The children's and their parents' integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board. Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants' articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions. The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care. Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child

  10. Lymphedema as a Cancer Treatment Side Effect

    Science.gov (United States)

    ... Considerations How Cancer is Treated Side Effects Dating, Sex, and Reproduction Advanced Cancer For Children For Teens For Young Adults For Older Adults Prevention and Healthy Living Cancer.Net Videos Coping With Cancer Research and Advocacy Survivorship Blog ...

  11. 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

  12. The international cancer expert corps: a unique approach for sustainable cancer care in low and lower-middle income countries.

    Science.gov (United States)

    Coleman, C Norman; Formenti, Silvia C; Williams, Tim R; Petereit, Daniel G; Soo, Khee C; Wong, John; Chao, Nelson; Shulman, Lawrence N; Grover, Surbhi; Magrath, Ian; Hahn, Stephen; Liu, Fei-Fei; DeWeese, Theodore; Khleif, Samir N; Steinberg, Michael; Roth, Lawrence; Pistenmaa, David A; Love, Richard R; Mohiuddin, Majid; Vikram, Bhadrasain

    2014-01-01

    The growing burden of non-communicable diseases including cancer in low- and lower-middle income countries (LMICs) and in geographic-access limited settings within resource-rich countries requires effective and sustainable solutions. The International Cancer Expert Corps (ICEC) is pioneering a novel global mentorship-partnership model to address workforce capability and capacity within cancer disparities regions built on the requirement for local investment in personnel and infrastructure. Radiation oncology will be a key component given its efficacy for cure even for the advanced stages of disease often encountered and for palliation. The goal for an ICEC Center within these health disparities settings is to develop and retain a high-quality sustainable workforce who can provide the best possible cancer care, conduct research, and become a regional center of excellence. The ICEC Center can also serve as a focal point for economic, social, and healthcare system improvement. ICEC is establishing teams of Experts with expertise to mentor in the broad range of subjects required to establish and sustain cancer care programs. The Hubs are cancer centers or other groups and professional societies in resource-rich settings that will comprise the global infrastructure coordinated by ICEC Central. A transformational tenet of ICEC is that altruistic, human-service activity should be an integral part of a healthcare career. To achieve a critical mass of mentors ICEC is working with three groups: academia, private practice, and senior mentors/retirees. While in-kind support will be important, ICEC seeks support for the career time dedicated to this activity through grants, government support, industry, and philanthropy. Providing care for people with cancer in LMICs has been a recalcitrant problem. The alarming increase in the global burden of cancer in LMICs underscores the urgency and makes this an opportune time fornovel and sustainable solutions to transform cancer care

  13. Health-related quality of life and health care use in cancer survivors compared with patients with chronic diseases.

    Science.gov (United States)

    Heins, Marianne J; Korevaar, Joke C; Hopman, Petra E P C; Donker, Gé A; Schellevis, François G; Rijken, Mieke P M

    2016-03-15

    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 compared health-related quality of life (HRQOL) and health care use among cancer survivors with that of patients with chronic diseases. Patients diagnosed at age >18 years with a cancer with a 5-year survival rate > 20% and no distant metastases at the time of diagnosis and patients aged >18 years with physician-diagnosed somatic chronic diseases without cancer were sent a questionnaire. HRQOL was measured with the RAND-36, a measure of HRQOL. Self-reported health care use was measured for general practitioner care, specialist care, rehabilitative care, physical therapy, ambulatory mental health care, and occupational health care. A total of 601 cancer survivors and 1052 patients with chronic diseases without cancer were included in the current study. Multimorbidity was observed in 63% of the cancer survivors and 61% of the patients with chronic diseases. The HRQOL of the cancer survivors was significantly better than that of patients with chronic diseases after adjustment for age and sex. For the mental functioning subscale, no significant differences were found between the 2 groups. Cancer survivors were found to be less likely to have visited a general practitioner or cardiologist compared with patients with chronic diseases. When considering physical HRQOL and health care use, cancer survivors appear to fare better than the average patient with chronic diseases. No difference in mental functioning was observed in the current study. © 2016 American Cancer Society.

  14. Nursing care dependence in the experiences of advanced cancer inpatients.

    Science.gov (United States)

    Piredda, Michela; Bartiromo, Chiara; Capuzzo, Maria Teresa; Matarese, Maria; De Marinis, Maria Grazia

    2016-02-01

    Increasing burden of cancer in Europe and socio-demographic trends imply that more cancer patients will face high levels of dependency. Care dependency is often perceived as a distressing experience by cancer patients who are concerned about becoming a burden to others. The experience of care dependence has been scarcely investigated in advanced cancer patients, especially in the hospital setting. This study aimed at describing advanced cancer patients' experiences of care dependence in hospital and of the factors perceived by them as contributing to decrease or increase this dependence. The study used a descriptive phenomenological approach based on Husserl's (1913) life world perspective. Data collection and analysis followed Giorgi's (1997) five basic methodological steps. Data were gathered by semi-structured interviews with thirteen advanced cancer adult inpatients of a teaching hospital. The interviews were audio-recorded and the recordings transcribed word for word. Three themes emerged: 'dependency discovers new meanings of life', 'active coping with dependency' and 'the care cures the dependent person'. The essential meaning of care dependency was the possibility to become aware of being a person as both an object and subject of care. Dependence appears as an experience with strong relational connotations, which enable patients to see differently their life, themselves, the world and others. Dependency is revealed as a natural experience, only partly in accordance with previous studies. Deeper insight into the meaning patients attach to care dependency can enable nurses to better meet the patient's needs, e.g. by improving caring relationships with patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Choosing Wisely: Opportunities for Improving Value in Cancer Care Delivery?

    Science.gov (United States)

    Rocque, Gabrielle B; Williams, Courtney P; Jackson, Bradford E; Wallace, Audrey S; Halilova, Karina I; Kenzik, Kelly M; Partridge, Edward E; Pisu, Maria

    2017-01-01

    Patients, providers, and payers are striving to identify where value in cancer care can be increased. As part of the Choosing Wisely (CW) campaign, ASCO and the American Society for Therapeutic Radiology and Oncology have recommended against specific, yet commonly performed, treatments and procedures. We conducted a retrospective analysis of Medicare claims data to examine concordance with CW recommendations across 12 cancer centers in the southeastern United States. Variability for each measure was evaluated on the basis of patient characteristics and site of care. Hierarchical linear modeling was used to examine differences in average costs per patient by concordance status. Potential cost savings were estimated on the basis of a potential 95% adherence rate and average cost difference. The analysis included 37,686 patients with cancer with Fee-for-Service Medicare insurance. Concordance varied by CW recommendation from 39% to 94%. Patient characteristics were similar for patients receiving concordant and nonconcordant care. Significant variability was noted across centers for all recommendations, with as much as an 89% difference. Nonconcordance was associated with higher costs for every measure. If concordance were to increase to 95% for all measures, we would estimate a $19 million difference in total cost of care per quarter. These results demonstrate ample room for reduction of low-value care and corresponding costs associated with the CW recommendations. Because variability in concordance was driven primarily by site of care, rather than by patient factors, continued education about these low-value services is needed to improve the value of cancer care.

  16. Communication about sexuality and intimacy in couples affected by lung cancer and their clinical-care providers.

    Science.gov (United States)

    Lindau, Stacy Tessler; Surawska, Hanna; Paice, Judith; Baron, Shirley R

    2011-02-01

    Little is known about the effects of lung cancer on intimate and sexual relationships. This study explores health-care provider, patient, and partner perspectives on: (1) the effects of lung cancer on physical and emotional intimacy, (2) the ways in which intimacy affects the experience of living with lung cancer, and (3) communication about intimacy and sexuality in the context of lung cancer. Qualitative, in-depth interviews with eight cancer-care providers and 13 married couples (ages 43-79) affected by lung cancer were conducted and audiotaped in the clinical setting. Interviews were transcribed, iteratively analyzed, and coded according to the above domains. Coding was performed independently by members of an interdisciplinary team; inter-rater reliability was assessed using the kappa statistic; and analyses were summarized by domain. Most cancer-care providers and couples affected by lung cancer believed intimacy and sexuality issues were salient, yet few reported discussing these. Couples described negative and positive effects of cancer on intimacy. Negative effects were driven by cancer or its treatment, including physical and psychological effects. Positive effects included an increase in non-coital physical closeness and appreciation of the spouse. Age was perceived as an important factor influencing the relationship between lung cancer and intimacy. Emotional intimacy and sexuality are important concerns for couples affected by lung cancer. The findings suggest previously unrecognized positive effects of lung cancer on emotional and physical intimacy. Couples affected by lung cancer and providers believe these issues are relevant for lung cancer care. Copyright © 2010 John Wiley & Sons, Ltd.

  17. Fertility effects of cancer treatment.

    Science.gov (United States)

    Marsden, Donald E; Hacker, Neville

    2003-01-01

    Cancer sufferers are a subfertile group, and most treatments have the potential to adversely affect gonadal function. As cancer treatment becomes more effective and survival rates improve there are more cancer survivors in the reproductive age group for whom parenting is an important consideration. This article outlines the effects on fertility of cancer treatments and techniques to minimise the risk of infertility. The overall prospects for younger cancer sufferers to either retain their fertility or have genetic offspring is now better than ever before, due to advances in assisted reproductive technology, the appropriate use of fertility sparing surgery and other techniques to reduce the toxicity of therapy on the reproductive organs. These advances raise new moral and ethical concerns that must be considered before advising cancer sufferers of the options for preserving reproductive capacity.

  18. Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer

    Science.gov (United States)

    Epstein, Ronald M.; Duberstein, Paul R.; Fenton, Joshua J.; Fiscella, Kevin; Hoerger, Michael; Tancredi, Daniel J.; Xing, Guibo; Gramling, Robert; Mohile, Supriya; Franks, Peter; Kaesberg, Paul; Plumb, Sandy; Cipri, Camille S.; Street, Richard L.; Shields, Cleveland G.; Back, Anthony L.; Butow, Phyllis; Walczak, Adam; Tattersall, Martin; Venuti, Alison; Sullivan, Peter; Robinson, Mark; Hoh, Beth; Lewis, Linda; Kravitz, Richard L.

    2018-01-01

    IMPORTANCE Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. OBJECTIVE To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life. DESIGN, SETTING, AND PARTICIPANTS Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers. INTERVENTIONS Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life. RESULTS Data from 38 oncologists (19 randomized

  19. 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.

  20. The Effect of Community-Based Specialist Palliative Care Teams on Place of Care.

    Science.gov (United States)

    Seow, Hsien; Dhaliwal, Gagan; Fassbender, Konrad; Rangrej, Jagadish; Brazil, Kevin; Fainsinger, Robin

    2016-01-01

    Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death. The study objective was to examine the place of care in the last 30 days of life. In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort. After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p care. Examining place of care in the last month can effectively illustrate the service use trajectory over time.

  1. Advance care planning within survivorship care plans for older cancer survivors: A systematic review.

    Science.gov (United States)

    O'Caoimh, Rónán; Cornally, Nicola; O'Sullivan, Ronan; Hally, Ruth; Weathers, Elizabeth; Lavan, Amanda H; Kearns, Tara; Coffey, Alice; McGlade, Ciara; Molloy, D William

    2017-11-01

    Advances in the medical treatment of cancer have increased the number of survivors, particularly among older adults, who now represent the majority of these. Survivorship care plans (SCPs) are documents that cancer patients receive summarising their care, usually at the end of treatment but preferably from initial diagnosis. These may increase patient satisfaction and represent an opportunity to initiate preventative strategies and address future care needs. Advance care planning (ACP), incorporating advance healthcare decision-making, including formal written directives, increases satisfaction and end-of-life care. This paper systematically reviews evaluations of ACP within SCPs among older (≥65 years) cancer survivors. No studies meeting the inclusion criteria were identified by search strategies conducted in PubMed/MEDLINE and the Cochrane databases. One paper examined cancer survivors' mainly positive views of ACP. Another discussed the use of a SCP supported by a 'distress inventory' that included an advance care directive (living will) as an issue, though no formal evaluation was reported. Although ACP is important for older adults, no study was found that evaluated its role within survivorship care planning. Despite the risk of recurrence and the potential for morbidity and mortality, especially among older cancer survivors, ACP is not yet a feature of SCPs. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. End-of-Life Care for Blood Cancers: A Series of Focus Groups With Hematologic Oncologists

    Science.gov (United States)

    Odejide, Oreofe O.; Salas Coronado, Diana Y.; Watts, Corey D.; Wright, Alexi A.; Abel, Gregory A.

    2014-01-01

    Purpose: Hematologic cancers are associated with aggressive cancer-directed care near death and underuse of hospice and palliative care services. We sought to explore hematologic oncologists' perspectives and decision-making processes regarding end-of-life (EOL) care. Methods: Between September 2013 and January 2014, 20 hematologic oncologists from the Dana-Farber/Harvard Cancer Center participated in four focus groups regarding EOL care for leukemia, lymphoma, multiple myeloma, and hematopoietic stem-cell transplantation. Focus groups employed a semistructured format with case vignettes and open-ended questions and were followed by thematic analysis. Results: Many participants felt that identifying the EOL phase for patients with hematologic cancers was challenging as a result of the continuing potential for cure with advanced disease and the often rapid pace of decline near death. This difficulty was reported to result in later initiation of EOL care. Barriers to high-quality EOL care were also reported to be multifactorial, including unrealistic expectations from both physicians and patients, long-term patient-physician relationships resulting in difficulty conducting EOL discussions, and inadequacy of existing home-based EOL services. Participants also expressed concern that some EOL quality measures developed for solid tumors may be unacceptable for patients with blood cancers given their unique needs at the EOL (eg, palliative transfusions). Conclusion: Our analysis suggests that hematologic oncologists need better clinical markers for when to initiate EOL care. In addition, current quality measures may be inappropriate for identifying overly aggressive care for patients with blood cancers. Further research is needed to develop effective interventions to improve EOL care for this patient population. PMID:25294393

  3. 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

    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...... continuing medical education (CME) initiatives, and an enhanced cooperative effort between those delivering and coordinating cancer care....

  4. Integration of Massage Therapy in Outpatient Cancer Care.

    Science.gov (United States)

    Cowen, Virginia S; Tafuto, Barbara

    2018-03-01

    Massage therapy can be helpful in alleviating cancer-related symptoms and cancer treatment-related symptoms. While surveys have noted that cancer patients seek out massage as a nonpharmacologic approach during cancer treatment, little is known about the integration of massage in outpatient cancer care. The purpose of this study was to examine the extent to which massage is being integrated into outpatient cancer care at NCI-designated Cancer Centers. This study used descriptive methods to analyze the integration of massage in NCI-designated Cancer Centers providing clinical services to patients (n = 62). Data were collected from 91.1% of the centers (n = 59) using content analysis and a telephone survey. A dataset was developed and coded for analysis. The integration of massage was assessed by an algorithm that was developed from a set of five variables: 1) acceptance of treatment as therapeutic, 2) institution offers treatment to patients, 3) clinical practice guidelines in place, 4) use of evidence-based resources to inform treatment, and 5) shared knowledge about treatment among health care team. All centers were scored against all five variables using a six-point scale, with all variables rated equally. The integration of massage ranged from not at all (0) to very high (5) with all five levels of integration evident. Only 11 centers (17.7% of total) rated a very high level of integration; nearly one-third of the centers (n = 22) were found to have no integration of massage at all-not even provision of information about massage to patients through the center website. The findings of this analysis suggest that research on massage is not being leveraged to integrate massage into outpatient cancer care.

  5. Integration of Massage Therapy in Outpatient Cancer Care

    Science.gov (United States)

    Cowen, Virginia S.; Tafuto, Barbara

    2018-01-01

    Background Massage therapy can be helpful in alleviating cancer-related symptoms and cancer treatment-related symptoms. While surveys have noted that cancer patients seek out massage as a nonpharmacologic approach during cancer treatment, little is known about the integration of massage in outpatient cancer care. Purpose The purpose of this study was to examine the extent to which massage is being integrated into outpatient cancer care at NCI-designated Cancer Centers. Setting This study used descriptive methods to analyze the integration of massage in NCI-designated Cancer Centers providing clinical services to patients (n = 62). Design Data were collected from 91.1% of the centers (n = 59) using content analysis and a telephone survey. A dataset was developed and coded for analysis. Main Outcome Measure The integration of massage was assessed by an algorithm that was developed from a set of five variables: 1) acceptance of treatment as therapeutic, 2) institution offers treatment to patients, 3) clinical practice guidelines in place, 4) use of evidence-based resources to inform treatment, and 5) shared knowledge about treatment among health care team. All centers were scored against all five variables using a six-point scale, with all variables rated equally. Results The integration of massage ranged from not at all (0) to very high (5) with all five levels of integration evident. Only 11 centers (17.7% of total) rated a very high level of integration; nearly one-third of the centers (n = 22) were found to have no integration of massage at all—not even provision of information about massage to patients through the center website. Conclusions The findings of this analysis suggest that research on massage is not being leveraged to integrate massage into outpatient cancer care. PMID:29593842

  6. Barriers to overcome for effective cancer control in Africa.

    Science.gov (United States)

    Harford, Joe B

    2015-08-01

    Cancer control in Africa is complicated due to large differences in cancer incidence between countries caused by differences in exposure to known risk factors. For example, substantial differences are seen when selected cancers in north Africa are compared with those in sub-Saharan Africa. In the future, population growth and demographic shifts are likely to have profound effects on the prevalence of cancer across the continent. Likewise, many factors outside of health care such as language differences, conflict, and poverty can affect cancer control efforts. Although cooperation in cancer control efforts is desirable, differences in cultural and geopolitical factors that characterise African countries and their populations, together with the sheer size of the continent, present unique challenges to effective cancer control. This Series paper discusses factors related to the size, diversity, and conditions within Africa that present barriers to optimal collaboration in cancer control efforts across the continent. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Regional implementation of a national cancer policy: taking forward multiprofessional, collaborative cancer care.

    Science.gov (United States)

    Ferguson, A; Makin, W; Walker, B; Dublon, G

    1998-09-01

    The vision of the Calman-Hine paper is of patient-centred care, delivered by co-ordinated services which have genuine partnerships with each other. There is integration of other providers of support, to meet psychological and non-clinical needs. There is access to palliative care when required, from diagnosis onwards, and not just in the terminal stage. Effective communications and networks are the keys to making this vision a reality. Our recommendations are based upon in-depth discussions with purchasers, doctors and nurses, and others involved with cancer services within hospitals or the community across the region. They reflect the priorities placed on the development of good practice. Purchasers and providers should work together to implement these guidelines.

  8. Identifying critical steps towards improved access to innovation in cancer care: a European CanCer Organisation position paper.

    Science.gov (United States)

    Aapro, Matti; Astier, Alain; Audisio, Riccardo; Banks, Ian; Bedossa, Pierre; Brain, Etienne; Cameron, David; Casali, Paolo; Chiti, Arturo; De Mattos-Arruda, Leticia; Kelly, Daniel; Lacombe, Denis; Nilsson, Per J; Piccart, Martine; Poortmans, Philip; Riklund, Katrine; Saeter, Gunnar; Schrappe, Martin; Soffietti, Riccardo; Travado, Luzia; van Poppel, Hein; Wait, Suzanne; Naredi, Peter

    2017-09-01

    In recent decades cancer care has seen improvements in the speed and accuracy of diagnostic procedures; the effectiveness of surgery, radiation therapy and medical treatments; the power of information technology; and the development of multidisciplinary, specialist-led approaches to care. Such innovations are essential if we are to continue improving the lives of cancer patients across Europe despite financial pressures on our healthcare systems. Investment in innovation must be balanced with the need to ensure the sustainability of healthcare budgets, and all health professionals have a responsibility to help achieve this balance. It requires scrutiny of the way care is delivered; we must be ready to discontinue practices or interventions that are inefficient, and prioritise innovations that may deliver the best outcomes possible for patients within the limits of available resources. Decisions on innovations should take into account their long-term impact on patient outcomes and costs, not just their immediate costs. Adopting a culture of innovation requires a multidisciplinary team approach, with the patient at the centre and an integral part of the team. It must take a whole-system and whole-patient perspective on cancer care and be guided by high-quality real-world data, including outcomes relevant to the patient and actual costs of care; this accurately reflects the impact of any innovation in clinical practice. The European CanCer Organisation is committed to working with its member societies, patient organisations and the cancer community at large to find sustainable ways to identify and integrate the most meaningful innovations into all aspects of cancer care. Copyright © 2017. Published by Elsevier Ltd.

  9. Availability of stage at diagnosis, cancer treatment delay and compliance with cancer guidelines as cancer registry indicators for cancer care in Europe: Results of EUROCHIP-3 survey

    NARCIS (Netherlands)

    Siesling, Sabine; Kwast, A.; Gavin, A.; Baili, P.; Otter, R.

    2013-01-01

    EUROCHIP (European Cancer Health Indicators Project) focuses on understanding inequalities in the cancer burden, care and survival by the indicators “stage at diagnosis,” “cancer treatment delay” and “compliance with cancer guidelines” as the most important indicators. Our study aims at providing

  10. Disparities in quality of cancer care: The role of health insurance and population demographics.

    Science.gov (United States)

    Parikh-Patel, Arti; Morris, Cyllene R; Kizer, Kenneth W

    2017-12-01

    Escalating costs and concerns about quality of cancer care have increased calls for quality measurement and performance accountability for providers and health plans. The purpose of the present cross-sectional study was to assess variability in the quality of cancer care by health insurance type in California.Persons with breast, ovary, endometrium, cervix, colon, lung, or gastric cancer during the period 2004 to 2014 were identified in the California Cancer Registry. Individuals were stratified into 5 health insurance categories: private insurance, Medicare, Medicaid, dual Medicare and Medicaid eligible, and uninsured. Quality of care was evaluated using Commission on Cancer quality measures. Logistic regression models were generated to assess the independent effect of health insurance type on stage at diagnosis, quality of care and survival after adjusting for age, sex, race/ethnicity, and socioeconomic status (SES).A total of 763,884 cancer cases were evaluated. Individuals with Medicaid or Medicare-Medicaid dual-eligible coverage and the uninsured had significantly lower odds of receiving recommended radiation and/or chemotherapy after diagnosis or surgery for breast, endometrial, and colon cancer, relative to those with private insurance. Dual eligible patients with gastric cancer had 21% lower odds of having the recommended number of lymph nodes removed and examined compared to privately insured patients.After adjusting for known demographic confounders, substantial and consistent disparities in quality of cancer care exist according to type of health insurance in California. Further study is needed to identify particular factors and mechanisms underlying the identified treatment disparities across sources of health insurance. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  11. Primary care and communication in shared cancer care: A Qualitative Study

    Science.gov (United States)

    Sada, Yvonne; Street, Richard L.; Singh, Hardeep; Shada, Rachel; Naik, Aanand D.

    2013-01-01

    Objective To explore perceptions of primary care physicians’ (PCPs) and oncologists’ roles, responsibilities, and patterns of communication related to shared cancer care in three integrated health systems that used electronic health records (EHRs). Study design Qualitative study. Methods We conducted semi-structured interviews with ten early stage colorectal cancer patients and fourteen oncologists and PCPs. Sample sizes were determined by thematic saturation. Dominant themes and codes were identified and subsequently applied to all transcripts. Results Physicians reported that EHRs improved communication within integrated systems, but communication with physicians outside their system was still difficult. PCPs expressed uncertainty about their role during cancer care, even though medical oncologists emphasized the importance of co-morbidity control during cancer treatment. Both patients and physicians described additional roles for PCPs, including psychological distress support and behavior modification. Conclusions Integrated systems that use EHRs likely facilitate shared cancer care through improved PCP-oncologist communication. However, strategies to facilitate a more active role for PCPs in managing co-morbidities, psychological distress and behavior modification, as well as to overcome communication challenges between physicians not practicing within the same integrated system, are still needed to improve shared cancer care. PMID:21615196

  12. [Development of Spiritual Care in Cancer Treatment in Japan].

    Science.gov (United States)

    Shimazono, Susumu

    2017-01-01

    Spiritual care started worldwide in the late 1960s with the development of the hospice movement and death studies. Why did spiritual care start duringthis time in history ? In some Christian societies, of that time,"pastoral care" evolved into an interfaith "spiritual care" where in the caretaker was the main agent instead of the caregiver. On the other hand, the importance of palliative care for cancer patients was gradually acknowledged. In addition, this progress was accompanied by the academic development of "death studies" which is called "death and life studies" in Japan. The Japanese hospice care and death studies movement started in the late 1970s. In the precedingperiod, the spiritual quest of cancer patients facingdeath was already gaining public attention. A scholar of religious studies, Hideo Kishimoto of the University of Tokyo, was diagnosed with cancer in 1954; he survived many operations until his death in 1964. Duringthose years, he wrote about his personal experience of acceptinghis approachingdeath. Although he did not believe in any specific faith, he had studied various religious teachings. It is important to understand his perception of his own death. His book, On Facing Death, was published immediately after his death. Therefore, it provided a prominent discourse on copingwith spiritual pain of approachingdeath even before the growth of spiritual care in Japan.

  13. The supportive care needs for prostate cancer patients in Sarawak.

    Science.gov (United States)

    Cheah, Whye Lian; Ling, Ngok Chuo; Chang, Kam Hock

    2016-02-01

    This cross-sectional study aimed to determine the prevalence of unmet supportive care needs among prostate cancer patients. The cross-sectional study was conducted among all prostate cancer patients at the Sarawak General Hospital. Interview was done using the Supportive Care Needs Survey-Short Form (SCNS-SF) and the Health Service Utilization Questionnaires (HSUQ). Data were analysed using Statistical Package for the Social Sciences (SPSS) 20. A total of ninety-five patients participated, with majority were aged 65 and above and of primary educational level. The two most frequently reported unmet supportive care needs were "informed about cancer which is under control or diminishing" and "informed about things you can do to help yourself to get well" under the domain Health System and Information. Respondents who were older (65 years and above) had significant lower unmet needs in psychology (P<0.01), and sexuality compared to the younger group below 65 years (P<0.01). Except for physical and daily living, respondents with primary school level had significant lower unmet needs in all domains compared to secondary school level. Respondents with known stages of cancer had higher unmet needs in all domains compared to those who did not know. Healthcare providers should provide more responsive, emotionally sensitive and client-centered care to patients with prostate cancer, particularly in the area of Health System and Information, and psychological support.

  14. Experiences of ethical issues when caring for children with cancer.

    Science.gov (United States)

    Bartholdson, Cecilia; Lützén, Kim; Blomgren, Klas; Pergert, Pernilla

    2015-01-01

    The treatment for pediatric cancer is often physically, socially, and psychologically demanding and often gives rise to ethical issues. The purpose of this study was to describe healthcare professionals' experiences of ethical issues and ways to deal with these when caring for children with cancer. A study-specific questionnaire was given to healthcare professionals at a pediatric hospital in Sweden. Qualitative content analysis was used to analyze answers to open-ended questions. The data were sorted into 2 domains based on the objective of the study. In the next step, the data in each domain were inductively coded, generating categories and subcategories. The main ethical issues included concerns of (1) infringing on autonomy, (2) deciding on treatment levels, and (3) conflicting perspectives that constituted a challenge to collaboration. Professionals desired teamwork and reflection to deal with ethical concerns, and they needed resources for dealing with ethics. Interprofessional consideration needs to be improved. Forums and time for ethics reflections need to be offered to deal with ethical concerns in childhood cancer care. Experiences of ethical concerns and dealing with these in caring for children with cancer evoked strong feelings and moral perplexity among nursing staff. The study raises a challenging question: How can conflicting perspectives, lack of interprofessional consideration, and obstacles related to parents' involvement be "turned around," that is, contribute to a holistic perspective of ethics in cancer care of children?

  15. 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.

  16. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... Information Advance Directives Using Trusted Resources Cancer Types Adolescents and Young Adults with Cancer Reports, Research, and Literature Cancers by Body Location/System Childhood Cancers Late Effects of Childhood Cancer Treatment Pediatric Supportive Care Unusual ...

  17. Quality of life and care needs in women with estrogen positive metastatic breast cancer

    DEFF Research Database (Denmark)

    Lee Mortensen, Gitte; Madsen, Ivan Bredbjerg; Krogsgaard, Randi

    2018-01-01

    BACKGROUND: In recent years, the prognosis of metastatic breast cancer (MBC) has improved with more effective therapies applicable to a wider range of patients. To many patients, a MBC diagnosis thus initiates a prolonged course of illness and treatment. This qualitative study aimed to explore...... approach to care including psychological support, in particular, but also manual physiotherapy, health care coordination and social counseling. The participants called for continuity of care with the same health care professionals as this facilitated communication and flexibility in planning treatment...

  18. Racial Disparities in Palliative Care for Prostate Cancer

    Science.gov (United States)

    2016-01-01

    1 | P a g e Award Number: W81XWH-10-1-0802 TITLE: " Racial Disparities in Palliative Care for Prostate Cancer." PRINCIPAL INVESTIGATOR: Alfred I...CONTRACT NUMBER W81XWH-10-1-0802 " Racial Disparities in Palliative Care for Prostate Cancer." 5b. GRANT NUMBER PC094372 5c. PROGRAM ELEMENT NUMBER...developed the tools/methods for working with SEER-Medicare. We plan to use analytic approaches and methods to explore racial disparities in the use of

  19. Impact of managed care on cancer trial enrollment.

    Science.gov (United States)

    Gross, C P; Krumholz, H M

    2005-06-01

    To determine the relationship between managed care market activity and cancer trial enrollment. Trial participant data were obtained from the National Cancer Institute. Participants in cooperative group trials of breast, colorectal, lung, or prostate cancer during the years 1996 through 2001 were assigned to counties based on their zip code of residence. Linear regression was used to determine the relationship between county enrollment rate and two measures of county managed care activity (penetration and index of competition [IOC]), adjusting for other county characteristics. In bivariate analysis, there was a strong inverse correlation between trial enrollment rate and IOC (r = -0.23; P penetration, proportion uninsured, and other county characteristics. Counties in the lowest quartile of managed care penetration tended to have lower enrollment rates than the remaining counties (r = -0.05; P = .048), while counties in the second, third, and fourth quartiles of penetration all had similar enrollment rates to one another. Cancer trial enrollment rates were suboptimal across all counties, and counties with higher levels of managed care competition had significantly lower enrollment rates. The relationship between managed care penetration and trial enrollment was less consistent. Future efforts to enhance trial participation should address the potential negative influence of market factors.

  20. Caring for cancer patients in the general dental office

    International Nuclear Information System (INIS)

    McDermott, I.

    1989-01-01

    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

  1. Yoga into cancer care: A review of the evidence-based research

    Directory of Open Access Journals (Sweden)

    Ram P Agarwal

    2018-01-01

    Full Text Available To cope with cancer and its treatment-related side effects and toxicities, people are increasingly using complementary and alternative medicine (CAM. Consequently, integrative oncology, which combines conventional therapies and evidence-based CAM practices, is an emerging discipline in cancer care. The use of yoga as a CAM is proving to be beneficial and increasingly gaining popularity. An electronic database search (PubMed, through December 15, 2016, revealed 138 relevant clinical trials (single-armed, nonrandomized, and randomized controlled trials on the use of yoga in cancer patients. A total of 10,660 cancer patients from 20 countries were recruited in these studies. Regardless of some methodological deficiencies, most of the studies reported that yoga improved the physical and psychological symptoms, quality of life, and markers of immunity of the patients, providing a strong support for yoga's integration into conventional cancer care. This review article presents the published clinical research on the prevalence of yoga's use in cancer patients so that oncologists, researchers, and the patients are aware of the evidence supporting the use of this relatively safe modality in cancer care.

  2. [Challenges for home care services in the pain management of cancer patients : A qualitative study].

    Science.gov (United States)

    Gnass, I; Krutter, S; Nestler, N

    2018-03-21

    People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation. By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted. On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment. Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.

  3. Comparative cost-effectiveness of fine needle aspiration biopsy versus image-guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of Affordable Care Act: a changing landscape.

    Science.gov (United States)

    Masood, Shahla; Rosa, Marilin; Kraemer, Dale F; Smotherman, Carmen; Mohammadi, Amir

    2015-08-01

    Proven as a time challenged and cost-effective sampling procedure, the use of FNAB has still remained controversial among the scientific community. Currently, other minimally invasive sampling procedures such as ultrasound guided fine needle aspiration biopsy (US-FNAB) and image guided core needle biopsy (IG-CNB) have become the preferred sampling procedures for evaluation of breast lesions. However, changes in the medical economy and the current growing emphasis on cost containment in the era of the Affordable Care Act make it necessary to stimulate a renewed interest in the use of FNAB as the initial diagnostic sampling procedure. This study was designed to define the changing trend in the practice of tissue sampling during the last several years, and to assess the comparative effectiveness and appropriateness of the procedure of choice for breast cancer diagnosis. After Institutional Review Board (IRB) approval, the computer database of the Pathology Department, University of Florida, College of Medicine-Jacksonville at UF Health was retrospectively searched to identify all breast biopsy pathology reports issued during the period of January 2004 to December 2011. The inclusion criteria were all women that underwent any of the following biopsy types: FNAB, US-FNAB, IG-CNB, and surgical biopsy (SB). Diagnostic procedures were identified using current procedural terminology (CPT) codes recorded on claims from the UF Health Jacksonville patient accounting application files. The data obtained was used to determine which technique has the best cost-effectiveness in the diagnosis of breast cancer. The outcome variable for this project was a positive breast cancer diagnosis resulting from these methodologies. The predictor variable was the biopsy type used for sampling. The rate of cancer detection for each procedure was also determined. Among the four groups of procedures compared, the lower cost was attributed to FNAB, followed by US-FNAB, and SB. IG-CNB was the most

  4. Exploring aspects of physiotherapy care valued by breast cancer patients.

    Science.gov (United States)

    Pidlyskyj, K; Roddam, H; Rawlinson, G; Selfe, J

    2014-06-01

    To explore the reported value of physiotherapy care received by patients who had accessed a Specialist Breast Care Physiotherapy Service. Exploratory qualitative study using in-depth interviews to explore aspects of physiotherapy care valued by breast cancer patients. Thematic network analysis was used to interpret the data and bring together the different experiences of the participants and identify common themes. Physiotherapy Department at a NHS Foundation Trust Teaching Hospital. Nineteen participants were recruited and three were selected to take part in the in-depth interviews. All participants had received physiotherapy care from a Specialist Breast Care Physiotherapy Service and had been discharged within the last six months. Participants valued a patient-centred holistic approach to care and access to a Specialist Service with an experienced clinician. In particular the importance of the therapeutic alliance and the value of psychological, emotional and educational support emerged, with the participants feeling empowered in their recovery. Participants reported an overall positive experience of their physiotherapy care. This study supports the need for service providers to evaluate their current physiotherapy provision and subsequently develop Specialised Services to meet the physiotherapy needs of breast cancer patients throughout all stages of their treatment pathway from the delivery of pre-operative care through to post-treatment follow-up. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  5. Knowledge, Attitudes and Practices Regarding Cervical Cancer and Screening among Haitian Health Care Workers

    Directory of Open Access Journals (Sweden)

    Leilah Zahedi

    2014-11-01

    Full Text Available It is estimated that Haiti has the highest incidence of cervical cancer in the Western Hemisphere. There are currently no sustainable and affordable cervical cancer screening programs in Haiti. The current status of screening services and knowledge of health care professionals was assessed through a Knowledge, Attitudes, and Practices survey on cervical cancer screening and prevention. It was distributed to Project Medishare for Haiti health care workers (n = 27 in the Central Plateau. The majority (22/27 of participants stated pre-cancerous cells could be detected through screening, however, only four had ever performed a pap smear. All of the participants felt a screening program should be started in their area. Our data establishes that knowledge is fairly lacking among healthcare workers and there is an opportunity to train them in simple, cost effective “screen-and-treat” programs that could have a great impact on the overall health of the population.

  6. 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 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....

  7. Australian patterns of prostate cancer care: Are they evolving?

    Science.gov (United States)

    Lo, Jonathon; Papa, Nathan; Bolton, Damien M.; Murphy, Declan; Lawrentschuk, Nathan

    2015-01-01

    Background Approaches to prostate cancer (PCa) care have changed in recent years out of concern for overdiagnosis and overtreatment. Despite these changes, many patients continue to undergo some form of curative treatment and with a growing perception among multidisciplinary clinicians that more aggressive treatments are being favored. This study examines patterns of PCa care in Australia, focusing on current rates of screening and aggressive interventions that consist of high-dose-rate (HDR) brachytherapy and pelvic lymph node dissection (PLND). Methods Health services data were used to assess Australian men undergoing PCa screening and treatment from 2001 to 2014. Age-specific rates of prostate-specific antigen (PSA) screening were calculated. Ratios of radical prostatectomy (RP) with PLND to RP without PLND, and HDR brachytherapy to low-dose-rate (LDR) brachytherapy were determined by state jurisdictions. Results From 2008, the rate of PSA screening trended downward significantly with year for all age ranges (P use of HDR brachytherapy (ratio of HDR to LDR brachytherapy < 0.5 for all jurisdictions except the Australian Capital Territory). Conclusion Rates of PLND and HDR brachytherapy for PCa have declined in Australia, providing evidence for the effect of stage migration due to widespread PSA screening. Currently, PSA screening rates remain high among older men, which may expose them to unnecessary investigations and treatment-related morbidity. PMID:27014660

  8. Perspectives on music therapy in adult cancer care: a hermeneutic study.

    Science.gov (United States)

    Olofsson, Anne; Fossum, Bjöörn

    2009-07-01

    To explore perspectives on music therapy as a nursing intervention in adult cancer care and to expand and integrate knowledge and understanding about music therapy as an adjunctive intervention in adult cancer nursing care. Published nursing articles. Medical and nursing journals have reported on research related to music and its effect as a nursing intervention. However, this research often lacks a musical context (i.e., knowledge and understanding from a musical perspective). Music therapy is not a consistent concept. Perspectives on the meanings of music therapy vary according to knowledge and scientific orientation. The perspective may influence the character and methodology of the music therapy intervention as well as the understanding of its results. To fully develop music therapy as an adjunct intervention in adult cancer care, interdisciplinary cooperation between nurses and music therapists should be supported on clinical and educational levels.

  9. Determinants of variable resource use for multidisciplinary team meetings in cancer care

    DEFF Research Database (Denmark)

    Alexandersson, Nathalie; Rosell, Linn; Wihl, Jessica

    2018-01-01

    discussion and an increasing number of participants raise questions on cost versus benefit. We aimed to determine cost of MDTMs and to define determinants hereof based on observations in Swedish cancer care. METHODS: Data were collected through observations of 50 MDTMs and from questionnaire data from 206....... CONCLUSIONS: We identify considerable variability in resource use for MDTMs in cancer care and demonstrate that 84% of the total cost is derived from physician time. The variability demonstrated underscores the need for regular and structured evaluations to ensure cost effective MDTM services....

  10. 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.

  11. Singing and Vocal Interventions in Palliative and Cancer Care: Music Therapists' Perceptions of Usage.

    Science.gov (United States)

    Clements-Cortés, Amy

    2017-11-01

    Music therapists in palliative and cancer care settings often use singing and vocal interventions. Although benefits for these interventions are emerging, more information is needed on what type of singing interventions are being used by credentialed music therapists, and what goal areas are being addressed. To assess music therapists' perceptions on how they use singing and vocal interventions in palliative and cancer care environments. Eighty credentialed music therapists from Canada and the United States participated in this two-part convergent mixed-methods study that began with an online survey, followed by individual interviews with 50% (n = 40) of the survey participants. In both palliative and cancer care, singing client-preferred music and singing for relaxation were the most frequently used interventions. In palliative care, the most commonly addressed goals were to increase self-expression, improve mood, and create a feeling of togetherness between individuals receiving palliative care and their family. In cancer care, the most commonly addressed goals were to support breathing, improve mood, and support reminiscence. Seven themes emerged from therapist interviews: containing the space, connection, soothing, identity, freeing the voice within, letting go, and honoring. Music therapists use singing to address the physical, emotional, social, and spiritual goals of patients, and described singing interventions as accessible and effective. Further research is recommended to examine intervention efficacy and identify factors responsible that contribute to clinical benefit. © the American Music Therapy Association 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  12. 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

  13. Effects of a problem-solving intervention (COPE) on quality of life for patients with advanced cancer on clinical trials and their caregivers: simultaneous care educational intervention (SCEI): linking palliation and clinical trials.

    Science.gov (United States)

    Meyers, Frederick J; Carducci, Michael; Loscalzo, Matthew J; Linder, John; Greasby, Tamara; Beckett, Laurel A

    2011-04-01

    Patients on investigational clinical trials and their caregivers experience poor quality of life (QOL), which declines as the disease progresses. To examine the effect of a standardized cognitive-behavioral problem-solving educational intervention on the QOL of patients enrolled on investigational clinical trials and their caregivers. Prospective, multi-institution, randomized trial. QOL was measured repeatedly over 6 months. Patients were simultaneously enrolled onto phase 1, 2, or 3 Institutional Review Board (IRB)-approved cancer clinical trials. Intervention arm dyads participated in three conjoint educational sessions during the first month, learning the COPE problem solving model. Nonintervention arm dyads received usual care. Global QOL was measured by the City of Hope Quality of Life Instruments for Patients or Caregivers; problem solving skills were measured by the Social Problem Solving Inventory-Revised. The results are reported using the CONSORT statement. The analytic data set included 476 dyads including 1596 patient data points and 1576 care giver data points. Patient QOL showed no significant difference in the rate of change between the intervention and usual care arms (p = 0.70). Caregiver QOL scores in the intervention arm declined, but at less than half the rate in the control arm (p = 0.02). The COPE intervention enabled the average caregiver to come much closer to stable QOL over the 6-month follow-up. Future studies should enroll subjects much earlier in the cancer illness trajectory, a common patient/caregiver theme. The maximum effect was seen in caregivers who completed the 6-month follow-up, suggesting that the impact may increase over time.

  14. Nutritional supportive care in children with cancer

    International Nuclear Information System (INIS)

    Riha, P.; Smisek, P.

    2013-01-01

    Appropriate nutritional support is an important part of comprehensive oncology treatment. The aim is to decrease the incidence of malnutrition. Malnourished patients are in higher risk of infectious and toxic complications, experience worse quality of life. Systematic survey of nutritional status and early nutritional intervention can eventually lead to better results of oncology treatment. We review the definitions, etiology and epidemiology of malnutrition, practical approaches to nutritional support of children with cancer. (author)

  15. Improving Goals of Care Discussion in Advanced Cancer Patients

    Science.gov (United States)

    2017-08-23

    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. 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...... and out of hours were collected 9 months after recruitment and the data from the two groups were compared quarterly. RESULTS: CM was associated with an overall tendency towards more positive GP evaluations, which for 3 of 20 items reached statistical significance. Statistically significantly fewer GPs...

  17. Assessing patients' experiences with communication across the cancer care continuum.

    Science.gov (United States)

    Mazor, Kathleen M; Street, Richard L; Sue, Valerie M; Williams, Andrew E; Rabin, Borsika A; Arora, Neeraj K

    2016-08-01

    To evaluate the relevance, performance and potential usefulness of the Patient Assessment of cancer Communication Experiences (PACE) items. Items focusing on specific communication goals related to exchanging information, fostering healing relationships, responding to emotions, making decisions, enabling self-management, and managing uncertainty were tested via a retrospective, cross-sectional survey of adults who had been diagnosed with cancer. Analyses examined response frequencies, inter-item correlations, and coefficient alpha. A total of 366 adults were included in the analyses. Relatively few selected Does Not Apply, suggesting that items tap relevant communication experiences. Ratings of whether specific communication goals were achieved were strongly correlated with overall ratings of communication, suggesting item content reflects important aspects of communication. Coefficient alpha was ≥.90 for each item set, indicating excellent reliability. Variations in the percentage of respondents selecting the most positive response across items suggest results can identify strengths and weaknesses. The PACE items tap relevant, important aspects of communication during cancer care, and may be useful to cancer care teams desiring detailed feedback. The PACE is a new tool for eliciting patients' perspectives on communication during cancer care. It is freely available online for practitioners, researchers and others. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. 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.

  19. Quantifying the Cumulative Impact of Differences in Care on Prostate Cancer Outcomes

    National Research Council Canada - National Science Library

    Fesinmeyer, Megan

    2007-01-01

    ... of the disparity in prostate cancer outcomes. This work involves first examining how care patterns are correlated throughout all phases of cancer care within racial groups in order to gain a fuller understanding of how racial differences across...

  20. Nutrition in Cancer Care (PDQ®)—Health Professional Version

    Science.gov (United States)

    Nutrition in cancer care can be affected by the tumor or by treatment and result in weight loss, malnutrition, anorexia, cachexia, and sarcopenia. Get information about strategies to screen, assess, and treat nutritional problems, including through diet and supplements, in this clinician summary.

  1. The interaction between informal cancer caregivers and health care professionals

    DEFF Research Database (Denmark)

    Lund, Line; Ross, Lone; Petersen, Morten Aagaard

    2015-01-01

    PURPOSE: In order to meet the caregiving challenges, informal caregivers often need a substantial level of interaction with health care professionals (HCPs). This study investigated to which extent the cancer caregivers' needs regarding the interaction with HCPs are met and the associations betwe...

  2. Psychosocial Assessment as a Standard of Care in Pediatric Cancer

    NARCIS (Netherlands)

    Kazak, Anne E.; Abrams, Annah N.; Banks, Jaime; Christofferson, Jennifer; DiDonato, Stephen; Grootenhuis, Martha A.; Kabour, Marianne; Madan-Swain, Avi; Patel, Sunita K.; Zadeh, Sima; Kupst, Mary Jo

    2015-01-01

    This paper presents the evidence for a standard of care for psychosocial assessment in pediatric cancer. An interdisciplinary group of investigators utilized EBSCO, PubMed, PsycINFO, Ovid, and Google Scholar search databases, focusing on five areas: youth/family psychosocial adjustment, family

  3. Finding the Right Care | Center for Cancer Research

    Science.gov (United States)

    Trained as a registered nurse and with a doctoral degree in public health, Jane D. is no stranger to the U.S. health care system. But, when she found herself facing a diagnosis of anal cancer in 2013, she felt adrift.

  4. 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.

  5. Optimisation of surgical care for rectal cancer

    NARCIS (Netherlands)

    Borstlap, W.A.A.

    2017-01-01

    Optimisation of surgical care means weighing the risk of treatment related morbidity against the patients’ potential benefits of a surgical intervention. The first part of this thesis focusses on the anaemic patient undergoing colorectal surgery. Hypothesizing that a more profound haemoglobin

  6. Coordinating cancer care: patient and practice management processes among surgeons who treat breast cancer.

    Science.gov (United States)

    Katz, Steven J; Hawley, Sarah T; Morrow, Monica; Griggs, Jennifer J; Jagsi, Reshma; Hamilton, Ann S; Graff, John J; Friese, Christopher R; Hofer, Timothy P

    2010-01-01

    The Institute of Medicine has called for more coordinated cancer care models that correspond to initiatives led by cancer providers and professional organizations. These initiatives parallel those underway to integrate the management of patients with chronic conditions. We developed 5 breast cancer patient and practice management process measures based on the Chronic Care Model. We then performed a survey to evaluate patterns and correlates of these measures among attending surgeons of a population-based sample of patients diagnosed with breast cancer between June 2005 and February 2007 in Los Angeles and Detroit (N = 312; response rate, 75.9%). Surgeon practice specialization varied markedly with about half of the surgeons devoting 15% or less of their total practice to breast cancer, whereas 16.2% of surgeons devoted 50% or more. There was also large variation in the extent of the use of patient and practice management processes with most surgeons reporting low use. Patient and practice management process measures were positively associated with greater levels of surgeon specialization and the presence of a teaching program. Cancer program status was weakly associated with patient and practice management processes. Low uptake of patient and practice management processes among surgeons who treat breast cancer patients may indicate that surgeons are not convinced that these processes matter, or that there are logistical and cost barriers to implementation. More research is needed to understand how large variations in patient and practice management processes might affect the quality of care for patients with breast cancer.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    /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......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...... 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...

  8. 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

  9. 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…

  10. Electronic health records (EHRs): supporting ASCO's vision of cancer care.

    Science.gov (United States)

    Yu, Peter; Artz, David; Warner, Jeremy

    2014-01-01

    ASCO's vision for cancer care in 2030 is built on the expanding importance of panomics and big data, and envisions enabling better health for patients with cancer by the rapid transformation of systems biology knowledge into cancer care advances. This vision will be heavily dependent on the use of health information technology for computational biology and clinical decision support systems (CDSS). Computational biology will allow us to construct models of cancer biology that encompass the complexity of cancer panomics data and provide us with better understanding of the mechanisms governing cancer behavior. The Agency for Healthcare Research and Quality promotes CDSS based on clinical practice guidelines, which are knowledge bases that grow too slowly to match the rate of panomic-derived knowledge. CDSS that are based on systems biology models will be more easily adaptable to rapid advancements and translational medicine. We describe the characteristics of health data representation, a model for representing molecular data that supports data extraction and use for panomic-based clinical research, and argue for CDSS that are based on systems biology and are algorithm-based.

  11. Survey of advanced radiation technologies used at designated cancer care hospitals in Japan

    International Nuclear Information System (INIS)

    Shikama, Naoto; Tsujino, Kayoko; Nakamura, Katsumasa; Ishikura, Satoshi

    2014-01-01

    Our survey assessed the use of advanced radiotherapy technologies at the designated cancer care hospitals in Japan, and we identified several issues to be addressed. We collected the data of 397 designated cancer care hospitals, including information on staffing in the department of radiation oncology (e.g. radiation oncologists, medical physicists and radiation therapists), the number of linear accelerators and the implementation of advanced radiotherapy technologies from the Center for Cancer Control and Information Services of the National Cancer Center, Japan. Only 53% prefectural designated cancer care hospitals and 16% regional designated cancer care hospitals have implemented intensity-modulated radiotherapy for head and neck cancers, and 62% prefectural designated cancer care hospitals and 23% regional designated cancer care hospitals use intensity-modulated radiotherapy for prostate cancer. Seventy-four percent prefectural designated cancer care hospitals and 40% regional designated cancer care hospitals employ stereotactic body radiotherapy for lung cancer. Our multivariate analysis of prefectural designated cancer care hospitals which satisfy the institute's qualifications for advanced technologies revealed the number of radiation oncologists (P=0.01) and that of radiation therapists (P=0.003) were significantly correlated with the implementation of intensity-modulated radiotherapy for prostate cancer, and the number of radiation oncologists (P=0.02) was correlated with the implementation of stereotactic body radiotherapy. There was a trend to correlate the number of medical physicists with the implementation of stereotactic body radiotherapy (P=0.07). Only 175 (51%) regional designated cancer care hospitals satisfy the institute's qualification of stereotactic body radiotherapy and 76 (22%) satisfy that of intensity-modulated radiotherapy. Seventeen percent prefectural designated cancer care hospitals and 13% regional designated cancer care hospitals

  12. [Exploration of the Care Needs of Post-Chemotherapy Lung Cancer Patients and Related Factors].

    Science.gov (United States)

    Chiu, Hui-Ying; Lin, Yu-Hua; Wang, Chin-Chou; Chen, Wan-Yi; Chang, Huang-Chih; Lin, Meng-Chih

    2016-06-01

    Chemotherapy (CT) is the first priority treatment for advanced stage lung cancer. However, symptom distress, impaired ability to conduct daily activities, and post-CT care needs are potential side effects of CT. To explore the factors related to the care needs of post-chemotherapy lung cancer patients. A cross-sectional study was used. One hundred and twenty-one adult patients who had been diagnosed with advanced-stage lung cancer and who had undergone CT using the Platinum and Docetaxel doublet regimen were recruited from a medical center in southern Taiwan. The instruments used included a nursing care needs survey, symptoms distress scale, daily activity interference scale, and patient characteristics datasheet. Participants self-prioritized their emergency management, health consultation, and emotional support activities based on their perceived care needs. The top three post-CT symptoms in terms of severity were: fatigue, appetite change, and sleep disorder. Primary disruptions in daily activities during the post-CT period related to: holding social activities, work, and stair climbing. Significant and positive correlations were found among daily activity interference (r = .30, p needs. The regression model indicated daily activity interference as a predictor of care needs, accounting for 10.7% of the total variance. These results highlight the relationships among care needs, symptom distress, and daily activity interference in post-chemotherapy lung-cancer patients. The present study provides a reference for nursing care to reduce the symptom distress, to enhance the performance of daily activities, and to meet the care needs of lung-cancer patients.

  13. Potential risks associated with traditional herbal medicine use in cancer care: A study of Middle Eastern oncology health care professionals.

    Science.gov (United States)

    Ben-Arye, Eran; Samuels, Noah; Goldstein, Lee Hilary; Mutafoglu, Kamer; Omran, Suha; Schiff, Elad; Charalambous, Haris; Dweikat, Tahani; Ghrayeb, Ibtisam; Bar-Sela, Gil; Turker, Ibrahim; Hassan, Azza; Hassan, Esmat; Saad, Bashar; Nimri, Omar; Kebudi, Rejin; Silbermann, Michael

    2016-02-15

    The authors assessed the use of herbal medicine by Middle Eastern patients with cancer, as reported by their oncology health care professionals (HCPs). Herbal products identified by the study HCPs were evaluated for potential negative effects. Oncology HCPs from 16 Middle Eastern countries received a 17-item questionnaire asking them to list 5 herbal products in use by their patients with cancer. A literature search (PubMed, Micromedex, AltMedDex, and the Natural Medicine Comprehensive Database) was conducted to identify safety-related concerns associated with the products listed. A total of 339 HCPs completed the study questionnaire (response rate of 80.3%), identifying 44 herbal and 3 nonherbal nutritional supplements. Safety-related concerns were associated with 29 products, including herb-drug interactions with altered pharmacodynamics (15 herbs), direct toxic effects (18 herbs), and increased in vitro response of cancer cells to chemotherapy (7 herbs). Herbal medicine use, which is prevalent in Middle Eastern countries, has several potentially negative effects that include direct toxic effects, negative interactions with anticancer drugs, and increased chemosensitivity of cancer cells, requiring a reduction in dose-density. Oncology HCPs working in countries in which herbal medicine use is prevalent need to better understand the implications of this practice. The presence of integrative physicians with training in complementary and traditional medicine can help patients and their HCPs reach an informed decision regarding the safety and effective use of these products. © 2015 American Cancer Society.

  14. Spirituality in cancer care at the end of life.

    Science.gov (United States)

    Ferrell, Betty; Otis-Green, Shirley; Economou, Denice

    2013-01-01

    There is a compelling need to integrate spirituality into the provision of quality palliative care by oncology professionals. Patients and families report the importance of spiritual, existential, and religious concerns throughout the cancer trajectory. Leading palliative care organizations have developed guidelines that define spiritual care and offer recommendations to guide the delivery of spiritual services. There is growing recognition that all team members require the skills to provide generalist spiritual support. Attention to person-centered, family-focused oncology care requires the development of a health care environment that is prepared to support the religious, spiritual, and cultural practices preferred by patients and their families. These existential concerns become especially critical at end of life and following the death for family survivors. Oncology professionals require education to prepare them to appropriately screen, assess, refer, and/or intervene for spiritual distress.

  15. [Play as a care strategy for children with cancer].

    Science.gov (United States)

    Lima, Kálya Yasmine Nunes de; Santos, Viviane Euzébia Pereira

    2015-06-01

    To understand the influence of play in the care process as perceived by children with cancer. 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. 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. There are several activities at the hospital that are considered play-related and, for the children, they all benefit their care process.

  16. 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.

  17. [Update of breast cancer in primary care (IV/V)].

    Science.gov (United States)

    Álvarez-Hernández, C; Brusint, B; Vich, P; Díaz-García, N; Cuadrado-Rouco, C; Hernández-García, M

    2015-01-01

    Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians must thoroughly understand this pathology in order to optimize the health care services and make the best use of available resources, for these patients. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. This fourth article deals with the treatment of the disease, the role of the primary care physician, and management of major complications. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors and helping them to support their patients and care for them throughout their illness. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

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

    Science.gov (United States)

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

    2016-01-01

    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. 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. 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. 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. "Clear and effective" communication of survivorship care for safety-net patients requires dedicated staff trained to address wide-ranging information needs and uncertainties.

  19. The performance of mHealth in cancer supportive care: a research agenda.

    Science.gov (United States)

    Nasi, Greta; Cucciniello, Maria; Guerrazzi, Claudia

    2015-02-13

    Since the advent of smartphones, mHealth has risen to the attention of the health care system as something that could radically change the way health care has been viewed, managed, and delivered to date. This is particularly relevant for cancer, as one of the leading causes of death worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing side effects. Given adequate knowledge, they are able to expect appropriate assessments and interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health care professionals; for enabling early detection and intervention; for lowering costs; and achieving better quality of life. Given its great potential, it is important to evaluate the performance of mHealth. This can be considered from several perspectives, of which organizational performance is particularly relevant, since mHealth may increase the productivity of health care providers and as a result even the productivity of health care systems. This paper aims to review studies on the evaluation of the performance of mHealth, with particular focus on cancer care and cancer supportive care processes, concentrating on its contribution to organizational performance, as well as identifying some indications for a further research agenda. We carried out a review of literature, aimed at identifying studies related to the performance of mHealth in general or focusing on cancer care and cancer supportive care. Our analysis revealed that studies are almost always based on a single dimension of performance. Any evaluations of the performance of mHealth are based on very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails to consider the real contribution that mHealth can offer for improving the performance of health care providers, health care systems, and the quality of life in general. Further research should start by stating and explaining what is meant

  20. Spiritual care of cancer patients by integrated medicine in urban green space: a pilot study.

    Science.gov (United States)

    Nakau, Maiko; Imanishi, Jiro; Imanishi, Junichi; Watanabe, Satoko; Imanishi, Ayumi; Baba, Takeshi; Hirai, Kei; Ito, Toshinori; Chiba, Wataru; Morimoto, Yukihiro

    2013-01-01

    Psycho-oncological care, including spiritual care, is essential for cancer patients. Integrated medicine, a therapy combining modern western medicine with various kinds of complementary and alternative medicine, can be appropriate for the spiritual care of cancer because of the multidimensional characteristics of the spirituality. In particular, therapies that enable patients to establish a deeper contact with nature, inspire feelings of life and growth of plants, and involve meditation may be useful for spiritual care as well as related aspects such as emotion. The purpose of the present study was to examine the effect of spiritual care of cancer patients by integrated medicine in a green environment. The present study involved 22 cancer patients. Integrated medicine consisted of forest therapy, horticultural therapy, yoga meditation, and support group therapy, and sessions were conducted once a week for 12 weeks. The spirituality (the Functional Assessment of Chronic Illness Therapy-Spiritual well-being), quality of life (Short Form-36 Health Survey Questionnaire), fatigue (Cancer Fatigue Scale), psychological state (Profile of Mood States, short form, and State-Trait Anxiety Inventory) and natural killer cell activity were assessed before and after intervention. In Functional Assessment of Chronic Illness Therapy-Spiritual well-being, there were significant differences in functional well-being and spiritual well-being pre- and postintervention. This program improved quality of life and reduced cancer-associated fatigue. Furthermore, some aspects of psychological state were improved and natural killer cell activity was increased. It is indicated that integrated medicine performed in a green environment is potentially useful for the emotional and spiritual well-being of cancer patients. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. 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.

  2. Psychologists involved in cancer palliative care in Japan: A nationwide survey.

    Science.gov (United States)

    Nakajima, Kasumi; Iwamitsu, Yumi; Matsubara, Mei; Oba, Akira; Hirai, Kei; Morita, Tatsuya; Kizawa, Yoshiyuki

    2015-04-01

    The aim of this study was to clarify, using a nationwide survey, what is perceived as necessary knowledge and skills for psychologists involved in cancer palliative care in Japan, the expectations of medical staff members, and the degree to which these expectations are met. We conducted a questionnaire survey of psychologists involved in cancer palliative care. A total of 419 psychologists from 403 facilities were asked to fill out the questionnaire and return it anonymously. Some 401 psychologists (89 males, 310 females, and 2 unspecified; mean age, 37.2 ± 9.5 years) responded about necessary knowledge and skills for psychologists working in cancer palliative care, the necessity for training, expectations at their current workplace, and the degree to which expectations are met. More than 90% of participants responded that many kinds of knowledge and skills related to the field of cancer palliative care are necessary. Over 80% of participants indicated a necessity for training related to these knowledge and skills. Although more than 50% (range, 50.1-85.8%) of participants responded that such services as "cooperation with medical staff within a hospital," "handling patients for whom psychological support would be beneficial," and "assessment of patients' mental state" were expected at their workplace, fewer than 60% (31.4-56.9%) responded that they actually performed these roles. Our results show that many psychologists in cancer palliative care feel unable to respond to the expectations at their current workplace and that they require more adequate knowledge and skills related to cancer palliative care to work effectively. No other nationwide surveys have generated this type of information in Japan, so we believe that the results of our study are uniquely important.

  3. Barriers and facilitators to implementing cancer survivorship care plans.

    Science.gov (United States)

    Dulko, Dorothy; Pace, Claire M; Dittus, Kim L; Sprague, Brian L; Pollack, Lori A; Hawkins, Nikki A; Geller, Berta M

    2013-11-01

    To evaluate the process of survivorship care plan (SCP) completion and to survey oncology staff and primary care physicians (PCPs) regarding challenges of implementing SCPs. Descriptive pilot study. Two facilities in Vermont, an urban academic medical center and a rural community academic cancer center. 17 oncology clinical staff created SCPs, 39 PCPs completed surveys, and 58 patients (breast or colorectal cancer) participated in a telephone survey. Using Journey Forward tools, SCPs were created and presented to patients. PCPs received the SCP with a survey assessing its usefulness and barriers to delivery. Oncology staff were interviewed to assess perceived challenges and benefits of SCPs. Qualitative and quantitative data were used to identify challenges to the development and implementation process as well as patient perceptions of the SCP visit. SCP, healthcare provider perception of barriers to completion and implementation, and patient perception of SCP visit. Oncology staff cited the time required to obtain information for SCPs as a challenge. Completing SCPs 3-6 months after treatment ended was optimal. All participants felt advanced practice professionals should complete and review SCPs with patients. The most common challenge for PCPs to implement SCP recommendations was insufficient knowledge of cancer survivor issues. Most patients found the care plan visit very useful, particularly within six months of diagnosis. Creation time may be a barrier to widespread SCP implementation. Cancer survivors find SCPs useful, but PCPs feel insufficient knowledge of cancer survivor issues is a barrier to providing best follow-up care. Incorporating SCPs in electronic medical records may facilitate patient identification, appropriate staff scheduling, and timely SCP creation. Oncology nurse practitioners are well positioned to create and deliver SCPs, transitioning patients from oncology care to a PCP in a shared-care model of optimal wellness. Institution support for

  4. Nanotechnology Strategies To Advance Outcomes in Clinical Cancer Care.

    Science.gov (United States)

    Hartshorn, Christopher M; Bradbury, Michelle S; Lanza, Gregory M; Nel, Andre E; Rao, Jianghong; Wang, Andrew Z; Wiesner, Ulrich B; Yang, Lily; Grodzinski, Piotr

    2018-01-23

    Ongoing research into the application of nanotechnology for cancer treatment and diagnosis has demonstrated its advantages within contemporary oncology as well as its intrinsic limitations. The National Cancer Institute publishes the Cancer Nanotechnology Plan every 5 years since 2005. The most recent iteration helped codify the ongoing basic and translational efforts of the field and displayed its breadth with several evolving areas. From merely a technological perspective, this field has seen tremendous growth and success. However, an incomplete understanding of human cancer biology persists relative to the application of nanoscale materials within contemporary oncology. As such, this review presents several evolving areas in cancer nanotechnology in order to identify key clinical and biological challenges that need to be addressed to improve patient outcomes. From this clinical perspective, a sampling of the nano-enabled solutions attempting to overcome barriers faced by traditional therapeutics and diagnostics in the clinical setting are discussed. Finally, a strategic outlook of the future is discussed to highlight the need for next-generation cancer nanotechnology tools designed to address critical gaps in clinical cancer care.

  5. [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.

  6. Faecal immunochemical tests to triage patients with lower abdominal symptoms for suspected colorectal cancer referrals in primary care: A systematic review and cost-effectiveness analysis

    NARCIS (Netherlands)

    M. Westwood (Marie); I. Corro Ramos (Isaac); Lang, S. (Shona); M. Luyendijk (Marianne); Zaim, R. (Remziye); Stirk, L. (Lisa); M.J. Al (Maiwenn); N. Armstrong (Nigel); J. Kleijnen (Jos)

    2017-01-01

    textabstractBackground: Colorectal cancer (CRC) is the third most common cancer in the UK. Presenting symptoms that can be associated with CRC usually have another explanation. Faecal immunochemical tests (FITs) detect blood that is not visible to the naked eye and may help to select patients who

  7. Ethics of cancer palliative care in Sri Lanka. A cross- cultural perspective.

    Directory of Open Access Journals (Sweden)

    Dayasiri MBKC

    2010-12-01

    Full Text Available The diagnosis of cancer is associated with an unexpected breakdown of the physical, psychological and social well being. In addition to cancer related physical outcomes, cross-cultural issues are known to hasten patients’ clinical deterioration and can impact upon orientation as a healthy human being in society. As members of a developing nation in the second world, to provide patient oriented quality care while maintaining high standards of ethical practice, health care workers in Sri Lanka have to be culturally competent. In Sri Lanka, the cross-cultural ethical issues related to patients with a diagnosis of cancer include, awareness of one’s own cultural identity, gaining knowledge of different cultural issues, verbal and non verbal communication skills, respect for patients’ autonomy, involvement of the family and the relatives, addressing moral and spiritual backgrounds, development of effective communication skills and provision of social support. Therefore in the management of cancer patients in Sri Lanka, cultural issues should be given a high priority to maintain ethical standards and quality in palliative care. Culturally competent Health care workers safeguard the rights of patients, as well as providing optimal medical and surgical care.

  8. 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.

  9. Patients’ and Family Members’ Views on Patient-Centered Communication During Cancer Care

    Science.gov (United States)

    Mazor, Kathleen M.; Beard, Renee L.; Alexander, Gwen L.; Arora, Neeraj K.; Firneno, Cassandra; Gaglio, Bridget; Greene, Sarah M.; Lemay, Celeste A.; Robinson, Brandi E.; Roblin, Douglas W.; Walsh, Kathleen; Street, Richard L.; Gallagher, Thomas H.

    2013-01-01

    Objectives To explore patients’ and family members’ views on communication during cancer care, and to identify those aspects of clinician-patient communication which were most important to patients and family members. Methods We conducted a secondary data analysis of qualitative data from 137 patients with cancer and family members of patients with cancer. We used a modified version of the constant comparative method and coding paradigm of grounded theory. Results Patients want sensitive, caring clinicians who provide information that they need, when they need it, in a way that they can understand; who listen and respond to questions and concerns, and who attempt to understand the patient’s experience. Effective information exchange and a positive interpersonal relationship with the clinician were of fundamental importance to patients and family members. These were interrelated; for instance, failure to provide information a patient needed could damage the relationship, while excellent listening could foster the relationship. Information exchange and relationship were also integral to decision making, managing uncertainty, responding to emotions, and self-management. Clinicians who were responsive to patients’ needs beyond the immediate medical encounter were valued. Conclusions The complexity of cancer care today suggest that efforts to improve communication must be multi-level, acknowledging and addressing patient, clinician, organizational and policy barriers and facilitators. Measurement tools are needed to assess cancer patients’ and family members’ experiences with communication over the course of cancer care in order to provide meaningful, actionable feedback to those seeking to optimize their effectiveness in communicating with patients with cancer. PMID:23780672

  10. Effects of Slow-Stroke Back Massage on Symptom Cluster in Adult Patients With Acute Leukemia: Supportive Care in Cancer Nursing.

    Science.gov (United States)

    Miladinia, Mojtaba; Baraz, Shahram; Shariati, Abdolali; Malehi, Amal Saki

    Patients with acute leukemia usually experience pain, fatigue, and sleep disorders, which affect their quality of life. Massage therapy, as a nondrug approach, can be useful in controlling such problems. However, very few studies have been conducted on the effects of massage therapy on the complications of leukemia. The aim of this study was to examine the effects of slow-stroke back massage (SSBM) on the symptom cluster in acute leukemia adult patients undergoing chemotherapy. In this randomized controlled trial, 60 patients with acute leukemia were allocated randomly to either the intervention or control group. The intervention group received SSBM 3 times a week (every other day for 10 minutes) for 4 weeks. The pain, fatigue, and sleep disorder intensities were measured using the numeric rating scale. The sleep quality was measured using the Pittsburgh Sleep Quality Index. Statistical tests of χ, t test, and the repeated-measure analysis of variance were used for data analysis. Results showed that the SSBM intervention significantly reduced the progressive sleep disorder, pain, fatigue, and improved sleep quality over time. Slow-stroke back massage, as a simple, noninvasive, and cost-effective approach, along with routine nursing care, can be used to improve the symptom cluster of pain, fatigue, and sleep disorders in leukemia patients. Oncology nurses can increase their knowledge regarding this symptom cluster and work to diminish the cluster components by using SSBM in adult leukemia patients.

  11. Evaluation of the impact of interdisciplinarity in cancer care

    Science.gov (United States)

    2011-01-01

    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 interdisciplinary teamwork

  12. Colorectal cancer: complexities and challenges in managed care.

    Science.gov (United States)

    Minkoff, Neil B

    2007-08-01

    Managed care weighs advances and associated costs to determine whether the combination of longer life at sometimes significantly increased cost represents value. The price of treatment is only 1 factor. To review treatment decision processes for oncologic agents in managed care environments. Price can be exceptionally high for individuals. But if the population size is low, the per-member-per-month (PMPM) impact can be almost negligible, unlike treatments that have moderate costs but are used ubiquitously. Cancer therapies have, for the most part, escaped managed care's notice. For 2007, the national Cancer Institute projects that antineoplastic agents will consume almost a quarter of the overall drug spend. The Medicare population is a unique concern with regard to cancer. Traditionally, Medicare reimbursement of chemotherapeutic agents was based on average wholesale price (AWP) discounting, not the oncologist's purchasing cost. This allowed oncologists to use reimbursement for infusions to support their medical practices. The proposed plan of the Center for Medicare & Medicaid Services (CMS) to use average sales price (ASP) plus 6% to reimburse for drugs used in the office setting leads to significant problems. Pharmacy and therapeutics committees will also face challenges: fewer data are available for some agents because they have become available through the U.S. Food and drug administration's Fast Track, Priority review, or accelerated approval processes. Oncology disease management programs must reach out to patients and not necessarily deal with oncology issues directly, but address tangential issues that impact care, especially depression and pain management.

  13. A value framework in head and neck cancer care.

    Science.gov (United States)

    de Souza, Jonas A; Seiwert, Tanguy Y

    2014-01-01

    The care of head and neck squamous cell carcinoma has greatly evolved over the past 30 years. From single modality to a multidisciplinary care, there has also been a concurrent increase in treatment intensity, resulting, at many times, in more zealous regimens that patients must endure. In this article, we apply Porter's value model as a framework to balance survival, toxicities, cost, and trade-offs from a patient's perspective in head and neck cancer. This model defines value as the health outcome per dollar achieved. Domains and outcomes that are important to patients, including not only survival or short-term quality of life, but also functional outcomes, recovery, sustainability of recovery, and the lasting consequences of therapy are included in this framework. Other outcomes that are seldom measured in head and neck cancer, such as work disability and financial toxicities, are also included and further discussed. Within this value model and based on evidence, we further discuss de-escalation of care, intensity-modulated radiation therapy, newer surgical methods, and enhancements in the process of care as potential approaches to add value for patients. Finally, we argue that knowing the patient's preferences is essential in the value discussion, as the attribute that will ultimately provide the most value to the individual patient with head and neck cancer.

  14. The economics of bladder cancer: costs and considerations of caring for this disease.

    Science.gov (United States)

    Svatek, Robert S; Hollenbeck, Brent K; Holmäng, Sten; Lee, Richard; Kim, Simon P; Stenzl, Arnulf; Lotan, Yair

    2014-08-01

    Due to high recurrence rates, intensive surveillance strategies, and expensive treatment costs, the management of bladder cancer contributes significantly to medical costs. To provide a concise evaluation of contemporary cost-related challenges in the care of patients with bladder cancer. An emphasis is placed on the initial diagnosis of bladder cancer and therapy considerations for both non-muscle-invasive bladder cancer (NMIBC) and more advanced disease. A systematic review of the literature was performed using Medline (1966 to February 2011). Medical Subject Headings (MeSH) terms for search criteria included "bladder cancer, neoplasms" OR "carcinoma, transitional cell" AND all cost-related MeSH search terms. Studies evaluating the costs associated with of various diagnostic or treatment approaches were reviewed. Routine use of perioperative chemotherapy following complete transurethral resection of bladder tumor has been estimated to provide a cost savings. Routine office-based fulguration of small low-grade recurrences could decrease costs. Another potential important target for decreasing variation and cost lies in risk-modified surveillance strategies after initial bladder tumor removal to reduce the cost associated with frequent cystoscopic and radiographic procedures. Optimizing postoperative care after radical cystectomy has the potential to decrease length of stay and perioperative morbidity with substantial decreases in perioperative care expenses. The gemcitabine-cisplatin regimen has been estimated to result in a modest increase in cost effectiveness over methotrexate, vinblastine, doxorubicin, and cisplatin. Additional costs of therapies need to be balanced with effectiveness, and there are significant gaps in knowledge regarding optimal surveillance and treatment of both early and advanced bladder cancer. Regardless of disease severity, improvements in the efficiency of bladder cancer care to limit unnecessary interventions and optimize effective

  15. Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: A systematic review

    Directory of Open Access Journals (Sweden)

    Zhang Li

    2006-12-01

    Full Text Available Abstract Background Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare. Methods Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care. Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement. The extent of each quality indicator's scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO was asked to contribute quality measures under development. Results Sixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12, most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care. Conclusion While some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCO's current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies.

  16. Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: a systematic review.

    Science.gov (United States)

    Schachter, Howard M; Mamaladze, Vasil; Lewin, Gabriela; Graham, Ian D; Brouwers, Melissa; Sampson, Margaret; Morrison, Andra; Zhang, Li; O'Blenis, Peter; Garritty, Chantelle

    2006-12-18

    Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare. Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care). Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement). The extent of each quality indicator's scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO) was asked to contribute quality measures under development. Sixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12), most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care. While some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCO's current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies.

  17. Primary care practice organization influences colorectal cancer screening performance.

    Science.gov (United States)

    Yano, Elizabeth M; Soban, Lynn M; Parkerton, Patricia H; Etzioni, David A

    2007-06-01

    To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors. Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001). Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (pmanagement and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.

  18. Primary Patient-Derived Cancer Cells and Their Potential for Personalized Cancer Patient Care

    Directory of Open Access Journals (Sweden)

    David P. Kodack

    2017-12-01

    Full Text Available Personalized cancer therapy is based on a patient’s tumor lineage, histopathology, expression analyses, and/or tumor DNA or RNA analysis. Here, we aim to develop an in vitro functional assay of a patient’s living cancer cells that could complement these approaches. We present methods for developing cell cultures from tumor biopsies and identify the types of samples and culture conditions associated with higher efficiency of model establishment. Toward the application of patient-derived cell cultures for personalized care, we established an immunofluorescence-based functional assay that quantifies cancer cell responses to targeted therapy in mixed cell cultures. Assaying patient-derived lung cancer cultures with this method showed promise in modeling patient response for diagnostic use. This platform should allow for the development of co-clinical trial studies to prospectively test the value of drug profiling on tumor-biopsy-derived cultures to direct patient care.

  19. Challenges faced by palliative care physicians when caring for doctors with advanced cancer

    NARCIS (Netherlands)

    Noble, S. I. R.; Nelson, A.; Finlay, I. G.

    2008-01-01

    Background: It is possible that patients with advanced cancer, who are from the medical profession, have different or additional care needs than other patients. Previous training, professional experiences and access to information and services may influence their needs and subsequent illness

  20. Masculinity and urogenital cancer: sensitive issues in health care.

    Science.gov (United States)

    Nobis, Regina; Sand, Inger; Elofsson, Kristina

    2007-02-01

    The aim of this literature review was to analyse the approaches adopted by patients, health professionals, spouses and other care-givers towards sensitive issues related to male urogenital cancer, and to describe how these findings can be applied in health care practice. The findings revealed five identifiable domains, namely 'the barrier to talking', 'the barrier of sensitivity', 'the barrier of masculinity', 'the barrier to seeking health care' and 'the communicative barrier'. The conclusion was that the phenomenon of a barrier is strongly connected with hegemonic masculinity. The review of literature confirmed that, for many men, talking about genitally-related health problems is not easy and that health care professionals need to learn more about gender and masculinity in order to address urogenitally sensitive issues.

  1. Implementing novel models of posttreatment care for cancer survivors: Enablers, challenges and recommendations.

    Science.gov (United States)

    Jefford, Michael; Kinnane, Nicole; Howell, Paula; Nolte, Linda; Galetakis, Spiridoula; Bruce Mann, Gregory; Naccarella, Lucio; Lai-Kwon, Julia; Simons, Katherine; Avery, Sharon; Thompson, Kate; Ashley, David; Haskett, Martin; Davies, Elise; Whitfield, Kathryn

    2015-12-01

    The American Society of Clinical Oncology and US Institute of Medicine emphasize the need to trial novel models of posttreatment care, and disseminate findings. In 2011, the Victorian State Government (Australia) established the Victorian Cancer Survivorship Program (VCSP), funding six 2-year demonstration projects, targeting end of initial cancer treatment. Projects considered various models, enrolling people of differing cancer types, age and residential areas. We sought to determine common enablers of success, as well as challenges/barriers. Throughout the duration of the projects, a formal "community of practice" met regularly to share experiences. Projects provided regular formal progress reports. An analysis framework was developed to synthesize key themes and identify critical enablers and challenges. Two external reviewers examined final project reports. Discussion with project teams clarified content. Survivors reported interventions to be acceptable, appropriate and effective. Strong clinical leadership was identified as a critical success factor. Workforce education was recognized as important. Partnerships with consumers, primary care and community organizations; risk stratified pathways with rapid re-access to specialist care; and early preparation for survivorship, self-management and shared care models supported positive project outcomes. Tailoring care to individual needs and predicted risks was supported. Challenges included: lack of valid assessment and prediction tools; limited evidence to support novel care models; workforce redesign; and effective engagement with community-based care and issues around survivorship terminology. The VCSP project outcomes have added to growing evidence around posttreatment care. Future projects should consider the identified enablers and challenges when designing and implementing survivorship care. © 2015 Wiley Publishing Asia Pty Ltd.

  2. Improving Symptom Control, QOL, and Quality of Care for Women with Breast Cancer: Developing a Research Program on Neurological Effects via Doctoral Education

    National Research Council Canada - National Science Library

    Bakitas, Marie; Ahles, Tim A

    2005-01-01

    The purpose of this traineeship is to develop the academic and research skills of an expert advanced practice nurse towards achieving the career goal of becoming a Clinical Breast Cancer Research Scientist...

  3. Cancer Services and Their Initiatives to Improve the Care of Indigenous Australians

    Directory of Open Access Journals (Sweden)

    Emma V. Taylor

    2018-04-01

    Full Text Available Indigenous Australians continue to experience significantly poorer outcomes from cancer than non-Indigenous Australians. Despite the importance of culturally appropriate cancer services in improving outcomes, there is a lack of awareness of current programs and initiatives that are aimed at meeting the needs of Indigenous patients. Telephone interviews were used to identify and describe the Indigenous-specific programs and initiatives that are implemented in a subset of the services that participated in a larger national online survey of cancer treatment services. Fourteen services located across Australia participated in the interviews. Participants identified a number of factors that were seen as critical to delivering culturally appropriate treatment and support, including having a trained workforce with effective cross-cultural communication skills, providing best practice care, and improving the knowledge, attitudes, and understanding of cancer by Indigenous people. However, over a third of participants were not sure how their service compared with others, indicating that they were not aware of how other services are doing in this field. There are currently many Indigenous-specific programs and initiatives that are aimed at providing culturally appropriate treatment and supporting Indigenous people affected by cancer across Australia. However, details of these initiatives are not widely known and barriers to information sharing exist. Further research in this area is needed to evaluate programs and initiatives and showcase the effective approaches to Indigenous cancer care.

  4. Outpatient treatment costs and their potential impact on cancer care

    International Nuclear Information System (INIS)

    Isshiki, Takahiro

    2014-01-01

    Cancer creates a tremendous financial burden. Cancer-related costs are categorized into direct, indirect, and psychosocial costs. Although there have been many reports on medical care costs, which are direct, those on other costs are extremely scarce. We estimated travel time and costs required for cancer patients to receive outpatient treatment. We studied 521 cancer patients receiving anti-cancer treatment between February 2009 and December 2012 at the Outpatient Chemotherapy Center of Teikyo University Chiba Medical Center. Address data were extracted from Data Warehouse electronic medical records, and travel distance and time required for outpatient treatment were calculated via MapInfo and ACT Distance Calculator Package. Transportation costs were estimated on the basis of ¥274 (=$3.00) per kilometer. The study design was approved by an ethics review board of Teikyo University (12-851). Average round-trip travel distance, time, and cost for all patients were 26.7 km, 72.5 min, and ¥7,303 ($79.99), respectively. Cancer patients incurred a travel cost of ¥4000–¥9000 ($40.00 to $100.00) for each outpatient treatment. With population aging, seniors living alone and senior households are increasing, and outpatient visits are becoming a common burden

  5. Hypnosis in breast cancer care: a systematic review of randomized controlled trials.

    Science.gov (United States)

    Cramer, Holger; Lauche, Romy; Paul, Anna; Langhorst, Jost; Kümmel, Sherko; Dobos, Gustav J

    2015-01-01

    Many breast cancer patients and survivors experience pain and emotional stress related to their disease, its diagnostic procedures, or treatment. Hypnosis has long been used for the treatment of such symptoms. The aim of this review was to systematically assess the effectiveness of hypnosis in women with breast cancer, breast cancer survivors, and in women undergoing diagnostic breast biopsy. PubMed, Scopus, the Cochrane Library, PsycINFO, and CAMBASE were screened through February 2014 for randomized controlled trials (RCTs) of hypnosis in women with breast cancer or undergoing diagnostic breast biopsy. RCTs on postmenopausal women without a history of breast cancer were also eligible. Primary outcomes were pain, distress, fatigue, nausea/vomiting, and hot flashes. Safety was defined as secondary outcome measure. Risk of bias was assessed by 2 reviewers independently using the Cochrane Risk of Bias Tool. Thirteen RCTs with 1357 patients were included. In women undergoing diagnostic breast biopsy (3 RCTs), hypnosis positively influenced pain and distress; 1 RCT on breast cancer surgery found effects of hypnosis on pain, distress, fatigue, and nausea. For women undergoing radiotherapy (3 RCTs), hypnosis combined with cognitive-behavioral therapy improved distress and fatigue. In 3 RCTs on women with and without a history of breast cancer experiencing hot flashes, hypnosis improved hot flashes and distress. Three RCTs on women with metastatic breast cancer found effects on pain and distress. This systematic review found sparse but promising evidence for the effectiveness of hypnosis in breast cancer care. While more research is needed to underpin these results, hypnosis can be considered as an ancillary intervention in the management of breast cancer-related symptoms. © The Author(s) 2014.

  6. 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

  7. [Case report: coordination of the care provided to patients with breast cancer].

    Science.gov (United States)

    Peinado-Barraso, M del Carmen; Cabrerizo-Cordero, M del Rosario; Granados-Matute, Ana Eva; Contreras-Fariñas, Raquel

    2008-01-01

    In Spain, cancer is the leading cause of death in absolute terms. Statistically, the most frequent type of cancer in women in developed countries is breast cancer, which is becoming the leading cause of death from cancer among women. The breast cancer is statistically the most frequent in women and it is getting the first reason of death by cancer between the feminine population, in most of developed countries. This health problem is usually associated with psychological dependency, which can be aggravated in elderly patients without adequate family support. TThe nursing process is the most commonly used tool to establish interaction among the nurse, the patient and the family. Through this interaction, the nurse can identify the patient's health objectives and energy limitations, as well as the resources available to obtain optimal health status. The nursing process is a systematic method for providing efficient humanistic care aimed at achieving expected outcomes. In the case presented herein, we employed Marjory Gordon's Functional Patterns and the taxonomies of the North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC). The nursing diagnoses detected were fear, anxiety, self-care deficit, impaired mobility, risk of low self-esteem, ineffective coping, and potential complications (pain and infection). The care session is one of the main interventions to improve the effectiveness of the care provided. During this session, methodological adjustments of the nursing process are analyzed, with special attention paid to the appropriateness of the interventions, the possible alternatives and encouragement of reflective practice Essential elements to improve quality of life in these elderly oncology patients are the role of nursing through the care provided and coordination among professionals in different disciplines and healthcare levels.

  8. [Update of breast cancer in Primary Care (II/V)].

    Science.gov (United States)

    Brusint, B; Vich, P; Ávarez-Hernández, C; Cuadrado-Rouco, C; Díaz-García, N; Redondo-Margüello, E

    2014-10-01

    Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family doctors need to thoroughly understand this disease in order to optimize the health care services for these patients, making the best use of available resources. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. The second one deals with population screening and its controversies, screening in high-risk women, and the current recommendations. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors, and helping them to be able to care for their patients for their benefit throughout their illness. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  9. 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...

  10. Lessons in Integrating Shared Decision-Making Into Cancer Care

    DEFF Research Database (Denmark)

    Steffensen, Karina Dahl; Vinter, Mette; Crüger, Dorthe

    2018-01-01

    The benefits of shared decision-making (SDM) in health care delivery are well documented, but implementing SDM at the institutional level is challenging, particularly when patients have complex illnesses and care needs, as in cancer. Denmark's Lillebaelt Hospital, in creating The Patient's Cancer...... championed. It organized multiple demonstration projects focused on use of decision aids, patient-reported outcome measures, and better communication tools and practices. It designed programs to train clinicians in the art of doctor-patient communication. It used research evidence to inform development...... of the decision aids that its clinicians use with their patients. And it rigorously measured SDM performance in an ongoing fashion so that progress could be tracked and refined to ensure continuous improvement. Initial data on the institution's SDM initiatives from the Danish national annual survey of patients...

  11. Cancer Care at Times of Crisis and War: The Syrian Example

    Directory of Open Access Journals (Sweden)

    Eman Sahloul

    2017-08-01

    Full Text Available Purpose: As Syria enters its fifth year of conflict, the number of civilians killed and injured continues to rise sharply. Along with this conflict comes the rapid decline of medical care, specifically cancer care. To determine physician and equipment availability, cancer screening and management, and possible solutions relative to various major cities, a survey was distributed to physicians inside Syria through the help of the humanitarian organization Syrian American Medical Society. Methods: Online surveys were distributed to both certified oncologists who work in cancer clinics and general physicians who work in rural and mobile clinics inside Syria. Variables assessed were physician specialty, location, population, cost, regional situation (besieged versus government controlled, and resource availability and access. Results were stratified by location and physician specialty. Results: Survey results revealed a large shortage of specialized physicians and inhibited accessibility to screening and management options in besieged areas compared with government-controlled regions. Physicians within both government-controlled and besieged cities reported limited or no targeted agents, radiation therapy, clinical trials, bone marrow transplantation, positron emission tomography scans, magnetic resonance imaging, and genetic testing. Conclusion: The Syrian civil war has resulted in suboptimal oncology care in the majority of the region. In consideration of specific deficiencies in cancer care, we recommend several solutions that may better the level of care in Syria: patient education on medical documentation and self-examination; online consultation; and cheap, effective screening methods. The implementation of these recommendations may change the course of cancer care in a country that has deteriorated into the worst humanitarian crisis of the century.

  12. Cancer Care at Times of Crisis and War: The Syrian Example.

    Science.gov (United States)

    Sahloul, Eman; Salem, Riad; Alrez, Wessam; Alkarim, Tayseer; Sukari, Ammar; Maziak, Wasim; Atassi, M Bassel

    2017-08-01

    As Syria enters its fifth year of conflict, the number of civilians killed and injured continues to rise sharply. Along with this conflict comes the rapid decline of medical care, specifically cancer care. To determine physician and equipment availability, cancer screening and management, and possible solutions relative to various major cities, a survey was distributed to physicians inside Syria through the help of the humanitarian organization Syrian American Medical Society. Online surveys were distributed to both certified oncologists who work in cancer clinics and general physicians who work in rural and mobile clinics inside Syria. Variables assessed were physician specialty, location, population, cost, regional situation (besieged versus government controlled), and resource availability and access. Results were stratified by location and physician specialty. Survey results revealed a large shortage of specialized physicians and inhibited accessibility to screening and management options in besieged areas compared with government-controlled regions. Physicians within both government-controlled and besieged cities reported limited or no targeted agents, radiation therapy, clinical trials, bone marrow transplantation, positron emission tomography scans, magnetic resonance imaging, and genetic testing. The Syrian civil war has resulted in suboptimal oncology care in the majority of the region. In consideration of specific deficiencies in cancer care, we recommend several solutions that may better the level of care in Syria: patient education on medical documentation and self-examination; online consultation; and cheap, effective screening methods. The implementation of these recommendations may change the course of cancer care in a country that has deteriorated into the worst humanitarian crisis of the century.

  13. Patterns of Colorectal Cancer Care in Europe, Australia, and New Zealand

    OpenAIRE

    Chawla, Neetu; Butler, Eboneé N.; Lund, Jennifer; Warren, Joan L.; Harlan, Linda C.; Yabroff, K. Robin

    2013-01-01

    Colorectal cancer is the second most common cancer in women and the third most common in men worldwide. In this study, we used MEDLINE to conduct a systematic review of existing literature published in English between 2000 and 2010 on patterns of colorectal cancer care. Specifically, this review examined 66 studies conducted in Europe, Australia, and New Zealand to assess patterns of initial care, post-diagnostic surveillance, and end-of-life care for colorectal cancer. The majority of studie...

  14. [Update of breast cancer in primary care (I/V)].

    Science.gov (United States)

    Vich, P; Brusint, B; Alvarez-Hernández, C; Cuadrado-Rouco, C; Diaz-García, N; Redondo-Margüello, E

    2014-09-01

    Breast cancer is a prevalent disease affecting all areas of the patients' lives. Therefore, family physicians should have a thorough knowledge of this disease in order to optimize the health care services for these patients, and making the best use of available resources. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. The first article reviews the epidemiology, risk factors, and protective factors in this disease This summary report aims to provide a current and practical review on breast cancer, providing answers to family doctors and helping them to support the patients for their benefit throughout their illness. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  15. Radiotherapy in Cancer Care: Facing the Global Challenge

    International Nuclear Information System (INIS)

    Rosenblatt, Eduardo; Zubizarreta, Eduardo

    2017-06-01

    Cancer treatment is complex and calls for a diverse set of services. Radiotherapy is recognized as an essential tool in the cure and palliation of cancer. Currently, access to radiation treatment is limited in many countries and non-existent in some. This lack of radiotherapy resources exacerbates the burden of disease and underscores the continuing health care disparity among States. Closing this gap represents an essential measure in addressing this global health equity problem. This publication presents a comprehensive overview of the major topics and issues to be taken into consideration when planning a strategy to address this problem, in particular in low and middle income countries. With contributions from leaders in the field, it provides an introduction to the achievements and issues of radiation therapy as a cancer treatment modality around the world. Dedicated chapters focus on proton therapy, carbon ion radiotherapy, intraoperative radiotherapy, radiotherapy for children, HIV/AIDS related malignancies, and costing and quality management issues.

  16. Patients' and parents' views regarding supportive care in childhood cancer.

    Science.gov (United States)

    Tenniglo, L J A; Loeffen, E A H; Kremer, L C M; Font-Gonzalez, A; Mulder, R L; Postma, A; Naafs-Wilstra, M C; Grootenhuis, M A; van de Wetering, M D; Tissing, W J E

    2017-10-01

    Intensive therapies in pediatric malignancies increased survival rates but also occurrence of treatment-related morbidities. Therefore, supportive care fulfills an increasingly important role. In planning development of guidelines with incorporation of shared decision making, we noticed that little is known about the needs and preferences of patients and their parents. Our goals were therefore to investigate (1) which supportive care topics patients and parents regard as most important and (2) the preferred role they wish to fulfill in decision making. This qualitative study consisted of three focus groups (two traditional, one online) with patients and parents of two Dutch pediatric oncology centers. Data were transcribed as simple verbatim and analyzed using thematic analysis. Eleven adolescent patients and 18 parents shared detailed views on various aspects of supportive care. Themes of major importance were communication between patient and physician (commitment, accessibility, proactive attitude of physicians), well-timed provision of information, and the suitability and accessibility of psychosocial care. In contrast to prioritized supportive care topics by medical professionals, somatic issues (e.g., febrile neutropenia) were infrequently addressed. Patients and parents preferred to be actively involved in decision making in selected topics, such as choice of analgesics and anti-emetics, but not in, e.g., choice of antibiotics. Children with cancer and parents were provided a valuable insight into their views regarding supportive care and shared decision making. These results have important implications towards improving supportive care, both in selecting topics for guideline development and incorporating preferences of patients and parents herein.

  17. 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.

  18. Parents' Voice in Managing the Pain of Children with Cancer during Palliative Care.

    Science.gov (United States)

    Mariyana, Rina; Allenidekania, Allenidekania; Nurhaeni, Nani

    2018-01-01

    Pain experienced by children can adversely affect their growth and development. Pain is a major health problem for cancer patients and remains an unresolved problem. To know how the experiences of mothers managing their children's pain during palliative care following cancer diagnosis. Pain experienced by children can adversely affect their growth and development. Using qualitative methods within a descriptive phenomenological approach, in-depth interviews were conducted with parents (mostly mothers) of eight children diagnosed with cancer. The data were collected using the snowball sampling method. Participants experienced in managing the pain of children with cancer. Analysis of the results identified 8 themes: the dimensions of pain experienced by children undergoing palliative care; mothers' physical and psychological responses; mothers' emotional responses; barriers encountered by mothers when taking care of their child at home; mothers' interventions to reduce their child's pain; mothers' efforts to distract their child from pain; giving encouragement when the child is in pain; and mothers' efforts and prayers to make their child comfort. It can be concluded that the child's pain is the main cause of mothers' stress and pressure and also affects the daily lives of mothers and children. Along with the most effective intervention, nurses need to provide mothers and children with adequate information about cancer pain.

  19. Parents' voice in managing the pain of children with cancer during palliative care

    Directory of Open Access Journals (Sweden)

    Rina Mariyana

    2018-01-01

    Full Text Available Context: Pain experienced by children can adversely affect their growth and development. Pain is a major health problem for cancer patients and remains an unresolved problem.Aim: To know how the experiences of mothers managing their children's pain during palliative care following cancer diagnosis.Background: Pain experienced by children can adversely affect their growth and development.Subject and Methods: Using qualitative methods within a descriptive phenomenological approach, in-depth interviews were conducted with parents (mostly mothers of eight children diagnosed with cancer. The data were collected using the snowball sampling method.Results: Participants experienced in managing the pain of children with cancer. Analysis of the results identified 8 themes: the dimensions of pain experienced by children undergoing palliative care; mothers' physical and psychological responses; mothers' emotional responses; barriers encountered by mothers when taking care of their child at home; mothers' interventions to reduce their child's pain; mothers' efforts to distract their child from pain; giving encouragement when the child is in pain; and mothers' efforts and prayers to make their child comfort.Conclusion: It can be concluded that the child's pain is the main cause of mothers' stress and pressure and also affects the daily lives of mothers and children. Along with the most effective intervention, nurses need to provide mothers and children with adequate information about cancer pain.

  20. Assessing Patients’ Experiences with Communication Across the Cancer Care Continuum

    Science.gov (United States)

    Mazor, Kathleen M.; Street, Richard L.; Sue, Valerie M.; Williams, Andrew E.; Rabin, Borsika A.; Arora, Neeraj K.

    2016-01-01

    Objective To evaluate the relevance, performance and potential usefulness of the Patient Assessment of cancer Communication Experiences (PACE) items. Methods Items focusing on specific communication goals related to exchanging information, fostering healing relationships, responding to emotions, making decisions, enabling self-management, and managing uncertainty were tested via a retrospective, cross-sectional survey of adults who had been diagnosed with cancer. Analyses examined response frequencies, inter-item correlations, and coefficient alpha. Results A total of 366 adults were included in the analyses. Relatively few selected “Does Not Apply”, suggesting that items tap relevant communication experiences. Ratings of whether specific communication goals were achieved were strongly correlated with overall ratings of communication, suggesting item content reflects important aspects of communication. Coefficient alpha was ≥.90 for each item set, indicating excellent reliability. Variations in the percentage of respondents selecting the most positive response across items suggest results can identify strengths and weaknesses. Conclusion The PACE items tap relevant, important aspects of communication during cancer care, and may be useful to cancer care teams desiring detailed feedback. PMID:26979476

  1. Socioeconomic status and patterns of care in lung cancer

    International Nuclear Information System (INIS)

    Hui, A.; Vinod, S.K.; Jalaludin, B.; Yuile, P.; Delaney, G.P.; Barton, M.

    2003-01-01

    This retrospective study aims to explore any associations between socioeconomic factors and lung cancer management and outcome in the Australian setting. The study population consisted of patients newly diagnosed with lung cancer in 1996 who were living in the Northern Sydney Area Health Service (NSAHS) or South Western Sydney Area Health Service (SWSAHS). These two Area Health Services differ in socioeconomic profiles based on socioeconomic indexes for areas (SEIFA), median income, education level and unemployment rate. Data on patient demographics, tumour characteristics, management details, recurrence and survival were collected, and the patterns of care were analysed. Socioeconomic status indicators of the two Area Health Services were imputed from the Australian Bureau of Statistics data. There were 270 and 256 new cases of lung cancer identified in NSAHS and SWSAHS respectively. Patients in NSAHS were slightly older (median age 73 versus 68 years) and there was less male predominance. The stage distributions and performance status of the two cohorts were similar. There were no significant differences in the utilisation rates of different treatment modalities between the two areas: radiotherapy (54% in NSAHS and 55% in SWSAHS), chemotherapy (34% and 25%), surgery (26% and 21%) and no treatment (22% and 25%). The 5-year overall survival was slightly in favour of NSAHS (10.5% and 7.4%), but did not reach statistical significance. Despite differences in socioeconomic profiles between the two area health services, patients with lung cancer had similar patterns of care and survival

  2. Barriers and challenges in integration of anthroposophic medicine in supportive breast cancer care.

    Science.gov (United States)

    Ben-Arye, Eran; Schiff, Elad; Levy, Moti; Raz, Orit Gressel; Barak, Yael; Bar-Sela, Gil

    2013-01-01

    In the last decade, more and more oncology centers are challenged with complementary medicine (CM) integration within supportive breast cancer care. Quality of life (QOL) improvement and attenuation of oncology treatment side effects are the core objectives of integrative CM programs in cancer care. Yet, limited research is available on the use of specific CM modalities in an integrative setting and on cancer patients' compliance with CM consultation. Studies are especially warranted to view the clinical application of researched CM modalities, such as anthroposophic medicine (AM), a unique CM modality oriented to cancer supportive care. Our objective was to characterize consultation patterns provided by physicians trained in CM following oncology health-care practitioners' referral of patients receiving chemotherapy. We aimed to identify characteristics of patients who consulted with AM and to explore patients' compliance to AM treatment. Of the 341 patients consulted with integrative physicians, 138 were diagnosed with breast cancer. Following integrative physician consultation, 56 patients were advised about AM treatment and 285 about other CM modalities. Logistic multivariate regression model found that, compared with patients receiving non-anthroposophic CM, the AM group had significantly greater rates of previous CM use [EXP(B) = 3.25, 95% C.I. 1.64-6.29, p = 0.001] and higher rates of cancer recurrence at baseline (p = 0.038). Most AM users (71.4%) used a single AM modality, such as mistletoe (viscum album) injections, oral AM supplements, or music therapy. Compliance with AM modalities following physician recommendation ranged from 44% to 71% of patients. We conclude that AM treatment provided within the integrative oncology setting is feasible based on compliance assessment. Other studies are warranted to explore the effectiveness of AM in improving patients' QOL during chemotherapy.

  3. 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.

  4. Quality of care in cancer: An exploration of patient perspectives

    Directory of Open Access Journals (Sweden)

    Sandeep Mahapatra

    2016-01-01

    Full Text Available Introduction: Patient satisfaction is as important as is the care itself. When the patient has a disease like cancer it becomes even more important. A cancer patient not only suffers from the disease but also undergoes substantial mental trauma, agony, stress, uncertainty, and apprehension. There are limited studies in India eliciting patient's views on the quality of care being received by cancer patients. Methodology: A cross-sectional triangulation data transformation model mixed method design (Quant + Qual was used to conduct the study between March and May 2015 among patients attending specialty hospitals providing oncology services in Odisha, India. The quantitative data were collected using, Patient Satisfaction Questionnaire-18 to assess satisfaction. The qualitative data were obtained through in-depth interviews using open-ended questionnaire. Results: The results showed that general satisfaction among the patients was 60%. The maximum score was obtained for the communication of doctors. The qualitative findings revealed that travel for distant places for minor illness, waiting period, and lack of services at the primary care facilities were reasons for patient's dissatisfaction. Conclusion: The study found that the patients were generally satisfied with the quality of services. However, more studies should be conducted including perceptions of the patients as well as the caregiver.

  5. Identification of Australian Aboriginal and Torres Strait Islander Cancer Patients in the Primary Health Care Setting

    Directory of Open Access Journals (Sweden)

    Audra de Witt

    2017-08-01

    .ConclusionIt is crucial to be able to easily identify Indigenous cancer patients accessing health services in the PHC setting to monitor progress, improve and evaluate care, and ultimately improve Indigenous cancer outcomes. It is also important for PHC staff to receive adequate training and support to utilize PCISs efficiently and effectively.

  6. Cost-effectiveness of continuation maintenance pemetrexed after cisplatin and pemetrexed chemotherapy for advanced nonsquamous non-small-cell lung cancer: estimates from the perspective of the Chinese health care system.

    Science.gov (United States)

    Zeng, Xiaohui; Peng, Liubao; Li, Jianhe; Chen, Gannong; Tan, Chongqing; Wang, Siying; Wan, Xiaomin; Ouyang, Lihui; Zhao, Ziying

    2013-01-01

    Continuation maintenance treatment with pemetrexed is approved by current clinical guidelines as a category 2A recommendation after induction therapy with cisplatin and pemetrexed chemotherapy (CP strategy) for patients with advanced nonsquamous non-small-cell lung cancer (NSCLC). However, the cost-effectiveness of the treatment remains unclear. We completed a trial-based assessment, from the perspective of the Chinese health care system, of the cost-effectiveness of maintenance pemetrexed treatment after a CP strategy for patients with advanced nonsquamous NSCLC. A Markov model was developed to estimate costs and benefits. It was based on a clinical trial that compared continuation maintenance pemetrexed therapy plus best supportive care (BSC) versus placebo plus BSC after a CP strategy for advanced nonsquamous NSCLC. Sensitivity analyses were conducted to assess the stability of the model. The model base case analysis suggested that continuation maintenance pemetrexed therapy after a CP strategy would increase benefits in a 1-, 2-, 5-, or 10-year time horizon, with incremental costs of $183,589.06, $126,353.16, $124,766.68, and $124,793.12 per quality-adjusted life-year gained, respectively. The most sensitive influential variable in the cost-effectiveness analysis was the utility of the progression-free survival state, followed by proportion of patients with postdiscontinuation therapy in both arms, proportion of BSC costs for PFS versus progressed survival state, and cost of pemetrexed. Probabilistic sensitivity analysis indicated that the cost-effective probability of adding continuation maintenance pemetrexed therapy to BSC was zero. One-way and probabilistic sensitivity analyses revealed that the Markov model was robust. Continuation maintenance of pemetrexed after a CP strategy for patients with advanced nonsquamous NSCLC is not cost-effective based on a recent clinical trial. Decreasing the price or adjusting the dosage of pemetrexed may be a better option

  7. Perceptions of lung cancer and potential impacts on funding and patient care: a qualitative study.

    Science.gov (United States)

    Tran, Kim; Delicaet, Kendra; Tang, Theresa; Ashley, Leslie Beard; Morra, Dante; Abrams, Howard

    2015-03-01

    The objective of this study was to explore health-care professionals', health administrators', and not-for-profit cancer organization representatives' perceptions of lung cancer-related stigma and nihilism and the perceived impacts on funding and patient care. This is a qualitative descriptive study using semi-structured interviews, which was conducted in Ontario, Canada. Seventy-four individuals from medical oncology, radiation oncology, thoracic surgery, respirology, pathology, radiology, primary care, palliative care, nursing, pharmacy, social work, genetics, health administration, and not-for-profit cancer organizations participated in this study. Participants described lung cancer-related stigma and nihilism and its negative impact on patients' psychological health, lung cancer funding, and patient care. The feeling of guilt and shame experienced by lung cancer patients as a result of the stigma associated with the disease was described. In terms of lung cancer funding, stigma was described as a reason lung cancer receives significantly less research funding compared to other cancers. In terms of patient care, lung cancer-related nihilism was credited with negatively impacting physician referral patterns with the belief that lung cancer patients were less likely to receive referrals for medical treatment. Health-care professionals, health administrators, and not-for-profit cancer organization representatives described lung cancer-related stigma and nihilism with far-reaching consequences. Further work is needed to increase education and awareness about lung cancer to reduce the stigma and nihilism associated with the disease.

  8. [Cancer Disease Trajectory and the Contribution of Artistic Outreach Activity to Palliative Care].

    Science.gov (United States)

    Oshiro, Hisako; Oshiro, Tatsuo; Tanimizu, Masahito

    2018-03-01

    The purpose of this article is to show some unintentional aspects of palliative supports offered by the community. The activities of the Opera Ehime, an amateur opera group, play an important role in palliative and grief care. This community is also committed to providing supportive care for home hospice cancer patients through an outreach music program that offers patients connection with others and reduces isolation. Assessment by the coordinator includes determiningthe patients' preferences and the relevance of music throughout their lives. Then, the coordinator predicts the cancer trajectory and invites patients to participate in the home hospice concert at any stage of their illness. These activities are an effective form of supportingcancer care for patients to promote wellness and improve physical and emotional well-being, as well as quality of life.

  9. 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. Copyright © 2014 The Royal College of Radiologists. Published by

  10. Differences in home-based palliative care service utilisation of people with cancer and non-cancer conditions.

    Science.gov (United States)

    Kralik, Debbie; Anderson, Barbara

    2008-11-01

    To identify home-based palliative care service utilisation by people with cancer and non-cancer conditions. Palliative care knowledge and skill have been derived from working with people with cancer. People with chronic conditions are now referred for home-based palliative care; however, there has been few studies published that have explored the impact of service utilisation by people with end-stage chronic conditions. The Australia-modified Karnofsky Performance Status (AKPS) scale was calculated for each person upon referral for home-based palliative care services to determine the functional capacity of the individual at the point of referral. Clients were divided into those with cancer diagnosis and those with non-cancer diagnosis. Service utilisation of the individual client was determined until separation from the palliative care service. The study was undertaken in 2007. The majority of people with cancer (63%) and non-cancer (71%) were assessed as having an AKPS score between 50-60. Thirty-one cancer clients (18·7%) and three non-cancer clients (7·1%) had an AKPS score between 70-90. This suggests that people with cancer are referred to palliative care services earlier than people with non-cancer conditions. People with non-cancer conditions were substantially higher users of home-based palliative care services over a longer period of time. Home-based palliative care service utilisation was higher for people with non-cancer conditions. Cost analysis research is recommended to delineate the actual costs of home-based palliative care service provision between people with cancer and non-cancer conditions. There is growing awareness of the need for palliative care services for people with non-cancer conditions. However, these services are provided for longer periods of time for this client group. Implications for practice are that the palliative care needs of people with non-cancer conditions may not be met within current palliative care service provision

  11. Do palliative care interventions reduce emergency department visits among patients with cancer at the end of life? A systematic review.

    Science.gov (United States)

    DiMartino, Lisa D; Weiner, Bryan J; Mayer, Deborah K; Jackson, George L; Biddle, Andrea K

    2014-12-01

    Frequent emergency department (ED) visits are an indicator of poor quality of cancer care. Coordination of care through the use of palliative care teams may limit aggressive care and improve outcomes for patients with cancer at the end of life. To systematically review the literature to determine whether palliative care interventions implemented in the hospital, home, or outpatient clinic are more effective than usual care in reducing ED visits among patients with cancer at the end of life. PubMed, EMBASE, and CINAHL databases were searched from database inception to May 7, 2014. Only randomized/non-randomized controlled trials (RCTs) and observational studies examining the effect of palliative care interventions on ED visits among adult patients with cancer with advanced disease were considered. Data were abstracted from the articles that met all the inclusion criteria. A second reviewer independently abstracted data from 2 articles and discrepancies were resolved. From 464 abstracts, 2 RCTs, 10 observational studies, and 1 non-RCT/quasi-experimental study were included. Overall there is limited evidence to support the use of palliative care interventions to reduce ED visits, although studies examining effect of hospice care and those conducted outside of the United States reported a statistically significant reduction in ED visits. Evidence regarding whether palliative care interventions implemented in the hospital, home or outpatient clinic are more effective than usual care at reducing ED visits is not strongly substantiated based on the literature reviewed. Improvements in the quality of reporting for studies examining the effect of palliative care interventions on ED use are needed.

  12. Chemotherapy versus supportive care alone in pediatric palliative care for cancer: comparing the preferences of parents and health care professionals.

    Science.gov (United States)

    Tomlinson, Deborah; Bartels, Ute; Gammon, Janet; Hinds, Pamela S; Volpe, Jocelyne; Bouffet, Eric; Regier, Dean A; Baruchel, Sylvain; Greenberg, Mark; Barrera, Maru; Llewellyn-Thomas, Hilary; Sung, Lillian

    2011-11-22

    The choice between palliative chemotherapy (defined as the use of cytotoxic medications delivered intravenously for the purpose of our study) and supportive care alone is one of the most difficult decisions in pediatric oncology, yet little is known about the preferences of parents and health care professionals. We compared the strength of these preferences by considering children's quality of life and survival time as key attributes. In addition, we identified factors associated with the reported preferences. We included parents of children whose cancer had no reasonable chance of being cured and health care professionals in pediatric oncology as participants in our study. We administered separate interviews to parents and to health care professionals. Visual analogue scales were shown to respondents to illustrate the anticipated level of the child's quality of life, the expected duration of survival and the probability of cure (shown only to health care professionals). Respondents were then asked which treatment option they would favour given these baseline attributes. In addition, respondents reported what factors might affect such a decision and ranked all factors identified in order of importance. The primary measure was the desirability score for supportive care alone relative to palliative chemotherapy, as obtained using the threshold technique. A total of 77 parents and 128 health care professionals participated in our study. Important factors influencing the decision between therapeutic options were child quality-of-life and survival time among both parents and health care professionals. Hope was particularly important to parents. Parents significantly favoured chemotherapy (42/77, 54.5%) compared with health care professionals (20/128, 15.6%; p parents' desire for supportive care; for health care professionals, the opinions of parents and children were significant factors influencing this decision. Compared with health care professionals, parents more

  13. Coping with Cosmetic Effects of Cancer Treatment

    Science.gov (United States)

    ... Search English Español Coping With Cosmetic Effects of Cancer Treatment KidsHealth / For Parents / Coping With Cosmetic Effects of Cancer Treatment What's in this article? Hair Loss Skin Problems ...

  14. 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.

  15. Cost of Care for the Initial Management of Ovarian Cancer.

    Science.gov (United States)

    Bercow, Alexandra S; Chen, Ling; Chatterjee, Sudeshna; Tergas, Ana I; Hou, June Y; Burke, William M; Ananth, Cande V; Neugut, Alfred I; Hershman, Dawn L; Wright, Jason D

    2017-12-01

    To examine the cost of care during the first year after a diagnosis of ovarian cancer, estimate the sources of cost, and explore the out-of-pocket costs. We performed a retrospective cohort study of women with ovarian cancer diagnosed from 2009 to 2012 who underwent both surgery and adjuvant chemotherapy using the Truven Health MarketScan database. This database is comprised of patients covered by commercial insurance sponsored by more than 100 employers in the United States. Medical expenditures, including physician reimbursement, for a 12-month period beginning on the date of surgery were estimated. All payments were examined, including out-of-pocket costs for patients. Payments were divided into expenditures for inpatient care, outpatient care (including chemotherapy), and outpatient drug costs. The 12-month treatment period was divided into three phases: surgery to 30 days (operative period), 1-6 months (adjuvant therapy), and 6-12 months after surgery. The primary outcome was the overall cost of care within the first year of diagnosis of ovarian cancer; secondary outcomes included assessment of factors associated with cost. A total of 26,548 women with ovarian cancer who underwent surgery were identified. After exclusion of patients with incomplete insurance enrollment or coverage, those who did not undergo chemotherapy, and those with capitated plans, our cohort consisted of 5,031 women. The median total medical expenditures per patient during the first year after the index procedure were $93,632 (interquartile range $62,319-140,140). Inpatient services accounted for $30,708 (interquartile range $20,102-51,107; 37.8%) in expenditures, outpatient services $52,700 (interquartile range $31,210-83,206; 58.3%), and outpatient drug costs $1,814 (interquartile range $603-4,402; 3.8%). The median out-of-pocket expense was $2,988 (interquartile range $1,649-5,088). This included $1,509 (interquartile range $705-2,878) for outpatient services, $589 (interquartile range

  16. Palliative care among heart failure patients in primary care: a comparison to cancer patients using English family practice data.

    Directory of Open Access Journals (Sweden)

    Amy Gadoud

    Full Text Available Patients with heart failure have a significant symptom burden and other palliative care needs often over a longer period than patients with cancer. It is acknowledged that this need may be unmet but by how much has not been quantified in primary care data at the population level.This was the first use of Clinical Practice Research Datalink, the world's largest primary care database to explore recognition of the need for palliative care. Heart failure and cancer patients who had died in 2009 aged 18 or over and had at least one year of primary care records were identified. A palliative approach to care among patients with heart failure was compared to that among patients with cancer using entry onto a palliative care register as a marker for a palliative approach to care.Among patients with heart failure, 7% (234/3 122 were entered on the palliative care register compared to 48% (3 669/7 608 of cancer patients. Of heart failure patients on the palliative care register, 29% (69/234 were entered onto the register within a week of their death.This confirms that the stark inequity in recognition of palliative care needs for people with heart failure in a large primary care dataset. We recommend a move away from prognosis based criteria for palliative care towards a patient centred approach, with assessment of and attention to palliative needs including advance care planning throughout the disease trajectory.

  17. CARING (CAncer Risk and INsulin analoGues)

    DEFF Research Database (Denmark)

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

    2013-01-01

    =1.2), breast (RR=1.1), cervix (RR=1.3), endometrial (RR=1.4), several digestive tract (RR=1.1-1.5), kidney (RR=1.4), and bladder cancer (RR=1.1). The findings were similar for men and women, and unrelated to study design. Meta-regression analyses showed limited effect modification of body mass index......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 PRISMA guidelines. DATA SOURCES: The systematic literature search includes Medline at PubMed, Embase, Cinahl, Bibliotek.dk, Cochrane library, Web of Science and SveMed+ with the search terms: "Diabetes mellitus", "Neoplasms", and "Risk of cancer". STUDY ELIGIBILITY CRITERIA: The included studies compared...

  18. Improving Cancer Care for Children in the Developing World: Challenges and Strategies.

    Science.gov (United States)

    Al Lamki, Zakiya

    2017-01-01

    Cancer is a global health problem particularly in developing countries where the burden of cancer is ever increasing and claiming the lives of about 100,000 children under the age of 15 years every year. Majority of these occur in the Low and Middle Income Countries (LMICs) where 90% of world children live. Contributing factors to this trend is the reduction of communicable diseases and emergence of new infections, improvement of nutrition and socio-economic conditions, industrialization and urbanization. However, due to its complexity, childhood cancer is given the least priority by the governments' funding. The weak health systems, poor and late access to diagnosis and care, fewer numbers of trained health care professionals and lack of cancer drugs are amongst the many challenges faced. A major challenge for the future is extending the work to reach the many children who die without access to cancer treatment and palliation. Given the inequalities in the survival rates of children with cancer there is therefore an urgent need to close the gap between developed and developing countries. Strategies at individual, institutional, country, regional and global levels must be implemented to improve cancer survival and its effects on human suffering. These strategies are able to strengthen the health systems, improve care and research, increase awareness and coordinate training of professionals thus meeting the challenges. Financial support should be an integral part of the strategy as the cost of drugs is often a substantial barrier to treatment of cancer in poor countries. However, in resource-limited settings without specialized services, much can still be done to support and offer curative and palliative treatment. As have been shown for several cancers, life can be extended with low-tech treatment protocols, which are effective at the same time, decrease sepsis and toxicity. The concept of twinning with privileged nations is paramount to the success of any national

  19. Clinician-led improvement in cancer care (CLICC) - testing a multifaceted implementation strategy to increase evidence-based prostate cancer care: phased randomised controlled trial - study protocol

    Science.gov (United States)

    2014-01-01

    Background Clinical practice guidelines have been widely developed and disseminated with the aim of improving healthcare processes and patient outcomes but the uptake of evidence-based practice remains haphazard. There is a need to develop effective implementation methods to achieve large-scale adoption of proven innovations and recommended care. Clinical networks are increasingly being viewed as a vehicle through which evidence-based care can be embedded into healthcare systems using a collegial approach to agree on and implement a range of strategies within hospitals. In Australia, the provision of evidence-based care for men with prostate cancer has been identified as a high priority. Clinical audits have shown that fewer than 10% of patients in New South Wales (NSW) Australia at high risk of recurrence after radical prostatectomy receive guideline recommended radiation treatment following surgery. This trial will test a clinical network-based intervention to improve uptake of guideline recommended care for men with high-risk prostate cancer. Methods/Design In Phase I, a phased randomised cluster trial will test a multifaceted intervention that harnesses the NSW Agency for Clinical Innovation (ACI) Urology Clinical Network to increase evidence-based care for men with high-risk prostate cancer following surgery. The intervention will be introduced in nine NSW hospitals over 10 months using a stepped wedge design. Outcome data (referral to radiation oncology for discussion of adjuvant radiotherapy in line with guideline recommended care or referral to a clinical trial of adjuvant versus salvage radiotherapy) will be collected through review of patient medical records. In Phase II, mixed methods will be used to identify mechanisms of provider and organisational change. Clinicians’ knowledge and attitudes will be assessed through surveys. Process outcome measures will be assessed through document review. Semi-structured interviews will be conducted to elucidate

  20. Aboriginal experiences of cancer and care coordination: Lessons from the Cancer Data and Aboriginal Disparities (CanDAD) narratives.

    Science.gov (United States)

    Reilly, Rachel; Micklem, Jasmine; Yerrell, Paul; Banham, David; Morey, Kim; Stajic, Janet; Eckert, Marion; Lawrence, Monica; Stewart, Harold B; Brown, Alex

    2018-04-24

    Aboriginal people with cancer experience worse outcomes than other Australians for a range of complex and interrelated reasons. A younger age at diagnosis, higher likelihood of more advanced cancer or cancer type with poorer prognosis, geographic isolation and cultural and language diversity mean that patient pathways are potentially more complex for Aboriginal people with cancer. In addition, variation in the quality and acceptability of care may influence cancer outcomes. This study sought to understand how care coordination influences Aboriginal people's experiences of cancer treatment. Interviews with 29 Aboriginal patients or cancer survivors, 11 carers and 22 service providers were carried out. Interviews were semi-structured and sought to elicit experiences of cancer and the health-care system. The manifest content of the cancer narratives was entered onto a cancer pathway mapping tool and underlying themes were identified inductively. The practice of cancer care coordination was found to address the needs of Aboriginal patients and their families/carers in 4 main areas: "navigating the health system"; "information and communication"; "things to manage at home"; and "cultural safety". The CanDAD findings indicate that, when the need for cancer care coordination is met, it facilitated continuity of care in a range of ways that may potentially improve cancer outcomes. However, the need remains unmet for many. Findings support the importance of dedicated care coordination to enable Aboriginal people to receive adequate and appropriate patient-centred care, so that the unacceptable disparity in cancer outcomes between Aboriginal and non-Aboriginal people can be addressed. © 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd.

  1. Innovations in health care and mortality trends from five cancers in seven European countries between 1970 and 2005.

    Science.gov (United States)

    Hoffmann, Rasmus; Plug, Iris; McKee, Martin; Khoshaba, Bernadette; Westerling, Ragnar; Looman, Caspar; Rey, Gregoire; Jougla, Eric; Lang, Katrin; Pärna, Kersti; Mackenbach, Johan P

    2014-04-01

    Although the contribution of health care to survival from cancer has been studied extensively, much less is known about its contribution to population health. We examine how medical innovations have influenced trends in cause-specific mortality at the national level. Based on literature reviews, we selected six innovations with proven effectiveness against cervical cancer, Hodgkin's disease, breast cancer, testicular cancer, and leukaemia. With data on the timing of innovations and cause-specific mortality (1970-2005) from seven European countries we identified associations between innovations and favourable changes in mortality. For none of the five specific cancers, sufficient evidence for an association between introduction of innovations and a positive change in mortality could be found. The highest association was found between the introduction of Tamoxifen and breast cancer mortality. The lack of evidence of health care effectiveness may be due to gradual improvements in treatment, to effects limited to certain age groups or cancer subtypes, and to contemporaneous changes in cancer incidence. Research on the impact of health care innovations on population health is limited by unreliable data on their introduction.

  2. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... Cancers Late Effects of Childhood Cancer Treatment Pediatric Supportive Care Unusual Cancers of Childhood Treatment Childhood Cancer ... can talk about it in a clear and supportive way. Two viewer guides are also available: for ...

  3. Distribution and Determinants of Unmet Need for Supportive Care Among Women with Breast Cancer in China.

    Science.gov (United States)

    Wang, Shouhua; Li, Yanqing; Li, Chaozhuo; Qiao, Yijun; He, Shuling

    2018-03-21

    BACKGROUND The aim of this study was to determine the need for supportive care among women suffering from breast cancer in China and to identify its potential determinants to inform the development of effective and efficient healthcare services across different settings. MATERIAL AND METHODS In a tertiary-care hospital in Weifang, China, between July 2015 and January 2016, all women attending the Breast Cancer Clinic for regular physical examinations after treatment for breast cancer were consecutively recruited. The 34-item Supportive Care Needs Survey tool (Chinese version) (SCNS-SF34-C) was used to assess the unmet needs among participants. RESULTS Among 264 recruited patients, based on at least single-item endorsement, 60.2% had moderate to high level of need for supportive care, while only 13.3% expressed no need. Lack of information regarding health systems was the most common domain with moderate to high unmet needs, more so among rural patients (8 vs. 5 out of 10). In each information-related domain, huge unmet need was observed among all patients irrespective of urban or rural residence. Both overall and individual information-related domain-specific unmet needs were significantly higher among rural patients as opposed to their urban counterparts. Multiple regression analyses revealed a significant rural-urban variation of unmet needs. Moreover, education and post-diagnosis time duration were negatively associated with unmet needs while stage of cancer was positively associated with these unmet needs. CONCLUSIONS There is a huge burden of unmet needs for information on the healthcare system among breast cancer survivors in China. Rural residence, less education, advanced stage of cancer, and shorter duration since diagnosis were the identified determinants requiring targeted intervention.

  4. Costs of cancer care in children and adolescents in Ontario, Canada.

    Science.gov (United States)

    de Oliveira, Claire; Bremner, Karen E; Liu, Ning; Greenberg, Mark L; Nathan, Paul C; McBride, Mary L; Krahn, Murray D

    2017-11-01

    Cancer in children and adolescents presents unique issues regarding treatment and survivorship, but few studies have measured economic burden. We estimated health care costs by phase of cancer care, from the public payer perspective, in population-based cohorts. Children newly diagnosed at ages 0 days-14.9 years and adolescents newly diagnosed at 15-19.9 years, from January 1, 1995 to June 30, 2010, were identified from Ontario cancer registries, and each matched to three noncancer controls. Data were linked with administrative records describing resource use for cancer and other health care. Total and net (patients minus controls) resource-specific costs ($CAD2012) were estimated using generalized estimating equations for four phases of care: prediagnosis (60 days), initial (360 days), continuing (variable), final (360 days). Mean ages at diagnosis were 6 years for children (N = 4,606) and 17 years for adolescents (N = 2,443). Mean net prediagnosis phase 60-day costs were $6,177 for children and $1,018 for adolescents. Costs for initial, continuing, and final phases were $138,161, $15,756, and $316,303 per 360 days for children, and $62,919, $7,071, and $242,008 for adolescents. The highest initial phase costs were for leukemia patients ($156,225 per 360 days for children and $171,275 for adolescents). The final phase was the most costly ($316,303 per 360 days for children and $242,008 for adolescents). Costs for children with cancer are much higher than for adolescents and much higher than those reported in adults. Comprehensive population-based long-term estimates of cancer costs are useful for health services planning and cost-effectiveness analysis. © 2017 Wiley Periodicals, Inc.

  5. Utilization of health care services in cancer patients with elevated fear of cancer recurrence.

    Science.gov (United States)

    Champagne, Alexandra; Ivers, Hans; Savard, Josée

    2018-05-02

    Cancer patients commonly report experiencing fear of cancer recurrence (FCR), which may lead to several negative consequences. This study aimed at examining whether clinical levels of FCR are linked to a greater use of health care services. This is a secondary analysis of a longitudinal study of 962 cancer patients on the epidemiology of cancer-related insomnia. They completed the Fear of Cancer Recurrence Inventory-Short form (FCRI-SF) and reported information on their consultations (medical, psychosocial, and complementary and alternative medicine [CAM]) and medication usage (anxiolytics/hypnotics and antidepressants) at 6 time points over an 18-month period. Results indicated that clinical FCR at baseline was associated with greater consultation rates of medical and psychosocial professionals and a greater usage of anxiolytics/hypnotics and antidepressants. No significant association was found between the FCR level and use of CAM services. While consultation rates of medical and CAM professionals and usage of antidepressants generally increased over time, consultation rates of psychosocial professionals and usage of anxiolytics/hypnotics tended to decrease. Cancer patients with clinical levels of FCR are more likely to consult health care providers and to use psychotropic medications, which may translate into significant costs for society and the patients themselves. Copyright © 2018 John Wiley & Sons, Ltd.

  6. 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.

  7. 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

  8. Adverse glycaemic effects of cancer therapy: indications for a rational approach to cancer patients with diabetes.

    Science.gov (United States)

    Gallo, Marco; Muscogiuri, Giovanna; Felicetti, Francesco; Faggiano, Antongiulio; Trimarchi, Francesco; Arvat, Emanuela; Vigneri, Riccardo; Colao, Annamaria

    2018-01-01

    Diabetes and cancer are common, chronic, and potentially fatal diseases that frequently co-exist. Observational studies have reported an increased risk of cancer in patients with diabetes. Furthermore, many patients with cancer already have diabetes, or develop hyperglycaemia as a consequence of the tumor or of cancer therapies, and coexisting diabetes confers a greater risk of mortality for many malignancies. Managing oncologic patients with diabetes is often complicated, since the co-existence of diabetes and cancer poses several complex clinical questions: what level of glycaemic control to achieve, which therapy to use, how to deal with glucocorticoid therapies and artificial nutrition, how diabetes complications can affect cancer management, which drug-drug interactions should be taken into account, or even how to manage diabetes at the end of life. In the clinical setting, both at hospital and at home, there are little agreed, evidence-based guidelines on the best management and criteria upon which clinical decisions should be based. A practical solution lies in the implementation of care networks based on communication and ongoing collaboration between Oncologists, Endocrinologists, and the nursing staff, with the patient at the centre of the care process. This manuscript aims to review the current evidence on the effect of cancer therapies on glucose metabolism and to address some of the more common challenges of diabetes treatment in patients with cancer. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Primary care colorectal cancer screening correlates with breast cancer screening: implications for colorectal cancer screening improvement interventions.

    Science.gov (United States)

    Weiss, Jennifer M; Pandhi, Nancy; Kraft, Sally; Potvien, Aaron; Carayon, Pascale; Smith, Maureen A

    2018-04-25

    National colorectal cancer (CRC) screening rates have plateaued. To optimize interventions targeting those unscreened, a better understanding is needed of how this preventive service fits in with multiple preventive and chronic care needs managed by primary care providers (PCPs). This study examines whether PCP practices of other preventive and chronic care needs correlate with CRC screening. We performed a retrospective cohort study of 90 PCPs and 33,137 CRC screening-eligible patients. Five PCP quality metrics (breast cancer screening, cervical cancer screening, HgbA1c and LDL testing, and blood pressure control) were measured. A baseline correlation test was performed between these metrics and PCP CRC screening rates. Multivariable logistic regression with clustering at the clinic-level estimated odds ratios and 95% confidence intervals for these PCP quality metrics, patient and PCP characteristics, and their relationship to CRC screening. PCP CRC screening rates have a strong correlation with breast cancer screening rates (r = 0.7414, p < 0.001) and a weak correlation with the other quality metrics. In the final adjusted model, the only PCP quality metric that significantly predicted CRC screening was breast cancer screening (OR 1.25; 95% CI 1.11-1.42; p < 0.001). PCP CRC screening rates are highly concordant with breast cancer screening. CRC screening is weakly concordant with cervical cancer screening and chronic disease management metrics. Efforts targeting PCPs to increase CRC screening rates could be bundled with breast cancer screening improvement interventions to increase their impact and success.

  10. Improving access to supportive cancer care through an eHealth application: a qualitative needs assessment among cancer survivors.

    NARCIS (Netherlands)

    Lubberding, S.; van Uden-Kraan, C.F.; te Velde, E.A.; Cuijpers, P.; Leemans, C.R.; Verdonck-de Leeuw, I.M.

    2015-01-01

    Aims and objectives: To gain insight into cancer survivors' needs towards an eHealth application monitoring quality of life and targeting personalised access to supportive care. Background: Supportive care in cancer addresses survivors' concerns and needs. However, many survivors are not taking

  11. Awareness of Breast Cancer among Female Care Givers in Tertiary Cancer Hospital, China

    Science.gov (United States)

    Dinegde, Negalign Getahun; Xuying, Li

    2017-01-01

    Objective: Breast cancer is a worldwide public health issue and most common cancer diagnosed among women including China, where advanced stages at diagnosis appears to be increasing and an ever-rising incidence twice as fast as global rates. The study was conducted to describe the awareness of breast cancer and associated factors among care giver women in tertiary Cancer Hospital, China. Methods: Institutional based cross-sectional study was conducted among 261 women selected by systematic random sampling. Information provided by the participants was converted into awareness scores for analysis using SPSS version 23. Awareness scores were dichotomized in to ‘good awareness and ‘poor awareness’ taking median score=11 as the cut-off point. Data analysis was performed using the binary logistic regression. A p-value of awareness. Breast lump was the most commonly known symptom of cancer by 61.7% of the respondents. Slightly more than half of the study participants acknowledged having a past history of breast cancer, drinking alcohol and having close relative with breast cancer as potential risk factors for breast cancer (63.6%, 58.6%, and 55.6% respectively). Nevertheless, a vast majority of the study participants were unable to appreciate modifiable risk factors of the disease. More than half of the participants had never/rarely checked their breasts and all of the participants wrongly answered breast cancer knowledge age related risk. Awareness level was significantly associated with entertainment preference (OR=3.57; 95%CI=1.71, 7.44) and residence setting areas (OR=2.4; 95%CI=1.04, 5.69). Conclusion: The study indicated suboptimal awareness while entertainment preference and residence setting were significantly associated with awareness level. Public awareness campaigns should be made by dissemination of information about breast cancer through health education and printed Medias with great emphases on women living in rural areas. PMID:28749635

  12. Information technology-enabled team-based, patient-centered care: The example of depression screening and management in cancer care.

    Science.gov (United States)

    Randhawa, Gurvaneet S; Ahern, David K; Hesse, Bradford W

    2017-03-01

    The existing healthcare delivery systems across the world need to be redesigned to ensure high-quality care is delivered to all patients. This redesign needs to ensure care is knowledge-based, patient-centered and systems-minded. The rapid advances in the capabilities of information and communication technology and its recent rapid adoption in healthcare delivery have ensured this technology will play a vital role in the redesign of the healthcare delivery system. This commentary highlights promising new developments in health information technology (IT) that can support patient engagement and self-management as well as team-based, patient-centered care. Collaborative care is an effective approach to screen and treat depression in cancer patients and it is a good example of the benefits of team-based and patient-centered care. However, this approach was developed prior to the widespread adoption and use of health IT. We provide examples to illustrate how health IT can improve prevention and treatment of depression in cancer patients. We found several knowledge gaps that limit our ability to realize the full potential of health IT in the context of cancer and comorbid depression care. These gaps need to be filled to improve patient engagement; enhance the reach and effectiveness of collaborative care and web-based programs to prevent and treat depression in cancer patients. We also identify knowledge gaps in health IT design and implementation. Filling these gaps will help shape policies that enable clinical teams to deliver high-quality cancer care globally.

  13. Day hospital as an alternative to inpatient care for cancer patients: a random assignment trial.

    Science.gov (United States)

    Mor, V; Stalker, M Z; Gralla, R; Scher, H I; Cimma, C; Park, D; Flaherty, A M; Kiss, M; Nelson, P; Laliberte, L

    1988-01-01

    A stratified, random-assignment trial of 442 cancer patients was conducted to evaluate medical, psychosocial, and financial outcomes of day hospital treatment as an alternative to inpatient care for certain cancer patients. Eligible patients required: a 4- to 8-hour treatment plan, including chemotherapy and other long-term intravenous (i.v.) treatment; a stable cardiovascular status; mental competence; no skilled overnight nursing; and a helper to assist with home care. Patients were ineligible if standard outpatient treatment was possible. No statistically significant (p less than 0.05) differences were found between the Adult Day Hospital (ADH) and Inpatient care in medical or psychosocial outcomes over the 60-day study period. The major difference was in medical costs--approximately one-third lower for ADH patients (p less than 0.001) than for the Inpatient group. The study demonstrates that day hospital care of medical oncology patients is clinically equivalent to Inpatient care, causes no negative psychosocial effects, and costs less than Inpatient care. Findings support the trend toward dehospitalization of medical treatment.

  14. [Breast cancer update in primary care: (V/V)].

    Science.gov (United States)

    Díaz García, Noiva; Cuadrado Rouco, Carmen; Vich, Pilar; Alvarez-Hernandez, Cristina; Brusint, Begoña; Redondo Margüello, Esther

    2015-03-01

    Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians ought to know thoroughly this pathology to optimize the health care services for these patients making the best use of available resources. A series of five articles on breast cancer is presented below. It is based on a review of the scientific literature over the last ten years. In this final section, the social, psychological, occupational and family issues related to the disease will be reviewed, as well as presenting some special situations of breast cancer, including breast cancer in men, during pregnancy and last stages of life. This summary report aims to provide a current and practical review about this disease, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  15. Caring for the person with cancer: Information and support needs and the role of technology.

    Science.gov (United States)

    Heynsbergh, Natalie; Botti, Mari; Heckel, Leila; Livingston, Patricia M

    2018-06-01

    Informal carers experience a variety of information and support needs when providing care to someone with cancer. It is unclear when carers seek information and what resources they access to support themselves throughout the cancer trajectory. A sample of 45 carers and 15 oncology nurses were recruited to participate in either focus groups or phone interviews. Carers in the study were more likely to be women (60%), caring for a spouse or partner (64.4%), living with the patient (86.7%), and hold a university degree (46.7%). The majority of oncology nurses were females (66.6%). Findings showed that carers had limited access to adequate information as needs arose. Supports used to address information needs included information booklets, the Internet, and communication with healthcare professionals or with other carers. Barriers in communication between nurses and carers impacted on the adequacy of information received. Participants reported that technology, such as smartphone applications, might be appropriate for improving information and support needs. Caring for someone with cancer is multifaceted. Carers need access to timely information to help them effectively manage patients' needs. Future studies should assess the role of contemporary approaches, such as digital technology, as a solution to the delivery of information and support for carers of people with cancer. © 2018 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.

  16. [Update of breast cancer in Primary Care (III/V)].

    Science.gov (United States)

    Álvarez Hernández, C; Vich Pérez, P; Brusint, B; Cuadrado Rouco, C; Díaz García, N; Robles Díaz, L

    2014-01-01

    Breast cancer is a prevalent disease with implications in all aspects of patientś life, therefore, family doctors must know this pathology in depth, in order to optimize the health care provided to these patients with the best available resources. This series of five articles on breast cancer is based on a review of the scientific literature of the last ten years. This third article will review the clinical context and the staging and prognostic factors of the disease. This summary report aims to provide a global, current and practical review about this problem, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  17. 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.

  18. Cost-effectiveness of colorectal cancer screening

    NARCIS (Netherlands)

    I. Lansdorp-Vogelaar (Iris); A.B. Knudsen (Amy); H. Brenner (Hermann)

    2011-01-01

    textabstractColorectal cancer is an important public health problem. Several screening methods have been shown to be effective in reducing colorectal cancer mortality. The objective of this review was to assess the cost-effectiveness of the different colorectal cancer screening methods and to

  19. 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

  20. Cancer Supportive and Survivorship Care in Singapore: Current Challenges and Future Outlook

    Directory of Open Access Journals (Sweden)

    Kiley Wei-Jen Loh

    2018-02-01

    Full Text Available Despite being a relatively young nation, Singapore has established itself as a leading multifaceted medical hub, both regionally and globally. Although Singapore continues to pursue excellence in oncology care, cancer supportive care and survivorship care remain in the infancy stage. In an effort to advance this important aspect of oncology care in Singapore, the first cancer supportive and survivorship care forum was held in December 2016, involving 74 oncology practitioners. The primary goals of this forum were to raise awareness of the importance of cancer supportive and survivorship care and to provide a platform for oncology practitioners of diverse backgrounds to converge and address the challenges associated with the delivery of cancer supportive and survivorship care in Singapore. Key challenges identified during this forum included, but were not limited to, care fragmentation in an oncologist-centric model of care, poor integration of allied health and rehabilitation services, passive engagement of community partners, lack of specialized skill sets and knowledge in supportive and survivorship care, and patient-related barriers such as poor health literacy. The survivorship care model commonly used in Singapore places an imbalanced emphasis on surveillance for cancer recurrence and second primary cancers, with little attention given to the supportive and survivorship needs of the survivors. In summary, these challenges set the stage for the development and use of a more survivor-centric model, one that focuses not only on cancer surveillance, but also on the broad and unique physical and psychosocial needs of survivors of cancer in Singapore.

  1. The effect of a supersaturated calcium phosphate mouth rinse on the development of oral mucositis in head and neck cancer patients treated with (chemo)radiation: a single-center, randomized, prospective study of a calcium phosphate mouth rinse + standard of care versus standard of care.

    Science.gov (United States)

    Lambrecht, Maarten; Mercier, Carole; Geussens, Yasmyne; Nuyts, Sandra

    2013-10-01

    Mucosal damage is an important and debilitating side effect when treating head and neck cancer patients with (chemo-)radiation. The aim of this randomized clinical trial was to investigate whether the addition of a neutral, supersaturated, calcium phosphate (CP) mouth rinse benefits the severity and duration of acute mucositis in head and neck cancer patients treated with (chemo)radiation. A total of 60 patients with malignant neoplasms of the head and neck receiving (chemo)radiation were included in this study. Fifty-eight patients were randomized into two treatment arms: a control group receiving standard of care (n = 31) and a study group receiving standard of care + daily CP mouth rinses (n = 27) starting on the first day of (chemo-)radiation. Oral mucositis and dysphagia were assessed twice a week using the National Cancer Institute common toxicity criteria scale version 3, oral pain was scored with a visual analogue scale. No significant difference in grade III mucositis (59 vs. 71 %; p = 0.25) and dysphagia (33 vs. 42 %, p = 0.39) was observed between the study group compared to the control group. Also no significant difference in time until development of peak mucositis (28.6 vs. 28.7 days; p = 0.48), duration of peak mucositis (22.7 vs. 24.6 days; p = 0.31), recuperation of peak dysphagia (20.5 vs 24.2 days; p = 0.13) and occurrence of severe pain (56 vs. 52 %, p = 0.5). In this randomized study, the addition of CP mouth rinse to standard of care did not improve the frequency, duration or severity of the most common acute toxicities during and early after (chemo)radiation. There is currently no evidence supporting its standard use in daily practice.

  2. Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit

    Science.gov (United States)

    Swann, Ruth; McPhail, Sean; Witt, Jana; Shand, Brian; Abel, Gary A; Hiom, Sara; Rashbass, Jem; Lyratzopoulos, Georgios; Rubin, Greg

    2018-01-01

    Background Continual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this. Aim To characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit. Design and setting Clinical audit of cancer diagnosis in general practices in England. Method Information on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management. Results Data were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15–86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0–27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more. Conclusion The findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer. PMID:29255111

  3. Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit.

    Science.gov (United States)

    Swann, Ruth; McPhail, Sean; Witt, Jana; Shand, Brian; Abel, Gary A; Hiom, Sara; Rashbass, Jem; Lyratzopoulos, Georgios; Rubin, Greg

    2018-01-01

    Continual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this. To characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit. Clinical audit of cancer diagnosis in general practices in England. Information on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management. Data were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15-86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0-27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more. The findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer. © British Journal of General Practice 2018.

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

    OpenAIRE

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

    2016-01-01

    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...

  5. Supportive care for head and neck cancer patients receiving radiotherapy

    International Nuclear Information System (INIS)

    Zenda, Sadamoto

    2015-01-01

    Recently (chemo-)radiotherapy has been widely used in head and neck cancer with definite evidence. As long survivor has increased, social problems associated with late toxicity have become more. Late toxicities induced by radiotherapy for head and neck lesion are often severe. Xerostomia is one of the severe late toxicities conventionally and dysphagia after chemoradiotherapy is a new topic. Some industrial development (ex. Intensity Modulated Radiotherapy: IMRT) play a great role in toxicity management. Multidisciplinary approach (cooperation between not only physicians but also nurses and dentists) is necessary to control toxicities. The research of supportive care will be needed same as definitive treatment in the future. (author)

  6. Impact of emotional competence on supportive care needs, anxiety and depression symptoms of cancer patients: a multiple mediation model.

    Science.gov (United States)

    Baudry, A-S; Lelorain, S; Mahieuxe, M; Christophe, V

    2018-01-01

    The aim of this study was to test the effect of intrapersonal and interpersonal emotional competence on cancer patients' supportive care needs, as mediated by anxiety and depression symptoms. Cross-sectional design: 137 cancer patients (42% breast or ovarian cancer, 58% gastrointestinal cancer) in 4 French hospitals completed the Profile of Emotional Competence (PEC), the Hospital Anxiety and Depression Scale (HADS), and the Supportive Care Needs Survey Short Form (SCNS-SF). Bootstrap methods with PROCESS Macro were used to test multiple mediation models. Emotional competence presented a direct or indirect beneficial effect on the satisfaction of supportive care needs, anxiety and depression symptoms. As expected, anxiety and depression symptoms had also strong positive correlations with unmet needs. All multiple mediation models were significant, except for physical needs: intrapersonal and interpersonal emotional competence impacted anxiety and depression symptoms, which in turn impacted psychological, sexual, care/support, and information needs. These innovative results show the important effect of patients' emotional competence on their supportive care need satisfaction, as mediated by anxiety and depression. Consequently, patients with high emotional competence may require less psychosocial input from medical clinicians. Thus, emotional competence may be integrated into health models and psychosocial interventions to improve patient adjustment. Further investigation is, however, needed to know which are the most beneficial specific emotional competences and at what point of the cancer pathway.

  7. Nursing care for patients with local recurrent rectal cancer after CT-guided 125I seed implantation therapy

    International Nuclear Information System (INIS)

    Yuan Li; Wei Fan; Ren Caifeng; Tu Mingmei; Qian Guixiang

    2010-01-01

    Objective: To discuss the nursing care strategy for patients with local recurrent rectal cancer who has been treated with CT-guided 125 I seed implantation therapy. Methods: Twenty patients with local recurrent rectal cancer received a series of nursing interventions, including comfort care and pain care. The clinical results were observed and analyzed. Results: The therapy was smoothly accomplished in all patients. The pain was remarkably relived and the anxiety was alleviated. No displacement of implanted 125 I seed occurred. Conclusion: For patients with local recurrent rectal cancer occurred after CT-guided 125 I seed implantation therapy, careful nursing can effectively relieve the pain and anxiety feeling,and the living quality can also be markedly improved. (authors)

  8. Effects of a sexual health care nursing record on the attitudes and practice of oncology nurses.

    Science.gov (United States)

    Jung, Dukyoo; Kim, Jung-Hee

    2016-10-01

    A nursing record focused on sexual health care for patients with cancer could encourage oncology nurses to provide sexual health care for oncology patients in a simple and effective manner. However, existing electronic information systems focus on professional use and not sexual health care, which could lead to inefficiencies in clinical practice. To examine the effects of a sexual health care nursing record on the attitudes and practice of oncology nurses. Twenty-four full-time registered nurses caring for oncology patients were randomly assigned to the intervention and control groups in Korea. The researchers developed a sexual health care record and applied it to the intervention group for one month. Data were analyzed by Mann-Whitney U test and chi-square test. Content analysis was used to analyze interviews. Oncology nurses using the sexual health care record had significantly higher levels of sexual health care practice at 4 weeks post-intervention as compared to those who provided usual care to patients with cancer. A sexual health care record may have the potential to facilitate oncology nurses' practice of sexual health care. This study highlighted the importance of using SHC records with oncology patients to improve nursing practice related to sexuality issues. A nursing record focused on SHC for patients with cancer could make it easier and more effective for oncology nurses to provide such care to their patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Need for global partnership in cancer care: perceptions of cancer care researchers attending the 2010 australia and Asia pacific clinical oncology research development workshop.

    Science.gov (United States)

    Lyerly, H Kim; Abernethy, Amy P; Stockler, Martin R; Koczwara, Bogda; Aziz, Zeba; Nair, Reena; Seymour, Lesley

    2011-09-01

    To understand the diversity of issues and the breadth of growing clinical care, professional education, and clinical research needs of developing countries, not typically represented in Western or European surveys of cancer care and research. A cross-sectional survey was conducted of the attendees at the 2010 Australia and Asia Pacific Clinical Oncology Research Development workshop (Queensland, Australia) about the most important health care questions facing the participant's home countries, especially concerning cancer. Early-career oncologists and advanced oncology trainees from a region of the world containing significant low- and middle-income countries reported that cancer is an emerging health priority as a result of aging of the population, the impact of diet and lifestyle, and environmental pollution. There was concern about the capacity of health care workers and treatment facilities to provide cancer care and access to the latest cancer therapies and technologies. Although improving health care delivery was seen as a critical local agenda priority, focusing on improved cancer research activities in this select population was seen as the best way that others outside the country could improve outcomes for all. The burden of cancer will increase dramatically over the next 20 years, particularly in countries with developing and middle-income economies. Cancer research globally faces significant barriers, many of which are magnified in the developing country setting. Overcoming these barriers will require partnerships sensitive and responsive to both local and global needs.

  10. Young female cancer survivors' use of fertility care after completing cancer treatment

    Science.gov (United States)

    Kim, Jayeon; Mersereau, Jennifer E.; Su, H. Irene; Whitcomb, Brian W.; Malcarne, Vanessa L.; Gorman, Jessica R.

    2016-01-01

    Purpose To investigate factors associated with female young adult cancer survivors’ (YCS) use of fertility care (FC), including consultation or fertility treatment, after completing their cancer treatment. Methods In this cross-sectional study, females between that ages of 18 and 35 years who had been diagnosed with childhood, adolescent, or young adult cancers completed a 20-min web-based survey that included demographics, reproductive history, use of FC, fertility-related informational needs, and reproductive concerns. Results A total of 204 participants completed the survey. Participants’ mean age was 28.3±4.5 years. Thirty (15%) participants reported using FC after cancer treatment. The majority of participants recalled not receiving enough information about FP options at the time of cancer diagnosis (73%). In multivariable analysis, those with higher concerns about having children because of perceived risk to their personal health (P=0.003) were less likely to report use of FC after cancer treatment. Those who had used FC before cancer treatment (P=0.003) and who felt less fertile than age-matched women (P=0.02) were more likely to use FC after their cancer treatment. Conclusions While most YCS in this cohort believed that they did not receive enough information about fertility and most wanted to have children, the vast majority did not seek FC. The findings of this study offer further evidence of the need for improved education and emotional support regarding reproductive options after cancer treatment is completed. Targeted discussions with YCS about appropriate post-treatment FC options may improve providers’ capacity to help YCS meet their parenthood goals. PMID:26939923

  11. Text Messaging (SMS) Helping Cancer Care in Patients Undergoing Chemotherapy Treatment: a Pilot Study.

    Science.gov (United States)

    Rico, Timóteo Matthies; Dos Santos Machado, Karina; Fernandes, Vanessa Pellegrini; Madruga, Samanta Winck; Noguez, Patrícia Tuerlinckx; Barcelos, Camila Rose Guadalupe; Santin, Mateus Madail; Petrarca, Cristiane Rios; Dumith, Samuel Carvalho

    2017-10-09

    Cancer treatment is an extremely stressful life experience that is accompanied by a range of psychological, social, physical, and practical difficulties. Cancer patients need to receive information that helps them to better understand the disease, assists them in decision-making, and helps them deal with treatment. Patients are interested in receiving such information. The degree of satisfaction with the information received has been associated with positive health outcomes, specifically regarding quality of life, severity of side effects, and psychological well-being. This study investigates a method of guiding cancer patients, in relation to outpatient chemotherapy treatment, using SMS (short message service) text messaging. A smartphone application called cHEmotHErApp was developed, and its primary function is to send out SMS text messages with guidance for self-care and emotional support for oncology patients undergoing chemotherapy. Thus, the main objective of this study is to evaluate the acceptance and perception of patients of the receipt of these SMS messages, as well as to evaluate the possible benefits reported by the participants. Adult patients diagnosed with cancer, who started the first outpatient chemotherapy treatment scheme between August and November 2016 at the School Hospital (HE) of the Federal University of Pelotas (UFPel), were invited to participate in this pilot study. In total, 14 cancer patients were adherent to this study. Each of these patients received a daily text message on their cell phone with some guidance on encouraging self-care and emotional support. Patients reported that, because of the SMS text messages they received, they felt more confident in their treatment, felt more supported and encouraged, and that the text messages facilitated self-care. In addition, patients reported that the SMS text messages they received helped them to take better care of themselves and to continue further treatment.

  12. 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.

  13. Methodological exemplar of integrating quantitative and qualitative evidence - supportive care for men with prostate cancer:what are the most important components?

    OpenAIRE

    Huntley, Alyson; King, Anna J L; Moore, Theresa H M; Paterson, Charlotte; Persad, Raj; Sharp, Debbie J; Evans, Maggie A

    2017-01-01

    AIMS: To present a methodological exemplar of integrating findings from a quantitative and qualitative review on the same topic to provide insight into components of care that contribute to supportive care that is acceptable to men with prostate cancer.BACKGROUND: Men with prostate cancer are likely to live a long time with the disease, experience side effects from treatment and therefore have ongoing supportive care needs. Quantitative and qualitative reviews have been published but the find...

  14. Cancer preventive services, socioeconomic status, and the Affordable Care Act.

    Science.gov (United States)

    Cooper, Gregory S; Kou, Tzuyung Doug; Dor, Avi; Koroukian, Siran M; Schluchter, Mark D

    2017-05-01

    Out-of-pocket expenditures are thought to be an important barrier to the receipt of cancer preventive services, especially for those of a lower socioeconomic status (SES). The Affordable Care Act (ACA) eliminated out-of-pocket expenditures for recommended services, including mammography and colonoscopy. The objective of this study was to determine changes in the uptake of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after ACA implementation. Using Medicare claims data, this study identified women who were 70 years old or older and had not undergone mammography in the previous 2 years and men and women who were 70 years old or older, were at increased risk for colorectal cancer, and had not undergone colonoscopy in the past 5 years. The receipt of procedures in the 2-year period before the ACA's implementation (2009-2010) and after its implementation (2011 to September 2012) was also identified. Multivariate generalized estimating equation models were used to determine the independent association and county-level quartile of median income and education with the receipt of testing. For mammography, a lower SES quartile was associated with less uptake, but the post-ACA disparities were smaller than those in the pre-ACA period. In addition, mammography rates increased from the pre-ACA period to the post-ACA period in all SES quartiles. For colonoscopy, in both the pre- and post-ACA periods, there was an association between uptake and educational level and, to some extent, income. However, there were no appreciable changes in colonoscopy and SES after implementation of the ACA. The removal of out-of-pocket expenditures may overcome a barrier to the receipt of recommended preventive services, but for colonoscopy, other procedural factors may remain as deterrents. Cancer 2017;123:1585-1589. © 2017 American Cancer Society. © 2017 American Cancer Society.

  15. Protein calorie malnutrition, nutritional intervention and personalized cancer care.

    Science.gov (United States)

    Gangadharan, Anju; Choi, Sung Eun; Hassan, Ahmed; Ayoub, Nehad M; Durante, Gina; Balwani, Sakshi; Kim, Young Hee; Pecora, Andrew; Goy, Andre; Suh, K Stephen

    2017-04-04

    Cancer patients often experience weight loss caused by protein calorie malnutrition (PCM) during the course of the disease or treatment. PCM is expressed as severe if the patient has two or more of the following characteristics: obvious significant muscle wasting, loss of subcutaneous fat; nutritional intake of 2% in 1 week, 5% in 1 month, or 7.5% in 3 months. Cancer anorexia-cachexia syndrome (CACS) is a multifactorial condition of advanced PCM associated with underlying illness (in this case cancer) and is characterized by loss of muscle with or without loss of fat mass. Cachexia is defined as weight loss of more than 5% of body weight in 12 months or less in the presence of chronic disease. Hence with a chronic illness on board even a small amount of weight loss can open the door to cachexia. These nutritional challenges can lead to severe morbidity and mortality in cancer patients. In the clinic, the application of personalized medicine and the ability to withstand the toxic effects of anti-cancer therapies can be optimized when the patient is in nutritional homeostasis and is free of anorexia and cachexia. Routine assessment of nutritional status and appropriate intervention are essential components of the effort to alleviate effects of malnutrition on quality of life and survival of patients.

  16. Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study.

    Science.gov (United States)

    Gianinazzi, Micol E; Rueegg, Corina S; von der Weid, Nicolas X; Niggli, Felix K; Kuehni, Claudia E; Michel, Gisela

    2014-02-01

    We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors. Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T ≥ 57 on two of three scales or the Global Severity Index were considered distressed. We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects. Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals.

  17. Recommendations for gonadotoxicity surveillance in male childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium

    NARCIS (Netherlands)

    Skinner, R.; Mulder, R.L.; Kremer, L.C.; Hudson, M.M.; Constine, L.S.; Bardi, E.; Boekhout, A.; Borgmann-Staudt, A.; Brown, M.C.; Cohn, R.; Dirksen, U.; Giwercman, A.; Ishiguro, H.; Jahnukainen, K.; Kenney, L.B.; Loonen, J.J.; Meacham, L.; Neggers, S.; Nussey, S.; Petersen, C.; Shnorhavorian, M.; Heuvel-Eibrink, M.M. van den; Santen, H.M. van; Wallace, W.H.; Green, D.M.

    2017-01-01

    Treatment with chemotherapy, radiotherapy, or surgery that involves reproductive organs can cause impaired spermatogenesis, testosterone deficiency, and physical sexual dysfunction in male pubertal, adolescent, and young adult cancer survivors. Guidelines for surveillance and management of potential

  18. Recommendations for gonadotoxicity surveillance in male childhood, adolescent, and young adult cancer survivors : a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium

    NARCIS (Netherlands)

    Skinner, Roderick; Mulder, Renee L.; Kremer, Leontien C.; Hudson, Melissa M.; Constine, Louis S.; Bardi, Edit; Boekhout, Annelies; Borgmann-Staudt, Anja; Brown, Morven C.; Cohn, Richard; Dirksen, Uta; Giwercman, Alexsander; Ishiguro, Hiroyuki; Jahnukainen, Kirsi; Kenney, Lisa B.; Loonen, Jacqueline J.; Meacham, Lilian; Neggers, Sebastian; Nussey, Stephen; Petersen, Cecilia; Shnorhavorian, Margarett; van den Heuvel-Eibrink, Marry M.; van Santen, Hanneke M.; Wallace, William H B; Green, Daniel M.

    2017-01-01

    Treatment with chemotherapy, radiotherapy, or surgery that involves reproductive organs can cause impaired spermatogenesis, testosterone deficiency, and physical sexual dysfunction in male pubertal, adolescent, and young adult cancer survivors. Guidelines for surveillance and management of potential

  19. Health Care Coach Support in Reducing Acute Care Use and Cost in Patients With Cancer

    Science.gov (United States)

    2017-05-12

    Acute Myeloid Leukemia; Brain Glioblastoma; Estrogen Receptor Negative; Extensive Stage Small Cell Lung Carcinoma; Head and Neck Carcinoma; HER2/Neu Negative; Hormone-Resistant Prostate Cancer; Limited Stage Small Cell Lung Carcinoma; Myelodysplastic Syndrome; Progesterone Receptor Negative; Progressive Disease; Recurrent Carcinoma; Stage II Pancreatic Cancer; Stage II Rectal Cancer; Stage IIA Pancreatic Cancer; Stage IIA Rectal Cancer; Stage IIB Pancreatic Cancer; Stage IIB Rectal Cancer; Stage IIC Rectal Cancer; Stage III Colon Cancer; Stage III Esophageal Cancer; Stage III Gastric Cancer; Stage III Non-Small Cell Lung Cancer; Stage III Ovarian Cancer; Stage III Pancreatic Cancer; Stage III Rectal Cancer; Stage III Skin Melanoma; Stage IIIA Colon Cancer; Stage IIIA Esophageal Cancer; Stage IIIA Gastric Cancer; Stage IIIA Non-Small Cell Lung Cancer; Stage IIIA Ovarian Cancer; Stage IIIA Rectal Cancer; Stage IIIA Skin Melanoma; Stage IIIB Colon Cancer; Stage IIIB Esophageal Cancer; Stage IIIB Gastric Cancer; Stage IIIB Non-Small Cell Lung Cancer; Stage IIIB Ovarian Cancer; Stage IIIB Rectal Cancer; Stage IIIB Skin Melanoma; Stage IIIC Colon Cancer; Stage IIIC Esophageal Cancer; Stage IIIC Gastric Cancer; Stage IIIC Ovarian Cancer; Stage IIIC Rectal Cancer; Stage IIIC Skin Melanoma; Stage IV Bladder Cancer; Stage IV Bone Sarcoma; Stage IV Breast Cancer; Stage IV Colon Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer; Stage IV Non-Small Cell Lung Cancer; Stage IV Ovarian Cancer; Stage IV Pancreatic Cancer; Stage IV Rectal Cancer; Stage IV Renal Cell Cancer; Stage IV Skin Melanoma; Stage IV Soft Tissue Sarcoma; Stage IVA Bone Sarcoma; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVB Bone Sarcoma; Stage IVB Colon Cancer; Stage IVB Rectal Cancer; Triple-Negative Breast Carcinoma

  20. Supportive care organisation in France: an in depth study by the French speaking association for supportive care in cancer (AFSOS).

    Science.gov (United States)

    Scotté, F; Hervé, C; Oudard, S; Bugat, M E; Bugat, R; Farsi, F; Namer, M; Tourani, J M; Tournigand, C; Yazbek, G; Richard, S; Krakowski, I

    2013-03-01

    Supportive care in cancer (SCC) was further enhanced in the Second National Cancer Act decreed in December 2009. The aim of our study was to assess current SCC efficacy. The French speaking association for supportive care in cancer (AFSOS) conducted an observational study to evaluate practices, organisations and information given to patients. A specific 32 point questionnaire was sent to 1621 French physicians (MDs) caring for cancer patients. Three different organisations were evaluated: the individual MDs, the transversal team and its particular structure specialised in global patient care specifically developed at comprehensive cancer centres - CCC. During their disease, 68% of patients received SCC, which was more available during the palliative period (90%) than at the diagnosis (44%). Our results found that 71% of cancer departments had a specific interdisciplinary cross-team to provide SCC, particularly in CCC (62%; p=0.01) while 37% had specific inpatient units. A specific organisation dedicated to home care was greater in CCC than in public or private centres (69%, 45%, 20% respectively; p=0.01). Adverse event information was performed more by an oncologist than other specialists (p=0.01). Our results suggest that the specific SCC organisation could be a useful management tool to improve supportive care for cancer patients. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Music Therapy in the Interdisciplinary Care of Children with Cancer.

    Science.gov (United States)

    Pfaff, Valerie Kalsbeck

    Music therapy, the systematic application of music and musical activities to elicit specific changes in emotional, physical, or social behavior, can help pediatric cancer patients to decrease their anxiety and cope with hospitalization. Because music is a nonverbal means of expression, it is an especially effective medium for young children who…

  2. The challenge of the approach to oral cancer in primary health care

    Directory of Open Access Journals (Sweden)

    Luiz Roberto Augusto Noro

    Full Text Available Abstract The aim of this study was to understand the performance of dentists in public health about mouth cancer. A cross-sectional study was performed whit 121 dentists from Fortaleza Health Department, interviewed through a semi-structured questionnaire. The study did not identify statistically significant difference regarding the ability to perform biopsy by gender, year of graduation, expertise or time of public service. Only 22 professionals (18.2% reported being able to perform biopsies and 13 (10.7% would do so at the Family Health Unit. The reference and counter-reference system, by including another stage in patient care, increase the possibility of absenteeism from patient to health service. Although clearly identify the relevance of oral cancer mortality in the population, the vast majority of dentists is not equipped to perform the biopsy as a routine activity. Whereas the vast majority of biopsies of the oral tissues is performed as an outpatient, low technological complexity to perform the procedure and the effectiveness of biopsy in the early diagnosis of oral cancer, it is essential to hold this procedure in primary care, what can effectively contribute to decreasing mortality from oral cancer.

  3. [Usefulness of palliative care for the patients with recurrent gastric cancer by home-IVH].

    Science.gov (United States)

    Sairenji, M; Okamoto, T; Motohashi, H; Kobayashi, O; Tsuburaya, A; Okugawa, T; Rino, Y; Tsukamoto, Y; Takamiya, M; Matoba, K

    1995-12-01

    Depending upon the type of cancer involved, the period of the end stage varies greatly, and with it decreases the quality of life (QOL). In gastric cancer, for example, the terminal stage is usually short and the QOL diminishes abruptly. Thus, it takes time keeping this decrease in QOL to minimum, despite the complications, so that the patient's last days will be even somewhat more acceptable. Improvement in QOL for the patient who cannot eat due to recurrent gastric cancer can be effectively achieved by alleviation through IVH. With this in mind, the conditions consonant with the application of home IVH are as follows: 1) The patient's pain can be kept under control at home. 2) The patient wishes to remain. 3)There is sufficient human support at home. The caretakers in the family, and especially the key person(s) must exert much effort and labor and they need rest as well. Home medical care in the terminal stage presupposes a social environment involving day care, short stay, and hospice nursing facilities of all kinds. At present, public services of this kind differ with the community, much remains uninformed to public, and clinic-hospital networking will be needed more than ever. In this difficult situation, the home-care medical services provided by the private sector are effective. These services are only for the short term, of course, and there will be a financial problem. Various measures (tax deduction, public assistance) must be considered to support the patients and caretakers.

  4. Cost-Utility of Stepped Care Targeting Psychological Distress in Patients With Head and Neck or Lung Cancer

    NARCIS (Netherlands)

    Jansen, Femke; Krebber, Anna M H; Coupé, Veerle M H; Cuijpers, Pim; de Bree, Remco; Becker-Commissaris, Annemarie; Smit, Egbert F; van Straten, Annemieke; Eeckhout, Guus M; Beekman, Aartjan T F; Leemans, C René; Verdonck-de Leeuw, Irma M

    2017-01-01

    Purpose A stepped care (SC) program in which an effective yet least resource-intensive treatment is delivered to patients first and followed, when necessary, by more resource-intensive treatments was found to be effective in improving distress levels of patients with head and neck cancer or lung

  5. The voice of postsurgical lung cancer patients regarding supportive care needs

    Directory of Open Access Journals (Sweden)

    Hoffman AJ

    2014-04-01

    hospital discharge and throughout the cancer survivorship trajectory; 3 unexpected symptom burden after initial month of recovery; 4 the quality of information given when pain and fatigue were troublesome during recovery; and 5 the effectiveness of exercise during the recovery process.Conclusion: Understanding the changing needs of this population during these transitions will assist in the development of targeted supportive care interventions, to preempt negative outcomes associated with breakdowns in care during critical transition periods of the cancer survivorship trajectory.Keywords: quality of life, symptom, exercise, qualitative research

  6. 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

    of the individual patient ’ s needs, values and experiences is key to developing the environment to support the patient quality of life. The present study holds implications for practice to inform design of future hospital environments for cancer treatment. The study points to the importance for being attentive...... 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...... 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...

  7. Spiritual pain among patients with advanced cancer in palliative care.

    Science.gov (United States)

    Mako, Caterina; Galek, Kathleen; Poppito, Shannon R

    2006-10-01

    The large body of empirical research suggesting that patients' spiritual and existential experiences influence the disease process has raised the need for health care professionals to understand the complexity of patients' spiritual pain and distress. The current study explores the multidimensional nature of spiritual pain, in patients with end-stage cancer, in relation to physical pain, symptom severity, and emotional distress. The study combines a quantitative evaluation of participants' intensity of spiritual pain, physical pain, depression, and intensity of illness, with a qualitative focus on the nature of patients' spiritual pain and the kinds of interventions patients believed would ameliorate their spiritual pain. Fifty-seven patients with advanced stage cancer in a palliative care hospital were interviewed by chaplains. Overall, 96% of the patients reported experiencing spiritual pain, but they expressed it in different ways: (1) as an intrapsychic conflict, (2) as interpersonal loss or conflict, or (3) in relation to the divine. Intensity of spiritual pain was correlated with depression (r = 0.43, p spiritual pain did not vary by age, gender, disease course or religious affiliation. Given both the universality of spiritual pain and the multifaceted nature of pain, we propose that when patients report the experience of pain, more consideration be given to the complexity of the phenomena and that spiritual pain be considered a contributing factor. The authors maintain that spiritual pain left unaddressed both impedes recovery and contributes to the overall suffering of the patient.

  8. Improving outcomes in lung cancer: the value of the multidisciplinary health care team

    Directory of Open Access Journals (Sweden)

    Denton E

    2016-03-01

    Full Text Available Eve Denton,1 Matthew Conron2 1Allergy, Immunology and Respiratory Department, Alfred Hospital, 2Department of Respiratory and Sleep Medicine, St Vincent's Hospital, Melbourne, VIC, Australia Abstract: Lung cancer is a major worldwide health burden, with high disease-related morbidity and mortality. Unlike other major cancers, there has been little improvement in lung cancer outcomes over the past few decades, and survival remains disturbingly low. Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, despite a relative lack of evidence that this model of care improves outcomes. In this article, the available literature concerning the impact of multidisciplinary care on key measures of lung cancer outcomes is reviewed. This includes the limited observational data supporting improved survival with multidisciplinary care. The impact of multidisciplinary care on other benchmark measures of quality lung cancer treatment is also examined, including staging accuracy, access to diagnostic investigations, improvements in clinical decision making, better utilization of radiotherapy and palliative care services, and improved quality of life for patients. Health service research suggests that multidisciplinary care improves care coordination, leading to a better patient experience, and reduces variation in care, a problem in lung cancer management that has been identified worldwide. Furthermore, evidence suggests that the multidisciplinary model of care overcomes barriers to treatment, promotes standardized treatment through adherence to guidelines, and allows audit of clinical services and for these reasons is more likely to provide quality care for lung cancer patients. While there is strengthening evidence suggesting that the multidisciplinary model of care contributes to improvements in lung cancer outcomes, more quality studies are needed. Keywords: lung cancer, multidisciplinary care, mortality, tumor board

  9. Cancer Care Ontario and integrated cancer programs: portrait of a performance management system and lessons learned.

    Science.gov (United States)

    Cheng, Siu Mee; Thompson, Leslee J

    2006-01-01

    A performance management system has been implemented by Cancer Care Ontario (CCO). This system allows for the monitoring and management of 11 integrated cancer programs (ICPs) across the Province of Ontario. The system comprises of four elements: reporting frequency, reporting requirements, review meetings and accountability and continuous improvement activities. CCO and the ICPs have recently completed quarterly performance review exercises for the last two quarters of the fiscal year 2004-2005. The purpose of this paper is to address some of the key lessons learned. The paper provides an outline of the CCO performance management system. These lessons included: data must be valid and reliable; performance management requires commitments from both parties in the performance review exercises; streamlining performance reporting is beneficial; technology infrastructure which allows for cohesive management of data is vital for a sustainable performance management system; performance indicators need to stand up to scrutiny by both parties; and providing comparative data across the province is valuable. Critical success factors which would help to ensure a successful performance management system include: corporate engagement from various parts of an organization in the review exercises; desire to focus on performance improvement and avoidance of blaming; and strong data management systems. The performance management system is a practical and sustainable system that allows for performance improvement of cancer care services. It can be a vital tool to enhance accountability within the health care system. The paper demonstrates that the performance management system supports accountability in the cancer care system for Ontario, and reflects the principles of the provincial governments commitment to continuous improvement of healthcare.

  10. Bayesian networks for clinical decision support in lung cancer care.

    Directory of Open Access Journals (Sweden)

    M Berkan Sesen

    Full Text Available Survival prediction and treatment selection in lung cancer care are characterised by high levels of uncertainty. Bayesian Networks (BNs, which naturally reason with uncertain domain knowledge, can be applied to aid lung cancer experts by providing personalised survival estimates and treatment selection recommendations. Based on the English Lung Cancer Database (LUCADA, we evaluate the feasibility of BNs for these two tasks, while comparing the performances of various causal discovery approaches to uncover the most feasible network structure from expert knowledge and data. We show first that the BN structure elicited from clinicians achieves a disappointing area under the ROC curve of 0.75 (± 0.03, whereas a structure learned by the CAMML hybrid causal discovery algorithm, which adheres with the temporal restrictions, achieves 0.81 (± 0.03. Second, our causal intervention results reveal that BN treatment recommendations, based on prescribing the treatment plan that maximises survival, can only predict the recorded treatment plan 29% of the time. However, this percentage rises to 76% when partial matches are included.

  11. Patient-Centered Care in Breast Cancer Genetic Clinics

    Directory of Open Access Journals (Sweden)

    Anne Brédart

    2018-02-01

    Full Text Available With advances in breast cancer (BC gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83% in France and 180 (97% in Germany, mostly BC patients (81% and 92%, respectively, returned the ‘Psychosocial Assessment in Hereditary Cancer’ questionnaire. Based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA BC risk estimation model, the mean BC lifetime risk estimates were 19% and 18% in France and Germany, respectively. In both countries, the most prevalent needs clustered around the “living with cancer” and “children-related issues” domains. In multivariate analyses, a higher number of psychosocial needs were significantly associated with younger age (b = −0.05, higher anxiety (b = 0.78, and having children (b = 1.51, but not with country, educational level, marital status, depression, or loss of a family member due to hereditary cancer. These results are in line with the literature review data. However, this review identified only seven studies that quantitatively addressed psychosocial needs in the BC genetic counseling setting. Current data lack understandings of how cancer risk counseling affects psychosocial needs, and improves patient-centered care in that setting.

  12. 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...... from 2003 through 2005. Logistic regression was used to assess the association between nativity and patient-reported quality of care and receipt of recommended treatments (adjuvant chemotherapy for stage III colon cancer, adjuvant chemotherapy and radiotherapy for stage II/III rectal cancer......, and curative surgery for stage I/II non-small cell lung cancer). The authors also assessed whether language explained any differences in care by nativity. RESULTS: Overall, 46% of patients reported excellent care, but foreign-born patients were less likely than US-born patients to report excellent quality...

  13. Complexity of care and strategies of self-management in patients with colorectal cancer

    Directory of Open Access Journals (Sweden)

    Ose D

    2017-04-01

    have to handle a high complexity of individual situations within treatment and care of their disease. Private and social challenges have a culminating effect. This complexity increases as patients experience a longer duration of treatment and follow-up as patients have to handle a significantly higher amount of data over time. Self-management support should focus more on the individual complexity in a patient’s life. This includes assisting patients with strategies that have already been established by themselves (like preparation of visits. Keywords: self-management, health care utilization, colorectal cancer, chronic care, health services research, complexity

  14. Effect of Health Care Professionals' Continuing Education ...

    African Journals Online (AJOL)

    Purpose: To evaluate the impact of educational intervention by health care providers on clinical outcomes in type 2 diabetes patients in a Yemeni health facility. Methods: A prospective, one-group and pre- and post-test design to assess the effects of health care providers' education on clinical patient outcomes was ...

  15. Colorectal cancer patients' preferences for type of caregiver during survivorship care

    NARCIS (Netherlands)

    Wieldraaijer, T.; Duineveld, L. A. M.; Donkervoort, S. C.; Busschers, W. B.; van Weert, H. C. P. M.; Wind, J.

    2018-01-01

    Colorectal cancer (CRC) survivors are currently included in a secondary care-led survivorship care programme. Efforts are underway to transfer this survivorship care to primary care, but met with some reluctance by patients and caregivers. This study assesses (1) what caregiver patients prefer to

  16. Administrators' perspectives on end-of-life care for cancer patients in Japanese long-term care facilities.

    Science.gov (United States)

    Fukahori, Hiroki; Miyashita, Mitsunori; Morita, Tatsuya; Ichikawa, Takayuki; Akizuki, Nobuya; Akiyama, Miki; Shirahige, Yutaka; Eguchi, Kenji

    2009-10-01

    The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

  17. External Beam Radiotherapy for Colon Cancer: Patterns of Care

    International Nuclear Information System (INIS)

    Dunn, Emily F.; Kozak, Kevin R.; Moody, John S.

    2010-01-01

    Purpose: Despite its common and well characterized use in other gastrointestinal malignancies, little is known about radiotherapy (RT) use in nonmetastatic colon cancer in the United States. To address the paucity of data regarding RT use in colon cancer management, we examined the RT patterns of care in this patient population. Methods and Materials: Patients with nonmetastatic colon cancer, diagnosed between 1988 and 2005, were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate methods were used to identify factors associated with RT use. Results: On univariate analysis, tumor location, age, sex, race, T stage, N stage, and geographic location were each associated with differences in RT use (all p < 0.01). In general, younger patients, male patients, and patients with more advanced disease were more likely to receive RT. On multivariate analysis, tumor location, age, gender, T and N stage, time of diagnosis and geographic location were significantly associated with RT use (all p < 0.001). Race, however, was not associated with RT use. On multivariate analysis, patients diagnosed in 1988 were 2.5 times more likely to receive RT than those diagnosed in 2005 (p = 0.001). Temporal changes in RT use reflect a responsiveness to evolving evidence related to the therapeutic benefits of adjuvant RT. Conclusions: External beam RT is infrequently used for colon cancer, and its use varies according to patient and tumor characteristics. RT use has declined markedly since the late 1980s; however, it continues to be used for nonmetastatic disease in a highly individualized manner.

  18. Nutritional care of cancer patients: a survey on patients' needs and medical care in reality.

    Science.gov (United States)

    Maschke, J; Kruk, U; Kastrati, K; Kleeberg, J; Buchholz, D; Erickson, N; Huebner, J

    2017-02-01

    Cancer patients represent a patient group with a wide-range of nutrition related problems which are often under-recognized and undertreated. In order to assess the status quo of nutritional care in Germany, we conducted a survey among patients with different types of cancer. A standardized questionnaire was distributed online by two national umbrella organizations for self-help groups. 1335 participants completed the questionnaire. 69 % of the participants reported having received information on nutrition and/or specific nutrition-related symptoms. Most often this information was derived from print media (68.5 %) or from within self-help groups (58.7 %). 57.0 % of participants reported having had questions concerning nutrition and/or problems with food intake. most frequently named topics of interest were "healthy diet" (35.0 %) weakness/fatigue (24.3 %), dietary supplements (21.3 %) and taste changes (19.8 %). Nutrition information was most often provided by dietitians (38.7 %) followed by physicians (9.8 %). Women reported receiving nutrition counseling in the hospital nearly twice as often as men (12.5 % versus 5.7 %; p nutrition information more often reported using supplements (p Nutrition is an essential element in cancer care and patients report a high interest and need: Yet, many patients do not have access to high quality nutrition therapy during and after cancer therapy. With respect to survival and quality of life, increasing the availability and resources for provision of evidence based nutrition information seems mandatory.

  19. Cancer - the delivery of nursing care. Pt. 2

    Energy Technology Data Exchange (ETDEWEB)

    Cox, S [Royal Marsden Hospital, Sutton (UK); Wark, E

    1978-09-07

    This and the preceding article (Nursing Mirror, Sept. 1, 1978) form a slightly shortened version of Chap. 5 from Vol. 2 of the book 'Oncology for Nurses and Health Care Professionals', ed. R. Tiffany, (Allen and Unwin, Oct. 1978). Teletherapy was dealt with in part 1. Part 2 is concerned with radiotherapy using radioisotope implants and applicators and unsealed sources, and with surgery and chemotherapy, including side effects of anti-tumour drugs. The physical and psychological effects on the patient of these forms of treatment are discussed, and nursing care and radiological safety precautions for both patients and nursing staff are described.

  20. Implementing a user-driven online quality improvement toolkit for cancer care.

    Science.gov (United States)

    Luck, Jeff; York, Laura S; Bowman, Candice; Gale, Randall C; Smith, Nina; Asch, Steven M

    2015-05-01

    Peer-to-peer collaboration within integrated health systems requires a mechanism for sharing quality improvement lessons. The Veterans Health Administration (VA) developed online compendia of tools linked to specific cancer quality indicators. We evaluated awareness and use of the toolkits, variation across facilities, impact of social marketing, and factors influencing toolkit use. A diffusion of innovations conceptual framework guided the collection of user activity data from the Toolkit Series SharePoint site and an online survey of potential Lung Cancer Care Toolkit users. The VA Toolkit Series site had 5,088 unique visitors in its first 22 months; 5% of users accounted for 40% of page views. Social marketing communications were correlated with site usage. Of survey respondents (n = 355), 54% had visited the site, of whom 24% downloaded at least one tool. Respondents' awareness of the lung cancer quality performance of their facility, and facility participation in quality improvement collaboratives, were positively associated with Toolkit Series site use. Facility-level lung cancer tool implementation varied widely across tool types. The VA Toolkit Series achieved widespread use and a high degree of user engagement, although use varied widely across facilities. The most active users were aware of and active in cancer care quality improvement. Toolkit use seemed to be reinforced by other quality improvement activities. A combination of user-driven tool creation and centralized toolkit development seemed to be effective for leveraging health information technology to spread disease-specific quality improvement tools within an integrated health care system. Copyright © 2015 by American Society of Clinical Oncology.

  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. [A Survey of the Factors of Influence and Interventional Strategies for Breast Cancer Survivors' Transition Care Across Multiple Theoretical Perspectives].

    Science.gov (United States)

    Chao, Yu-Huan; Lee, Tzu-I; Sheu, Shuh-Jen

    2018-02-01

    Breast cancer significantly threatens the life of women, while the adverse effects of cancer treatment degrade quality of life and psychological well-being. The quality of transitional care following the completion of treatment significantly affects the ability of breast cancer patients to transition successfully into survivorship. This paper introduces multiple theoretical perspectives and provides an overview of the tenets of each in order to identify the positions of breast cancer survivors and to highlight the factors and strategies that influence their transitional care. The theoretical perspectives that are introduced include the social-ecological model, transition theory, and the strengths perspective. In order to improve the holistic care of women with breast cancer, factors relevant to transition are categorized into the individual, interpersonal, organizational, community, and policy levels. Furthermore, empirical interventions, which are based on the respective advantages of the various levels of the social-ecological model, are proposed in order to conform to the sociocultural context and clinical practices. Healthcare providers should leverage the strengths and resources at each level to develop feasible strategies and to provide quality of care in order to assist breast cancer patients to transition successfully from treatment to survivorship and to holistically improve their subsequent quality of life and function.

  3. Late effects of treatment of cancer in children

    International Nuclear Information System (INIS)

    Byrd, R.L.

    1983-01-01

    Advances in surgical techniques, in chemotherapy, and in radiation therapy have led to improved survival in children treated for cancer. Children cured of cancer will soon form a significant fraction of our adult population. As we follow such survivors, we have become more aware of long-term side effects of treatment. This is not a reason to withhold therapy. Instead, careful followup of oncology patients is needed to document the late effects, to identify the etiologic agents, and to alter treatment to give the least toxic therapy without sacrificing quality or duration of survival

  4. Improving the quality of lung cancer care in Ontario: the lung cancer disease pathway initiative.

    Science.gov (United States)

    Evans, William K; Ung, Yee C; Assouad, Nathalie; Chyjek, Anna; Sawka, Carol

    2013-07-01

    Before 2008, Cancer Care Ontario (CCO) undertook provincial cancer control quality-improvement initiatives on a programmatic basis. CCO has now added Disease Pathway Management (DPM) to its quality improvement strategy, with the intent of achieving high-quality care, processes, and patient experience across the patient pathway for specific cancers. The three goals of DPM are: to describe and share evidence-based best practice along the cancer continuum for specific cancers; identify quality-improvement priorities for specific cancers and catalyze action; monitor performance against best practice for specific cancers. The objective of this article is to describe the process by which the CCO lung cancer (LC) DPM was initiated and some of its early successes. In 2009, LC DPM began with a draft LC disease pathway map and the establishment of five multidisciplinary working groups, each focused on a phase of the LC patient journey: prevention, screening, and early detection; diagnosis; treatment; palliative care, end-of-life care, and survivorship; and patient experience. The working groups held 25 meetings of 2-hour duration and developed concepts for 17 quality-improvement projects across the patient journey. Eight were selected for detailed discussion at a provincial consensus conference, which provided input on priorities for action. A report on the priorities for action was prepared and widely circulated, and regional roadshows were held in all 14 regions of the province of Ontario. Region-specific data on incidence, stage, treatment compliance, and wait times among other issues relevant to LC, were shared with the regional care providers at these roadshows. Funding was provided by CCO to address opportunities for regional improvement based on the data and the priorities identified. The LC disease pathways were refined through substantial multidisciplinary discussion, and the diagnostic pathway was posted on CCO's Web site in February 2012. The treatment pathways

  5. General practitioners' role in cancer care: a French-Norwegian study.

    Science.gov (United States)

    Demagny, Lise; Holtedahl, Knut; Bachimont, Janine; Thorsen, Tommy; Letourmy, Alain; Bungener, Martine

    2009-09-29

    In cancer care, a GP's work is rarely defined clearly. Our aim was to assess GPs' work with cancer patients in France and in Norway, where the roles of the GP and the organization of the system are rather different. A questionnaire with 40 closed-ended questions about GP involvement in diagnosis, treatment, follow-up and terminal care was constructed and mailed to samples of GPs. The patients had seen the doctor at least once over the past year. In France 1679 and in Norway 386 individual patient questionnaires were completed. GPs have a major role in the diagnosis of cancer, and this role varies according to cancer type. The GPs participated actively in different phases of follow-up after cancer treatment. Low response rates do not allow direct comparison between countries, but higher PSA screening rates in France seem to increase the percentage of patients diagnosed after screening rather than after a clinical suspicion. Interaction between GPs and specialists during cancer treatment and follow-up was important in both countries. Both in France and in Norway GPs participate actively in cancer care. Early clinical diagnosis is a challenge. More research is needed about how GPs can improve their early diagnostic work. Organisational issues may influence cancer responsibilities for the GP, and national health systems should be challenged to look at possible new roles for GPs in cancer care. Medical training, both pre- and post-graduate, should prepare doctors for collaboration between primary and secondary care, particularly important in cancer care.

  6. Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial.

    Science.gov (United States)

    Pyszora, Anna; Budzyński, Jacek; Wójcik, Agnieszka; Prokop, Anna; Krajnik, Małgorzata

    2017-09-01

    Cancer-related fatigue (CRF) is a common and relevant symptom in patients with advanced cancer that significantly decreases their quality of life. The aim of this study was to evaluate the effect of a physiotherapy programme on CRF and other symptoms in patients diagnosed with advanced cancer. The study was designed as a randomized controlled trial. Sixty patients diagnosed with advanced cancer receiving palliative care were randomized into two groups: the treatment group (n = 30) and the control group (n = 30). The therapy took place three times a week for 2 weeks. The 30-min physiotherapy session included active exercises, myofascial release and proprioceptive neuromuscular facilitation (PNF) techniques. The control group did not exercise. The outcomes included Brief Fatigue Inventory (BFI), Edmonton Symptom Assessment Scale (ESAS) and satisfaction scores. The exercise programme caused a significant reduction in fatigue scores (BFI) in terms of severity of fatigue and its impact on daily functioning. In the control group, no significant changes in the BFI were observed. Moreover, the physiotherapy programme improved patients' general well-being and reduced the intensity of coexisting symptoms such as pain, drowsiness, lack of appetite and depression. The analysis of satisfaction scores showed that it was also positively evaluated by patients. The physiotherapy programme, which included active exercises, myofascial release and PNF techniques, had beneficial effects on CRF and other symptoms in patients with advanced cancer who received palliative care. The results of the study suggest that physiotherapy is a safe and effective method of CRF management.

  7. Prostate cancer in primary care, Port Harcourt, Nigeria

    Directory of Open Access Journals (Sweden)

    Andrew Bock-Oruma

    2014-01-01

    Full Text Available Context: Prostate cancer (PC is under-researched in primary care settings in the developing world, and diagnostic modalities available to the primary care physician could limit the making of the diagnosis, thus affecting the prevalence. Aims: This study aims to determine the prevalence of prostate cancer in patients that presented with LUTS to a family medicine clinic, using the screening tools (DRE and PSA available in the facility. Settings and Design: A cross-sectional study of middle-aged and elderly men that presented to the Family Medicine Clinic, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, with LUTS. Materials and Methods: Consenting and eligible males that presented to the Family Medicine Clinic with LUTS were assessed for prostate cancer using the PSA and digital rectal examination (DRE between October 2010 and April 2012. Data were entered and analyzed using the statistical package for the social sciences (SPSS version 16.0. Association between the variables was compared using chi-Square test with statistical significance set at P < 0.05. Results: Two hundred and ninety subjects participated in the study; the mean age of the subjects was 62.50 ± 11.66 years with an age range of 40 to 100 years. The prevalence for DRE-detected abnormal prostate was 13%, suggestive of PC. One hundred and sixty-one (55.5% of the subjects had their PSA done and results retrieved, with 51.6% of them having PSA values within the normal range of 0-4 ng/ml, and 48.4% had PSA values outside the normal limits. An association of PSA and DRE gave 24.2% prevalence for probable PC and a significant association between elevated PSA and DRE. Conclusion: The diagnostic modality in study is inconclusive, but it offers the family physician the opportunity of improving the quality of life of the patient that presented to him with PC by initiating early referral for secondary care.

  8. Knowledge of Dutch GPs in caring for cancer patients using oral anticancer therapy at home

    NARCIS (Netherlands)

    van Roosmalen, Sanne L. C.; Pols, A. Jeannette; Willems, Dick L.

    2013-01-01

    The GP's role in cancer care is changing and will become increasingly important. One of the challenges for GPs in caring for cancer patients is their lack of specialized knowledge and the impossibility to keep up to date with developments in the field of oncology. We investigated GPs use of

  9. 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....

  10. 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

  11. An economic evaluation of colorectal cancer screening in primary care practice.

    Science.gov (United States)

    Meenan, Richard T; Anderson, Melissa L; Chubak, Jessica; Vernon, Sally W; Fuller, Sharon; Wang, Ching-Yun; Green, Beverly B

    2015-06-01

    Recent colorectal cancer screening studies focus on optimizing adherence. This study evaluated the cost effectiveness of interventions using electronic health records (EHRs); automated mailings; and stepped support increases to improve 2-year colorectal cancer screening adherence. Analyses were based on a parallel-design, randomized trial in which three stepped interventions (EHR-linked mailings ["automated"]; automated plus telephone assistance ["assisted"]; or automated and assisted plus nurse navigation to testing completion or refusal [navigated"]) were compared to usual care. Data were from August 2008 to November 2011, with analyses performed during 2012-2013. Implementation resources were micro-costed; research and registry development costs were excluded. Incremental cost-effectiveness ratios (ICERs) were based on number of participants current for screening per guidelines over 2 years. Bootstrapping examined robustness of results. Intervention delivery cost per participant current for screening ranged from $21 (automated) to $27 (navigated). Inclusion of induced testing costs (e.g., screening colonoscopy) lowered expenditures for automated (ICER=-$159) and assisted (ICER=-$36) relative to usual care over 2 years. Savings arose from increased fecal occult blood testing, substituting for more expensive colonoscopies in usual care. Results were broadly consistent across demographic subgroups. More intensive interventions were consistently likely to be cost effective relative to less intensive interventions, with willingness to pay values of $600-$1,200 for an additional person current for screening yielding ≥80% probability of cost effectiveness. Two-year cost effectiveness of a stepped approach to colorectal cancer screening promotion based on EHR data is indicated, but longer-term cost effectiveness requires further study. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  12. Insurance denials for cancer clinical trial participation after the Affordable Care Act mandate.

    Science.gov (United States)

    Mackay, Christine B; Antonelli, Kaitlyn R; Bruinooge, Suanna S; Saint Onge, Jarron M; Ellis, Shellie D

    2017-08-01

    The Affordable Care Act (ACA) includes a mandate requiring most private health insurers to cover routine patient care costs for cancer clinical trial participation; however, the impact of this provision on cancer centers' efforts to accrue patients to clinical trials has not been well described. First, members of cancer research centers and community-based institutions (n = 252) were surveyed to assess the status of insurance denials, and then, a focused survey (n = 77) collected denial details. Univariate and multivariate analyses were used to examine associations between the receipt of denials and site characteristics. Overall, 62.7% of the initial survey respondents reported at least 1 insurance denial during 2014. Sites using a precertification process were 3.04 times more likely to experience denials (95% confidence interval, 1.55-5.99; P ≤ .001), and similar rates of denials were reported from sites located in states with preexisting clinical trial coverage laws versus states without them (82.3% vs 85.1%; χ = 50.7; P ≤ .001). Among the focused survey sites, academic centers reported denials more often than community sites (71.4% vs 46.4%). The failure of plans to cover trial participation was cited as the most common reason provided for denials (n = 33 [80.5%]), with nearly 80% of sites (n = 61) not receiving a coverage response from the insurer within 72 hours. Despite the ACA's mandate for most insurers to cover routine care costs for cancer clinical trial participation, denials and delays continue. Denials may continue because some insurers remain exempt from the law, or they may signal an implementation failure. Delays in coverage may affect patient participation in trials. Additional efforts to eliminate this barrier will be needed to achieve federal initiatives to double the pace of cancer research over the next 5 years. Future work should assess the law's effectiveness at the patient level to inform these efforts

  13. Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program

    Science.gov (United States)

    Howell, Doris M.; Abernathy, Tom; Cockerill, Rhonda; Brazil, Kevin; Wagner, Frank; Librach, Larry

    2011-01-01

    Purpose: Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Methods: Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. Results: Subjects with gastrointestinal symptoms (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; phome care expenditures. Conclusions: Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Relevance: Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources. PMID:22294993

  14. The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO).

    Science.gov (United States)

    Popescu, R A; Schäfer, R; Califano, R; Eckert, R; Coleman, R; Douillard, J-Y; Cervantes, A; Casali, P G; Sessa, C; Van Cutsem, E; de Vries, E; Pavlidis, N; Fumasoli, K; Wörmann, B; Samonigg, H; Cascinu, S; Cruz Hernández, J J; Howard, A J; Ciardiello, F; Stahel, R A; Piccart, M

    2014-01-01

    The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire 'cancer journey'. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today's and tomorrow's professional cancer care.

  15. Is screening effective in detecting untreated psychiatric disorders among newly diagnosed breast cancer patients?

    NARCIS (Netherlands)

    Palmer, Steven C.; Taggi, Alison; DeMichele, Angela; Coyne, James C.

    2012-01-01

    BACKGROUND: A key purpose of routine distress screening is to ensure that cancer patients receive appropriate mental health care. Most studies validating screening instruments overestimate the effectiveness of screening by not differentiating between patients with untreated disorders and patients

  16. Palliative and End-of-Life Care for Lesbian, Gay, Bisexual, and Transgender (LGBT) Cancer Patients and Their Caregivers.

    Science.gov (United States)

    Cloyes, Kristin G; Hull, William; Davis, Andra

    2018-02-01

    To identify the unique needs of lesbian, gay, bisexual, and transgender (LGBT) cancer patients and caregivers, and review recommendations supporting more effective and inclusive palliative and end-of-life care. Published research and clinical guidelines. Transitions in care raise particular challenges for LGBT patients, including provider communication, perceptions of safety and acceptance, and assessing and respecting patients' definitions of family and spirituality. LGBT patients and their caregivers need competent nurses to support them, especially during transitions. Implementing LGBT-inclusive education, training, and practice will improve outcomes for LGBT cancer patients and their caregivers - and potentially all patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: A randomized, controlled trial.

    Science.gov (United States)

    Livaudais-Toman, Jennifer; Karliner, Leah S; Tice, Jeffrey A; Kerlikowske, Karla; Gregorich, Steven; Pérez-Stable, Eliseo J; Pasick, Rena J; Chen, Alice; Quinn, Jessica; Kaplan, Celia P

    2015-12-01

    To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern. From June 2011-August 2012, we enrolled women from two clinics, aged 40-74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1-2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern. 580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19-2.23). A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern. ClinicalTrials.gov identifier NCT01830933. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: A randomized, controlled trial

    Science.gov (United States)

    Livaudais-Toman, Jennifer; Karliner, Leah S.; Tice, Jeffrey A.; Kerlikowske, Karla; Gregorich, Steven; Pérez-Stable, Eliseo J.; Pasick, Rena J.; Chen, Alice; Quinn, Jessica; Kaplan, Celia P.

    2015-01-01

    Purpose To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern. Methods From June 2011–August 2012, we enrolled women from two clinics, aged 40–74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1–2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern. Results 580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19–2.23). Conclusions A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern. Trial Registration ClinicalTrials.gov identifier NCT01830933. PMID:26476466

  19. 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...

  20. Continuous palliative sedation for patients with advanced cancer at a tertiary care cancer center.

    Science.gov (United States)

    Prado, Bernard Lobato; Gomes, Diogo Bugano Diniz; Usón Júnior, Pedro Luiz Serrano; Taranto, Patricia; França, Monique Sedlmaier; Eiger, Daniel; Mariano, Rodrigo Coutinho; Hui, David; Del Giglio, Auro

    2018-01-04

    Palliative sedation (PS) is an intervention to treat refractory symptoms and to relieve suffering at the end of life. Its prevalence and practice patterns vary widely worldwide. The aim of our study was to evaluate the frequency, clinical indications and outcomes of PS in advanced cancer patients admitted to our tertiary comprehensive cancer center. We retrospectively studied the use of PS in advanced cancer patients who died between March 1st, 2012 and December 31st, 2014. PS was defined as the use of continuous infusion of midazolam or neuroleptics for refractory symptoms in the end of life. This study was approved by the Research Ethics Committee of our institution (project number 2481-15). During the study period, 552 cancer patients died at the institution and 374 met the inclusion criteria for this study. Main reason for exclusion was death in the Intensive Care Unit. Among all included patients, 54.2% (n = 203) received PS. Patients who received PS as compared to those not sedated were younger (67.8 vs. 76.4 years-old, p sedation were dyspnea (55%) and delirium (19.7%) and the most common drugs used were midazolam (52.7%) or midazolam and a neuroleptic (39.4%). Median initial midazolam infusion rate was 0.75 mg/h (interquartile range - IQR - 0.6-1.5) and final rate was 1.5 mg/h (IQR 0.9-3.0). Patient survival (length of hospital stay from admission to death) of those who had PS was more than the double of those who did not (33.6 days vs 16 days, p palliative care team was involved in the care of 12% (n = 25) of sedated patients. PS is a relatively common practice in the end-of-life of cancer patients at our hospital and it is not associated with shortening of hospital stay. Involvement of a dedicated palliative care team is strongly recommended if this procedure is being considered. Further research is needed to identify factors that may affect the frequency and outcomes associated with PS.

  1. Patterns in Health Care Access and Affordability Among Cancer Survivors During Implementation of the Affordable Care Act.

    Science.gov (United States)

    Nipp, Ryan D; Shui, Amy M; Perez, Giselle K; Kirchhoff, Anne C; Peppercorn, Jeffrey M; Moy, Beverly; Kuhlthau, Karen; Park, Elyse R

    2018-03-29

    Cancer survivors face ongoing health issues and need access to affordable health care, yet studies examining health care access and affordability in this population are lacking. To evaluate health care access and affordability in a national sample of cancer survivors compared with adults without cancer and to evaluate temporal trends during implementation of the Affordable Care Act. We used data from the National Health Interview Survey from 2010 through 2016 to conduct a population-based study of 30 364 participants aged 18 years or older. We grouped participants as cancer survivors (n = 15 182) and those with no reported history of cancer, whom we refer to as control respondents (n = 15 182), matched on age. We excluded individuals reporting a cancer diagnosis prior to age 18 years and those with nonmelanoma skin cancers. We compared issues with health care access (eg, delayed or forgone care) and affordability (eg, unable to afford medications or health care services) between cancer survivors and control respondents. We also explored trends over time in the proportion of cancer survivors reporting these difficulties. Of the 30 364 participants, 18 356 (57.4%) were women. The mean (SD) age was 63.5 (23.5) years. Cancer survivors were more likely to be insured (14 412 [94.8%] vs 13 978 [92.2%], P care (odds ratio [OR], 1.38; 95% CI, 1.16-1.63), forgone medical care (OR, 1.76; 95% CI, 1.45-2.12), and/or inability to afford medications (OR, 1.77; 95% CI, 1.46-2.14) and health care services (OR, 1.46; 95% CI, 1.27-1.68) (P care decreased each year (B = 0.47; P = .047), and the proportion of those needing and not getting medical care also decreased each year (B = 0.35; P = .04). In addition, the proportion of cancer survivors who reported being unable to afford prescription medication decreased each year (B=0.66; P = .004) and the proportion of those unable to afford at least 1 of 6 services decreased each year (B = 0

  2. Palliative Care To The Elderly Patient With Cancer: Speech Of Nurses

    Directory of Open Access Journals (Sweden)

    Irany Carvalho da Silva

    2017-02-01

    Full Text Available Palliative care is aimed at people with diseases without perspective of cure or terminally, aiming to provide a better quality of life. This study aims to investigating the discourse of nurses about their understanding of palliative care to elderly patient with cancer and identify strategies used by nurses to promote palliative care to the elderly cancer patient. It is an exploratory research of a qualitative nature, carried out with thirteen nurses from a philanthropic institution in the city of João Pessoa, through a questionnaire. The empirical material was subjected to thematic content analysis, resulting in three categories: design of nurses to assist the elderly in Palliative Care: promoting comfort and minimizing the suffering, the importance of palliative care in humanized care to the elderly with cancer and strategies for the Promotion of Care of the Elderly with Cancer. Participants highlighted the palliative care as essential in the humanization of care, ensuring the dignity and quality of life among the elderly with cancer without possibilities of cure, adding such assistance, the family. Keywords: Palliative Care; Nurse; Elderly; Cancer.

  3. Improving Anatomic Pathology in Sub-Saharan Africa to Support Cancer Care.

    Science.gov (United States)

    Wilson, Michael L; Ayers, Stephanie; Berney, Daniel; Eslan, Alexia; Guarner, Jeannette; Lester, Susan; Masia, Ricard; Moloo, Zahir; Mutuku, Angela; Roberts, Drucilla; Stall, Jennifer; Sayed, Shahin

    2018-03-07

    Cancer care requires both accurate pathologic diagnosis as well as pathologic cancer staging. We evaluated three approaches to training pathologists in sub-Saharan Africa to perform pathologic cancer staging of breast, cervix, prostate, and colorectal cancers. One of three training methods was used at each workshop: didactic, case-based testing (CBT), or a blended approach. The project involved 52 participants from 16 pathology departments in 11 countries in East, Central, and Southern Africa. Evaluation of each method included pre- and postworkshop knowledge assessments, online pre- and postworkshop surveys of practice changes at the individual and institutional levels, and selected site visits. While CBT resulted in the highest overall average postassessment individual scores, both CBT and blended approaches resulted in 19% increases in average scores from pre- to postworkshop assessments. Institutions that participated in the blended workshop had increased changes in practice as indicated by the institutional survey. Both CBT and a blended approach are effective methods for training pathologists in pathologic cancer staging. Both are superior to traditional lectures alone.

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

    Science.gov (United States)

    Høybye, Mette Terp

    2013-02-01

    Given the growing attention to the importance of design in shaping healing hospital environments this study extends the understanding of healing environments, beyond causal links between environmental exposure and health outcome by elucidating how environments and practices interrelate. The study was conducted as an ethnographic fieldwork from March 2011 to September 2011 at the Department of Haematology at Odense University Hospital, Denmark, systematically using participant observation and interviews as research strategies. It included 20 patients, four of who were followed closely over an extended time period. Through thematic analysis five key concepts emerged about the social dynamics of hospital environments: practices of self; creating personal space; social recognition; negotiating space; and ambiguity of space and care. Through these concepts, the study demonstrates how the hospital environment is a flow 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 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. Healing environments are complex relations between practices, space and care, where recognition of the individual patient's needs, values and experiences is key to developing the environment to support the patient quality of life. The present study holds implications for practice to inform design of future hospital environments for cancer treatment. The study points to the importance for being attentive to the need for flexible 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

  5. Survivorship care planning in skin cancer: An unbiased statistical approach to identifying patterns of care-plan use.

    Science.gov (United States)

    Benci, Joseph L; Minn, Andy J; Vachani, Carolyn C; Bach, Christina; Arnold-Korzeniowski, Karen; Hampshire, Margaret K; Metz, James M; Hill-Kayser, Christine E

    2018-01-01

    Nearly 1 in 5 Americans will develop skin cancer, and as a result, survivors of skin cancer compose one of the largest groups of cancer survivors. Survivorship care plans (SCPs) are an important tool for improving patient outcomes and provide critical information to both survivors and health care professionals. Recent efforts have been made to expand SCP utilization; however, which patients currently receive SCPs is poorly understood. This study used 596 individuals with a diagnosis of melanoma (n = 391) or nonmelanoma skin cancer (n = 205) who had used an Internet-based SCP tool from May 2010 to December 2016 to model the patient and provider characteristics that determine SCP utilization. Survivors were predominantly white (95.3%) and female (56.5%). Survivors who received a treatment summary were more likely to also receive an SCP. University and nonuniversity cancer centers used SCPs at a higher rate than other care settings. Survivors whose care was managed by a team rather than just an individual physician were also more likely to receive an SCP. Survivors older than 70 years at diagnosis were almost twice as likely to receive a plan as survivors who were diagnosed at a younger age. With a convenience sample of skin cancer survivors, it is possible to model factors that predict the receipt of SCPs. Important variables include the diagnosis age, treatment setting, physician type, and treatment-summary utilization. A closer examination of these variables identified several disparities in care-plan use and, therefore, opportunities to improve the distribution of SCPs. Further validation in additional cohorts of survivors is necessary to confirm these conclusions. Cancer 2018;124:183-91. © 2017 American Cancer Society. © 2017 American Cancer Society.

  6. 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. Copyright © 2015 John Wiley & Sons, Ltd.