Cancer Survivorship Program Research Articles

Impact of a novel breast cancer survivorship program on patient-centered outcomes: A single institutional study.

Impact of a novel breast cancer survivorship program on patient-centered outcomes: A single institutional study.

Cancer Survivorship Program: Implementation for Individuals With Recurrent Breast Cancer.

Patients are living longer with recurrent breast cancer, but survivorship programs for these individuals are lacking. The aims were to implement a survivorship program for individuals with recurrent breast cancer, increase their quality of life (QOL), and evaluate patient satisfaction with the program. Survivors were referred for a one-hour coaching intervention tailored to their needs based on results of the Functional Assessment of Cancer Therapy-Breast (FACT-B) survey. Satisfaction was assessed immediately and two weeks postintervention. A paired t test was used to evaluate QOL scores before and two weeks following participation. Statistically significant (p = 0.000) improvements were observed overall and in each subscale of the FACT-B survey. Patient satisfaction was high immediately postintervention and remained high at the two-week assessment.

Integrating Shared Survivorship Care into an Allogeneic Bone Marrow Transplant Long Term Follow up Service

Topic Significance & Study Purpose/Background/Rationale Successful developments in disease control and management of early toxicity have seen outcome improvements in allogeneic bone marrow transplant (AlloBMT) resulting in increased numbers of patients transitioning to long term follow up (LTFU) care. LTFU care has traditionally been provided in quaternary centres by a dedicated LTFU team. A successful Victorian (Australia) Cancer Survivorship Program grant was utilised to pilot a shared survivorship model of care for eligible patients post AlloBMT. The Breaking Good shared survivorship care project built on the success in establishing a dedicated hospital based LTFU clinic by extending and modifying our service to be appropriate for and inclusive of primary care providers (PCP). Aim 1. To assess the feasibility & acceptability of shared survivorship care after AlloBMT in an established hospital based LTFU service. 2. To pilot a shared survivorship model for eligible patients Methods, Intervention, & Analysis 1. 250 patients and PCP pairs were surveyed to determine feasibility and acceptability of shared survivorship care. 16 patients consented to semi structured interviews that were analysed by thematic content analysis. An eligibility tool based on post allograft complexity criteria was tested and utilised to identify suitable patients for shared survivorship care. 2. 10 existing LTFU patients were identified as eligible to participate in a pilot to transition to shared survivorship care. Findings & Interpretation 1. Application of eligibility tool, patient and PCP surveys identified approximately 55% of patients suitable for & confident to receive shared survivorship care. 2. Pilot evaluation demonstrated high satisfaction with (a) quality of information provided in preparation for shared care review (b) confidence in provision of shared survivorship care by PCP (b) ongoing willingness of patient and PCP to participate in shared care Discussion & Implications This paper will discuss the feasibility & acceptability by patients and PCPs to participate in shared survivorship care. Resource development including eligibility tool, modified care plans, education video, clinical placements and rapid access portal will be described. Implementation of shared survivorship care into standard model of LTFU care will be discussed including communication & resource facilitators & barriers.

Identification of Korean cancer survivors' unmet needs and desired psychosocial assistance: A focus group study.

PurposeThis qualitative study identifies difficulties and unmet needs in psychosocial aspect that Korean cancer survivors reported.Materials and MethodsWe enrolled 18 cancer survivors who agreed to participate in the focus groups. Each focus group consisted of four to six cancer survivors, considering homogeneity of sex and age. Participants were asked to freely describe the practical difficulties they faced and their unmet needs when living as cancer survivors. A cross-case interview analysis was used to identify major themes. Consensual qualitative research analysis was applied to complement the objectivity of results obtained from participants’ interviews.ResultsWe identified three major themes: 1) shifts what cancer connotes, 2) development of government policies regarding integrative management for cancer survivors, and 3) preparing for cancer survivors’ future through vocational rehabilitation or career development.ConclusionKorean cancer survivors had difficulties in psychosocial adjustment even after the completion of anti-cancer treatments. We identified several unmet needs among participants who were living as cancer survivors. This qualitative study may expand the view of cancer survivorship in Korea by incorporating their voices and experiences to facilitate the development of a more holistic cancer survivorship program.

The renal adverse effects of cancer immunotherapy.

Over the past decade, the development and clinical use of immunotherapy agents has increased exponentially. As clinical experience builds with these agents so too does our understanding of the associated adverse effects. In particular, the effects of immunotherapy on the kidneys, individual nephrons, and kidney function remain less well described than the adverse effects on barrier organ systems such as the gastrointestinal tract and skin. However, phase IV post-marketing surveillance and clinical case studies together with basic research has begun to reveal mechanisms by which immunotherapy mediates renal adverse effects. This work may lead to improvements in treatment guidelines and therapy. These advances are particularly important as post-cancer survival increases leaving patients to cope with the consequences of not only the cancer, but the short- and long-term adverse effects of treatment. Here we discuss the major renal adverse effects encountered with individual immunotherapeutic agents, putative mechanisms, their current management, and how cancer survivorship programs can help patients who have been treated with immunotherapy.

Building a comprehensive cancer survivorship program.

There is a significant increase in the number of people surviving cancer as a result of improved detection and better treatments. In the United States (US) alone, these numbers are estimated to reach 20 million by 2026 [Miller et al (2016) CA Cancer J Clin 66(4) 271–289)]; [Bluethmann et al (2016) Cancer Epidemiol Biomarkers Prev 25(7) 1029–1036]. Living through cancer treatment represents a life-changing event, often including residual and long-term emotional, physical, psychological and spiritual sequelae. Survivorship programming must encompass the clinical management of medical issues, local support services for patients and their caregivers, protocols for communicating with community primary care providers (PCPs) and education for all clinicians in the survivorship continuum on the issues impacting survivors. This article will discuss a range of issues that should be addressed when developing a comprehensive, multi-disciplinary cancer survivorship care.

Outcomes of a text message, Fitbit, and coaching intervention on physical activity maintenance among cancer survivors: a randomized control pilot trial.

We aimed to determine the effect of a health coach, text message, and Fitbit intervention on moderate-to-vigorous physical activity (MVPA) maintenance in cancer survivors following a supervised exercise program compared to provision of a Fitbit alone. Participants were recruited during the last month of an exercise-based oncology rehabilitation program and randomly assigned to the full intervention (n = 34) or Fitbit-only control groups (n = 32). In total, 59 cancer survivors completed the program (81% female; mean age 61.4 ± 9.0). Group by time differences in accelerometer-measured MVPA was assessed using linear mixed models. Additionally, we examined mean weekly Fitbit-derived MVPA levels. Intervention participants maintained weekly MVPA from pre- (295.7 ± 139.6) to post-intervention (322.0 ± 199.4; p = 0.37), whereas those in the Fitbit-only group had a significant decrease in MVPA (305.5 ± 181.1 pre vs 250.7 ± 166.5 post; p = 0.03, effect size 0.57). The intervention participants maintained recommended levels of MPVA for health benefits during the 8-week intervention, whereas the Fitbit-only control group did not. The findings demonstrate that a remote intervention delivered through health coaching, text messages, and Fitbit can promote maintenance of MVPA after a structured program for cancer survivors. However, use of a Fitbit alone was not sufficient to prevent expected decline in MVPA. Additional research is warranted to examine long-term impacts and efficacy in a more diverse population of cancer survivors. Use of a wearable tracker alone may not be sufficient for exercise maintenance among cancer survivors after transition to an independent program. Additional planning for relapse prevention is recommended.

A model of cancer survivorship care within a community health setting: the Good Life Cancer Survivorship program.

This study aimed to establish and evaluate the referral pathway from a hospital-based oncology service to a multidisciplinary community-based health service supporting survivors to engage in self-management. The evaluation involved understanding patterns of health service utilisation and health professionals' perspectives on the implementation of the community-based model of survivorship care, the Good Life Cancer Survivorship (GLCS) program. Survivors referred to GLCS were undergoing or had completed cancer treatment and unable to participate in intensive ambulatory oncology rehabilitation. Health service utilisation was tracked over 5 months, and the perspectives of health professionals referring to and involved in the GLCS program were recorded using semi-structured interviews. The oncology service made 25 referrals. The most accessed services at Carrington Health were physiotherapy with 18 appointments, followed by psychology (12) and dietitian services (11). Four themes emerged from the interviews: (1) Allied health services are relevant to people with cancer; (2) Education and information needs; (3) Communication gaps; (4) A one-stop multidisciplinary and holistic care model. This project demonstrated that community health may be a valid setting to support cancer survivors in managing their health. Supporting ongoing awareness, education and understanding of services across both community and acute care settings will foster care coordination and strengthen referral pathways. Accessing appropriate community-based allied health services can support cancer survivors in developing self-management skills to manage their own health and improve their health outcomes and wellbeing in the survivorship phase.

Risk Factors and Outcomes During a First Acute Myocardial Infarction in Breast Cancer Survivors Compared with Females Without Breast Cancer

PurposeThe purpose of this research was to study the differences in epidemiology and outcomes of a first myocardial infarction in breast cancer survivors compared with the general female population in the United States. MethodsWe retrospectively analyzed the US National Inpatient Sample years 2005-2015 to identify adult women with a first myocardial infarction. In this cohort, breast cancer survivors were identified. Outcomes evaluated were the differences in baseline demographics, comorbidities, and adjusted in-hospital mortality in women with and without breast cancer. ResultsAmong 1,644,032 first myocardial infarction cases in adult women, there were 56,842 (3.5%) breast cancer survivors. Compared with women without breast cancer, breast cancer survivors were 6 years older (mean age 77 vs 71 years, P < .001), had significantly higher prevalence of dyslipidemia and hypertension, and lower prevalence of obesity, diabetes mellitus, and smoking. Breast cancer survivors were more likely to have a non-ST segment elevation acute myocardial infarction and less likely to receive mechanical revascularization. In-hospital mortality was lower in breast cancer survivors (7.1%) compared with those without (7.9%, P < .001), findings that persisted after risk adjustment (odds ratio 0.89; 95% CI, 0.82-0.94). ConclusionsBreast cancer survivors had a first acute myocardial infarction at an older age and had small but favorable differences in cardiovascular disease risk factors and outcomes compared with women without breast cancer. The favorable impact of health education, preventative medical care, greater motivation for a healthier lifestyle, and participation in cancer survivorship programs on these seemingly paradoxical findings in breast cancer survivors should be further explored.

Implementation of the Smoking Treatment and Recovery (STAR) program: healthy cancer survivorship through integrated tobacco control.

It is well-established that persistent tobacco use among patients with cancer results in numerous adverse outcomes. However, the assessment and treatment of tobacco use with evidence-based methods have been lacking in cancer care. Our cancer center has established its first tobacco treatment program, a multidisciplinary, evidence-based, clinical program for hematology/oncology patients. We describe the development and implementation of the program, emphasizing lessons learned in treating nicotine addiction among patients who are at very high risk for continuing to use tobacco throughout the survivorship phase. We developed a system to assess tobacco use at each outpatient visit, from those recently diagnosed to long-term survivors. For patients who have smoked in the past month, the protocol offers standard behavioral and pharmacological treatments, delivered by tobacco treatment specialists and nurse practitioners over four in-person and/or telephone-based sessions. Partnerships with the Psychosocial Oncology and Cancer Survivorship Programs have provided integrated and comprehensive care for patients during and after their cancer treatment. The systematic efforts to reach and engage current smokers have laid the groundwork for maximizing the program's future effectiveness and impact. Our initial results demonstrate not only the complexities but also the feasibility of developing a new tobacco treatment program in the oncology setting. The implications for cancer survivors are the significant improvements in treatment outcomes that occur with tobacco abstinence.

421O - Effects of an educational program on knowledge and quality of life for Korean breast cancer survivors: A prospective cohort study

BackgroundThe number of long-term cancer survivors has increased substantially over past decades. However, there is insufficient understanding of the symptoms and quality of life (QoL) after cancer treatment, and there is no adequate education program for cancer survivors. The purpose of this study is to investigate the improvement of knowledge and QoL through education among breast cancer survivors. MethodsWe prospectively recruited 100 breast cancer survivors – the education cohort (EC) – who received the educational program. Breast cancer survivors who visited the survivor clinic during the same period were retrospectively enrolled as control cohort (CC) (n = 40). EC was pretested for knowledge on breast cancer survivorship and a trained nurse conducted a 30-minute individual education program which was based on ASCO survivorship guideline, with post-test knowledge assessment to measure changes in this aspect. For measure QoL change, we conducted QoL survey at the time enrollment and six months later in both groups. ResultsFor EC, participants’ mean age was 52.7 years, 86% were married, and 75% were high school or college graduates. Further, 78% were employed and over 94% said the economy was in the middle or better. The correct answer rate during pre-test ranged from 28% to 97%, showing an improvement from 96% to 100% in post-test, immediately after education. While there was no statistically significant difference among the CC, EC showed significant improvement on anxiety (mean [SD] 4.63 [3.58] → 3.66 [3.51]; p = 0.025) and depression (5.60 [3.39] → 4.11 [3.30]; p < 0.001). The FACT-B test showed statistically significant improvement in physical and functional well-being for EC. There was no significant difference in lifestyle change for either group.Table421OTableCCECMean±SDp-valueMean±SDp-valuePrePostPrePostHADS anxiety4.98±3.963.80±3.000.0564.63±3.583.66±3.510.025HADS depression4.78±3.833.98±2.570.1855.60±3.394.11±3.30<0.001 ConclusionsWe found education effective in reducing anxiety and depression as well as physical and functional well-being in breast cancer survivors. However, we failed to demonstrate significant intervention effects in lifestyle change. In order to elicit lifestyle changes, more active intervention is needed along with education. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Computerized programs for cancer survivors with cognitive problems: a systematic review.

This study aimed to review and identify characteristics and lessons learned from studies on computerized cognitive interventions for cancer survivors (CSs) with cognitive dysfunction, exploring the content and results of interventions. Studies were collected from the CINAHL, Web of Science, PubMed, and PsycINFO databases. Seven articles that met the inclusion criteria were included. Reviewed studies measured objective cognitive function, subjective cognitive function, and psychological aspects. Computerized interventions for CSs with cognitive decline were effective for executive function, memory, working memory, and speed of thought in the domain of objective cognitive function. Some subjective cognitive functions also showed significant improvement. Computerized cognitive interventions have a positive impact on objective, subjective, and psychological aspects of cognitive problems. Further research needs to include more men as well as different cancer types. Programs also should include more than one target domain. Future researchers need to develop mobile applications that can effectively use computerized cognitive interventions. Results of this study should help provide optimal approaches to develop and apply effective computerized-cognitive-intervention programs. Health care providers need to be involved in these types of interventions and methods to encourage CSs to proactively practice cognitive-function training need to be developed.

P1.16-13 Development of a Veterans Affairs Based Comprehensive Lung Cancer Survivorship Program

P1.16-13 Development of a Veterans Affairs Based Comprehensive Lung Cancer Survivorship Program

CN49 - Implementing a cancer survivorship program for individuals with recurrent breast cancer

BackgroundPatients are living longer with recurrent breast cancer, yet there is a lack of survivorship programs for these individuals. They face unique challenges due to the lack of curative treatments and limited supportive care resources. Challenges include fluctuations in functional status, changes in relationships, communication with loved ones, and existential concerns. Health related quality of life has been found to be different, further widening the gap in care. MethodsSurvivors were referred for a one-hour coaching intervention tailored to their needs based upon results of their Functional Assessment of Cancer Therapy-Breast (FACT-B) survey. Patient satisfaction was assessed immediately after and at two weeks post the intervention. A paired t-test was used to evaluate quality of life sores before and two weeks following participation in the survivorship session. ResultsStatistically significant (p=.000) improvements were observed overall and in each subscale of the FACT-B survey. Patient satisfaction was high immediately post the intervention and remained high at the two-week assessment. ConclusionsThis project successfully demonstrated that an individual coaching intervention can be implemented to improve the quality of life in patients with recurrent breast cancer. The key findings support that integration of a survivorship program is associated with high patient satisfaction and increased quality of life. As chronic breast cancer survivors encompass a broad and heterogeneous population, survivorship programs should be developed that address the needs of this unique patient population. Creation of an infrastructure that promotes individualized care to survivors with recurrent breast cancer is an essential component of providing holistic care across the cancer continuum. Oncology nurse navigators have a unique relationship with their patients and implementing this program provides an opportunity to address these important and clinically relevant unmet needs. Legal entity responsible for the studyThe author. FundingGraduate scholarship in Cancer Nursing Practice GSCNP-18-07501 from the American Cancer Society and a Clinical Doctoral Scholarship from the Oncology Nursing Foundation Endowment. DisclosureAll authors have declared no conflicts of interest.

Implementation Characteristics of Community-Based Exercise Programs for Cancer Survivors

Implementation Characteristics of Community-Based Exercise Programs for Cancer Survivors

Survivorship: Leveraging the EMR to better care.

283 Background: UCHealth is a 10-hospital health system located on the Front Range of the Rocky Mountains. In 2018, UCHealth Cancer Care diagnosed or treated more than 8,400 analytic cases. In this presentation, we will discuss how we formulated a response to our organizational need for the creation of a Cancer Survivorship Program that not only met the ASCO QOPI &amp; Commission on Cancer (CoC) Standards but also the needs of our patients. Methods: Our response plan included devising processes for the development and delivery of treatment summary care plans (TS/SCP). The development phase comprised the formation of UCHealth Cancer Care governance structure, creation of 22 disease specific templates containing the Institute of Medicine (IOM) / National Comprehensive Care Network (NCCN) recommended elements of survivorship care, Electronic Health Record (EHR) automation to increase efficiency and finally designing dashboard reports to identify eligible patients and capture compliance. The delivery phase consisted of securing dedicated resources, a communication plan and education for staff and providers regarding the benefits of a Cancer Survivorship program. Results: A jump in compliance from 7% in 2015 to 29% in 2018, demonstrates the success and impact of TS/SCPs at UCHealth. We will also discuss the 2019 work plan to achieve 50% compliance as required by the CoC. Conclusions: Leveraging the EHR is necessary when developing a Cancer Survivorship Program. UCHealth will provide examples of the treatment summary care plans, reference and reporting metrics to get other programs started on their journey.

Evaluating an Online Training Course to Develop and Sustain Cancer Navigation and Survivorship Programs.

To evaluate the impact of the Executive Training on Navigation and Survivorship (Executive Training) online training course, designed by the George Washington University Cancer Center, on nurses and other healthcare professionals. A volunteer sample of 499 healthcare professionals, including nurses and patient navigators, were recruited through multiple Internet-based channels. Participants completed questionnaires before and after each module and at the end of the training. Descriptive statistics were calculated, and paired t tests were used to assess pre- and post-test learning confidence gains for each module. Qualitative feedback from participants was also summarized. From pre- to post-test, each group demonstrated statistically significant improvements in confidence (p < 0.05) for all seven training modules. Confidence gains were statistically significant for 19 of 20 learning objectives (p < 0.05). Overall rating scores and qualitative feedback were positive. The Executive Training course prepares healthcare professionals from diverse backgrounds to establish navigation and survivorship programs. In addition, the training content addresses gaps in nursing education on planning and budgeting that can improve success.

Exploring the Relationships between Posttraumatic Growth, Wisdom, and Quality of Life in Older Cancer Survivors.

Objective:The number of older cancer survivors is steadily rising with a growing aging population, and a great interest in evaluating the quality of life is emerged. Although understanding how to improve the quality of life in older cancer survivors is critical as the number of older survivors continues to grow in communities, little is known about empirical evidence regarding predictors of the quality of life in older cancer survivors. This study aimed to examine relationships between posttraumatic growth, wisdom, and quality of life in older cancer survivors. Methods:A convenience sample of older cancer survivors after completing cancer treatments (n=121) participated from one public health center, and they filled out self-report questionnaires on measures of posttraumatic growth, wisdom, and quality of life. Results:As results of multiple regression analysis, the most significant factor on each domain of the quality of life has shown that higher levels of subjective economic status were associated with significant improvement of four domains of quality of life, and wisdom and posttraumatic growth were associated with significant improvement in social/family well-being. Conclusion:This study highlights predictors of each domain of quality of life that subjective economic status, posttraumatic growth and wisdom significantly affected the quality of life in older cancer survivors. Findings indicate that psychological interventions need to be developed and implemented for older cancer survivors to prevent long-term effects of cancer and to increase their quality of life. For improving their quality of life, primary care providers or community health professionals need to develop tailored interventions, such as home-based cancer survivorship programs.

Partnered, adapted argentine tango dance for cancer survivors: A feasibility study and pilot study of efficacy

BackgroundNeurotoxic cancer treatments can cause chemotherapy-induced peripheral neuropathy and postural control deficits that cancer survivors report as a concern. Exercise-based sensorimotor training has emerged as a promising treatment for symptoms including balance deficits, however, more study is needed to optimize engagement and participation. We evaluated feasibility, satisfaction, and preliminary efficacy of a novel balance training program for cancer survivors: partnered, Adapted Argentine Tango dance (Tango). MethodsTwenty-two individuals participated (n = 22). Tango classes (1 h) were offered twice/week. At baseline, midpoint (8 classes), and conclusion of the training (15 or 16 classes), we assessed postural control by measuring center-of-pressure (CoP) measures during quiet standing with eyes closed. We also documented attendance, barriers to attendance, and satisfaction (7 point scale; 1 high). At conclusion, we analyzed whether 1) attendance and satisfaction met feasibility criteria; 2) postural control improved among participants who were outside of normal range at baseline; and 3) co-enrolling with a companion increased attendance. FindingsFeasibility criteria were met: more than half of participants attended more than half the classes offered with a mean satisfaction rate of 1.2 (SD 0.4). Those who enrolled with a companion (n = 9) attended more sessions than those who did not (n = 13) (Mann-Whitney U value = 20; p = 0.012). Participants with demonstrated deficits (n = 9) improved in 3 CoP measures at midpoint (i.e., medial-lateral sway, ellipse area, medial-lateral velocity), retaining improvement in 2 CoP measures at endpoint (i.e., medial-lateral sway, ellipse area). InterpretationPartnered, Adapted Argentine Tango is feasible for cancer survivors and may improve postural control. Enrolling with a companion improved attendance.

Community-based exercise programs for cancer survivors: a scoping review of practice-based evidence.

Based on randomized controlled trials, exercise is an efficacious strategy to improve quality of life (QOL) among cancer survivors. However, the effectiveness of exercise programs to improve QOL in real-world settings is unknown, as are factors related to external validity. This hinders dissemination and scalability. This scoping review synthesized published research on community-based exercise programs for cancer survivors and reported on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM). A systematic literature search identified community-based exercise programs for adult cancer survivors (1980-March 2018), that met the following inclusion criteria: at least one face-to-face exercise session, the primary aim of program evaluation (i.e., feasibility/effectiveness), and pre/post measure of QOL. Data were coded using the RE-AIM framework. The effect size was calculated for overall QOL. Electronic database search yielded 553 articles; 31 studies describing unique programs were included for review. All studies described at least one element of implementation and most (80.6%) reported a significant (p < .05) improvement in at least one subscale, or total QOL. Few studies reported on indicators of reach (16.1%), adoption (6.5%), individual (16.1%), or system-level maintenance (32.3%). Community-based exercise programs are effective for improving QOL in adult cancer survivors. Recommendations are provided to improve reporting across RE-AIM dimensions, which is an important step to enhance the scalability of programs and thus, the potential for exercise to be fully integrated into system-level standard care for cancer survivors. Community-based exercise programs are a resource to improve QOL for adult cancer survivors.