Follow-up Care For Cancer Patients Research Articles

Sharing Colorectal Cancer Follow-Up Using an E-Care Plan Between Cancer Services and Primary Health Care.

High quality, long term follow-up care for cancer patients needs to be coordinated, comprehensive and tailored to the diverse needs of patients. This study implemented shared follow-up care using an interactive e-care plan that provided a collaborative space to schedule and share goals, tasks and information and support the monitoring of care. Qualitative results identified good relational coordination. Increasing communication from the cancer service is important.

SCANXIETY AND PSYCHOLOGICAL DISTRESS IN CANCER PATIENTS AT ROUTINE FOLLOW UP VISITS

Background: Follow-up care for cancer patients after definitive treatment, includes: routine follow up visits and surveillance imaging to detect recurrence, new primaries, and maintaining quality of life. Scans may cause emotional - distress, including anxiety and fear of recurrence, a condition called “scanxiety’, which may lead to poor quality of life.Aim of work: To assess scanxiety and psychological distress associated with surveillance imaging at routine follow up visits among cancer patients, and different factors affecting its severity.Patients and methods:Consecutive sample of (179) cancer patients attending outpatient clinic at oncology department at Ain Shams University Hospital in Cairo, Egypt, for surveillance imaging from the period between October 2019 to February 2020. The General Health Questionnaire (GHQ), was used as a screening tool for psychological distress; patients with score ≥ 7, were subjected to Hamilton Anxiety Rating Scale (HAM-A), to assess the severity of anxiety symptoms during the periodsurrounding imaging scans. Sociodemographic and clinical data were obtained from the patients and from the medical records.Results: 179 Participants,with mean age of 52.64 (SD= 11.20), and 69.8% were females. Most of the patients had some degree of psychological distress during the time of follow up scans, as 60.9% of patients (n=109) found to have a score ≥ 7 at General Health Questionnaire. Using Hamilton Anxiety Scale,Mild degree of anxiety (HAM-A score ≤ 17) was found in 16.2% of patients, mild to moderate anxiety (score 18-24) in 14.0 %, moderate to severe anxiety (score 25-30) in 17.3%, and very severe anxiety (score 31-56) in 13.4%.Moderate to severe anxiety was the most common degree of anxiety in our patients (28.4 % of patients with anxiety). Significant relationship was found between high GHQ score: (≥ 7) and age of patients (mean age of: 50.7 and SD 11.16), Not having children,type of cancer, and years since diagnosis (median of 2 years). The highest prevalence of scan-associated distress in our study was found in patients with CNS tumor, skin cancer, sarcoma and head and neck cancer, and lowest prevalence in breast cancer.Conclusion: Surveillance imaging scans can provoke anxiety and fear of recurrence in cancer patients, so these studies should be justified, and supported by high quality evidence and guidelines recommendations. And psychological care should be a part of follow up care for cancer patients.

Evidence-Based Follow-up for Adults With Cancer.

The objectives of follow-up care for cancer patients include psycho- social assistance and the detection of health problems. The concept of follow-up care rests on the assumption that the early detection of cancer recurrences and disease- or treatment-related complications is beneficial to patients. In this article, we provide an overview of the scientific evidence supporting current recommen- dations for the follow-up care of patients with colorectal cancer, lung cancer, and lymphoma. This review is based on pertinent publications that were retrieved by a selective search in PubMed, supplemented by the authors' own experience in patient care and guideline creation. As recurrences usually arise soon after initial treatment, the recommended follow-up interval is shorter in the first two years (3-6 months) and longer thereafter (6-12 months). The question of which particular follow-up studies should be per- formed has only been systematically analyzed in a few cases. For patients with colorectal cancer, colonoscopy is the most important study. Intensive follow-up care is associated with a statistically non-significant increase in the survival rate compared to minimal follow-up care (77.5% versus 75.8%). Intensive diagnostic follow-up studies have been found to lead to a doubling of the frequency of operations for recurrence with curative intent, yet without any effect on the average survival time. The findings in lung cancer are similar. However, after tumor resection with curative intent, regularly repeated CT scanning leads to a survival advantage. In lymphoma patients, the longer the interval from primary treatment, the greater the likelihood of treatment-related secondary illnesses. It is not yet known how follow-up care should be provided to these patients in order to help them best. The evidence supporting the efficacy of currently recommended modalities of follow-up care for cancer patients is weak. Until more data from clinical studies become available, the current guidelines should be followed.

General practitioners’ attitudes toward follow-up after cancer treatment: A cross-sectional questionnaire study

Objective An increasing number of cancer patients place a significant workload on hospital outpatient clinics, and health authorities are considering alternative follow-up regimens. It has been suggested that follow-up of cancer patients could be provided by GPs. This study aimed to explore GPs’ experiences with the provision of follow-up care for cancer patients, and their views on assuming greater responsibility in the future.Design Electronic questionnaire study.Subjects GPs in seven regions in Norway.Results A total of 317 GPs responded. Many GPs reported experience in providing follow-up care to cancer patients, during the years following initial diagnosis primarily in collaboration with hospital specialists. More than half of the GPs were satisfied with their collaboration. Most GPs preferred to be involved at an early stage in follow-up care and, generally, GPs felt confident in their skills to provide this type of service. Fewer than 10% were willing to assume responsibility for additional cancer patients, citing potentially increased workload as the main reason.Conclusions GPs acknowledged the importance of providing follow-up care to cancer patients, and the majority felt confident in their own ability to provide such care. However, they were hesitant to assume greater responsibility primarily due to fears of increased workload.Key PointsIt has been suggested that follow-up of cancer patients can be provided by general practitioners (GPs). The viewpoints and attitudes of GPs regarding such follow-up were investigated.GPs reported broad experience in providing follow-up care to patients after active cancer treatment.GPs acknowledged the importance of follow-up care, and they felt confident in their own ability to provide such care.Fewer than 10% of GPs were willing to assume responsibility for additional cancer patients, citing potentially increased workload as the main reason.

Nurse-led follow-up care for cancer patients: what is known and what is needed

Traditionally, cancer patient follow-up has focused on disease surveillance and detecting recurrence. However, an increasing number of patients who have survived cancer acknowledge the importance of cancer rehabilitation issues and the need for more patient-oriented models of care by reporting their unmet physical, emotional, and social needs. Nurse-led follow-up care for cancer patients fulfills this need and has been developing gradually for various cancer diagnoses and prognoses. A growing body of evidence suggests that these services provide high-quality care that is both safe and efficient. Furthermore, patients benefit from the continuity of care and easy access to support for their multitude of needs, provided by such organized care. In this paper, we review the literature published in the past 5 years regarding nurse-led follow-up care for cancer patients in order to provide input and opinion for future research, clinical practice development, and nursing leadership. We pay special attention to head and neck cancer patients, a group that has been largely understudied and hence underreported in the literature. These patients have specific needs with respect to information and education regarding their cancer and potential treatment side-effects as well as a particular need for long-term psychosocial support and practical advice.

Redesigning follow-up care for cancer patients

Redesigning follow-up care for cancer patients

Improving follow-up care for cancer patients

Traditional follow-up services for cancer are no longer meeting the needs of patients. Julia Ozdilli, Anne Wilkinson and Gilmour Frew outline new self-managed pathways of aftercare from NHS Improvement

How do Specialist Breast Nurses help breast cancer patients at follow-up?

As the proportion of survivors from breast cancer increases it is possible that follow-up care could be delivered wholly by generalists to relieve over subscribed hospital clinics. However, guidelines seldom take into account the nature of interactions between patients and health care professionals involved in hospital-based follow-up. Consultations between four Specialist Breast Nurses (SBNs) and 21 consecutive women attending a hospital-based breast cancer follow-up clinic in Western Australia were audio recorded and subjected to a thematic analysis. Recording of consultations ceased with saturation of themes. We analysed the data with reference to theoretical frameworks which postulate that social support is a powerful factor in determining positive health outcomes. We also drew on theories focusing on biographical disruption, biographical reinforcement and biographical reinvention. The majority of participants were Australian born, married women in their sixties. The mean duration of the consultations was 19 min (SD = 7.5, min = 8, max = 43.5). A core theme was the established relationship between the woman and her SBN. Overall, the SBNs played an important role in facilitating the transition of patients by supporting the woman in adjustment to a new self-image and bodily functioning. The SBN accompanies each woman through this phase in her life, white supporting a new narrative, promoting her 'rebirth' as someone with ideas, concerns and expectations that have altered significantly after the diagnosis of cancer. Five key themes emerged to demonstrate this supportive role: normalising; facilitating access to services; prevention; promoting self-esteem and promoting a proactive approach. Many women with breast cancer claimed a new perspective on what was now possible, acceptable or desirable in a host of life domains. Our data suggest that the follow-up care of cancer patients is more than just dealing with a checklist of symptoms but requires an understanding of the biographical disruption occasioned by a diagnosis of breast cancer.

Care of long‐term cancer survivors

Studies have shown that follow-up care for cancer patients differs by physician specialty, and that coordination between specialists and generalists results in better care. Little is known, however, regarding which specialties of physicians provide care to long-term cancer survivors. The authors used Surveillance, Epidemiology, and End Results data from 1992 through 1997 that were linked to 1997-2003 Medicare data to identify persons diagnosed >5 years earlier with bladder, female breast, colorectal, prostate, or uterine cancer. Physician specialties were assigned by combining Medicare data with the American Medical Association Masterfile and the Unique Physician Identification Number Registry. The percentage of long-term survivors who visited physicians of interest was determined by analyzing Medicare outpatient claims submitted 6 to 12 years after initial diagnosis. Over the entire study period, 46% of female breast cancer survivors, 26% of colorectal cancer survivors, and 14% of prostate cancer survivors saw hematologists/oncologists. Radiation oncologists were seen by 11%, 2%, and 14% of breast, colorectal, and prostate cancer survivors, respectively. Survivors also sought care from specialists related to their cancer: 19% of breast cancer survivors had a cancer-coded visit with a surgeon, 26% of colorectal cancer survivors visited a gastroenterologist, and 68% of prostate cancer survivors visited a urologist. The percentage of survivors who visited cancer and cancer-related physicians declined each year. In contrast, nearly 75% of female breast, colorectal, and prostate cancer survivors saw primary care providers, and these percentages did not decrease annually. The findings of the current study underscore the need to include both primary care providers and cancer-related specialists in education and guidelines regarding cancer survivorship.

The benefits of nurse-led cancer follow-up

Despite the shortage in the nursing workforce, Jan Morrison argues that their clinical background and holistic approach means that nurses are best equipped to provide follow-up care for cancer patients

Methodological issues in the use of administrative claims data to study surveillance after cancer treatment.

Administrative claims databases linked to tumor registry data provide an excellent opportunity for studying the follow-up care of cancer patients. Methodological principles of study design are reviewed, using examples drawn from the recently published literature. Most follow-up care is outpatient-based. Therefore, in studies using Medicare claims, the patient should be eligible for Medicare Part B and should not be enrolled in a Medicare HMO. In studies of surveillance testing, it may be appropriate to exclude subjects who are near death, in a hospice, or in whom a new or recurrent cancer develops. The definition of the period for measurements of surveillance testing requires consideration, as does periodicity in patterns of testing. Several analytic methods can be employed, from proportions undergoing testing to survival analysis methods. Measurement of 'surveillance tests' among control subjects (those without cancer) may be useful for comparison with cancer patients. To date, administrative claims data have been most useful in studies investigating the quality of, and disparities in, cancer care. With appropriate attention to methodological issues, linked tumor registry and administrative databases can provide important insights into the quality of survivorship care for cancer.

Quality of life profile: from measurement to clinical application

Quality of life (QoL) can be assessed in an accurate, valid and reliable way by means of standardized QoL questionnaires and is an important endpoint in clinical trials today. The aim of this study is to implement quality of life as a diagnostic tool for problem-oriented follow-up care of cancer patients. This is done in the framework of an intervention study in the area of regional health care research using qualitative analysis and the methodological concept of barrier analysis. We developed the diagnostic tool by generating individual, graphic QoL profiles based on patients' responses to the EORTC QLQ-C30 and the corresponding disease-specific modules BR23 for breast cancer and CR38 for rectal cancer. The clinical application is investigated by assessing physicians' responses. The QoL profile is judged as a useful diagnostic tool by all participating physicians. It enables physicians to assess the QoL of the patient and incorporate the knowledge they gain in their daily practice. Especially in breast cancer follow-up care QoL profiles give added value to both patients and doctors. The next implementation steps have to extend the concept of QoL to larger groups of patients and physicians by overcoming the restraining factors as identified in the barrier analysis.

Cost-effective follow-up of the cancer patient. Time for a new look.

Physicians are increasingly aware of their complex responsibilities in finding the difficult compromise necessary to achieve cost-effective follow-up care of cancer patients. They must consider not only the best interests of their patients but also the interests of a cost-conscious society. To meet their new societal obligations, physicians trained solely to serve the patient's best interest must now learn how to do so at the least expense. This implies knowing both the costs and the performance characteristics of the diagnostic tests ordered in follow-up. The authors analyze this dilemma as it applies to follow-up of patients following primary treatment for colon cancer or nonseminomatous testicular cancer. Principles of cost-effective patient management are reviewed.