Training In Survivorship Care Research Articles

Use of Cancer Survivorship Care Guidelines by Primary Care Providers in the United States.

National organizations have issued comprehensive cancer survivorship care guidelines to improve care of cancer survivors, many of whom receive care from primary care providers (PCPs). We analyzed Porter Novelli's 2019 fall DocStyles survey to assess use of cancer survivorship care guidelines, receipt of survivorship training, types of survivorship services provided, and confidence providing care among PCPs in the United States. We grouped PCPs by use of any guideline ("users") versus no guideline use ("nonusers"). We calculated descriptive statistics and conducted multivariable logistic regression analyses to examine guideline use, having received training on providing survivorship care services, and confidence in providing care. Within the panel, sampling quotas were set so that 1000 primary care physicians, 250 OB/GYNs, 250 pediatricians, and 250 nurse practitioners/physician assistants were recruited. To reach selected quotas, 2696 health professionals were initially contacted to participate, resulting in a response rate of 64.9%. Sixty-two percent of PCPs reported using guidelines and 17% reported receiving survivorship care training. Use of any guidelines or receiving training was associated with reporting providing a range of survivorship services and confidence in providing care. After adjusting for demographic characteristics, guideline users were more likely than nonusers to report assessing genetic cancer risk (OR = 2.65 95% confidence interval (CI) (1.68, 4.17)), screening for cancer recurrence (OR = 2.32 95% CI (1.70, 3.18)) or a new cancer (OR = 1.63, 95% CI (1.20, 2.22)), and treating depression (OR = 1.64, 95% CI (1.20, 2.25)). Receipt of training was also positively associated with providing genetic risk assessment, surveillance for recurrence, as well as assessing late/long-term effects, and treating pain, fatigue, and sexual side effects. Survivorship care guidelines and training support PCPs in providing a range of survivorship care services.

Incorporating cancer survivorship care in dental education.

Incorporating cancer survivorship care in dental education.

Current practice patterns and gaps in guideline-concordant breast cancer survivorship care

PurposeBreast cancer-specific survivorship care guidelines for the more than 3.8 million survivors in the U.S. are available, but implementation in clinical practice remains challenging. We examined current practice patterns and factors associated with guideline-concordant survivorship care among oncologists.MethodsA national sample of medical oncologists, recruited using two databases, participated in a survey focused on practice patterns for breast cancer survivorship care. A “survivorship care composite score” was calculated for each respondent based on provision of services recommended in the survivorship guidelines. Descriptive statistics and multivariable linear regression analyses examined associations between physician and practice characteristics and composite scores.ResultsThe survey was completed by 217 medical oncologists, with an overall response rate of 17.9% and eligibility rate of 56.9% for those who responded. Oncologists reported high engagement in evaluation of disease recurrence (78%). Performed less frequently were the provision of survivorship care plans (46%), assessment of psychosocial long-term and late effects (34%), and screening for subsequent cancers (34%). Lack of survivorship care training (p = 0.038) and not routinely informing patients about potential late effects (p = 0.003) were significantly associated with poorer survivorship care composite scores.ConclusionsDespite the availability of disease-specific survivorship care guidelines, adherence to their recommendations in clinical practice is suboptimal. Survey results identified key gaps in survivorship care for breast cancer survivors, particularly related to subsequent primary cancers and psychosocial long-term and late effects.Implications for Cancer SurvivorsImproving the delivery of comprehensive survivorship care for the growing population of breast cancer survivors is a high priority. Disease-specific clinical guidelines for cancer survivorship provide valuable recommendations, but innovative strategies are needed to integrate them into the care of long-term breast cancer survivors.

Impact of Cancer Survivorship Care Training on Rural Primary Care Practice Teams: a Mixed Methods Approach.

With the increasing numbers of individuals surviving a diagnosis of cancer, an aging population, and more individuals experiencing multi-morbidity, primary care providers (PCPs) are seeing more patients with a history of cancer. Effective strategies are needed to adequately prepare the primary care workforce for the phase of cancer care now widely recognized as survivorship. A survivorship education program for rural primary care practices was developed using a community engagement process and delivered at the practice level by community health liaisons. A mixed method approach was used to evaluate the program impact which included a questionnaire and interviews. Descriptive analyses and generalized linear regression were used to evaluate quantitative outcomes from the questionnaires. Immersion crystallization was used to define themes from the qualitative components. Thirty-two (32) practices participated, averaging 10.3 team members/practice. The percent of correct responses to the knowledge questionnaire increased significantly, almost doubling between baseline and post-test (25% vs 46%, p < .001). Four major themes emerged from the interviews which included positive impact of the training, putting the training into practice, intention to change care delivery, contextual influences in survivorship care. Evidence from the cancer survivorship education program evaluation supports its value to key stakeholders and the potential wider dissemination of the iSurvive Program. These data also suggest the need for additional investigation into other ways beyond education that primary care practices can be supported to ensure the needs of the growing cancer survivor population in the US are met.

Abstract B015: Women in survivorship health using Project ECHO: Creating a model for navigated care transitions

Abstract There are currently over 15 million cancer survivors in the US, and this number is expected to exceed 20 million by 2026 due to population aging and growth. The majority of these patients are older; many are ethnically diverse and face unique health care challenges and comorbidities due to their cancer treatment. Despite this recognition, research clearly documents the persistence of unmet needs among cancer survivors, including less than optimal preventive and cancer surveillance screening rates. Several barriers have been identified in the effort to achieve optimal survivorship care: the current health care system is fragmented, difficult to navigate, and communication between oncologists and primary care providers is often minimal. While research has been devoted to developing integrated care models, systematic reviews conclude that no standard of care exists for survivorship models. Further, given the variability of cancer survivors in terms of health needs, socioeconomic circumstances, and health care environment, it is likely that such models will need to be adaptive. Building on prior formative research, our research team at the University of New Mexico Comprehensive Cancer Center (UNMCCC) is creating a survivorship care model for implementation. New Mexico, a large, rural, minority-majority state, with deep socioeconomic disparities that limit access to care, presents an ideal environment to address the current evidence gap in survivorship care transitions. Our developing research program features the following major components to this survivorship care model: 1) identifying risk-stratified patients at the UNMCCC and delivering a survivorship care plan; 2) using the Project ECHO telementoring platform, implement a survivorship care training curriculum with primary care providers; 3) an oncology nurse navigator based at the UNMCCC will actively navigate patients to the community-based providers; and 4) all components of the model will be assessed using implementation science research and evaluation strategies. We are in the early phases of developing and implementing this model and we will report on the content and process associated with each of the major components. Identified outcomes pertain to feasibility and acceptability of implementation, and we will categorize these using the RE-AIM and Consolidated Framework for Implementation Research frameworks. Citation Format: Andrew L. Sussman, Teresa Rutledge, Zoneddy Dayao, Miria Kano, Amy Gundelach, Stephanie McGirt, Jolene Lobo, Shiraz Mishra. Women in survivorship health using Project ECHO: Creating a model for navigated care transitions [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B015.

Oncology Nurses' Perspectives and Practices Toward the Delivery of Cancer Survivorship Care in Hong Kong.

Despite tremendous progress in understanding the unmet needs of cancer survivors, our understanding of oncology nurses' perspectives and practices in the delivery of survivorship care is inadequate. The aims of this study were to assess oncology nurses' perceptions about their responsibility and frequency of delivery of survivorship care to cancer patients and to examine the factors influencing such care. A cross-sectional survey was administered to 81 nurses working in the oncology unit of hospitals in Hong Kong. Participants completed an investigator-developed questionnaire designed to assess oncology nurses' perceptions of responsibility, practices, and barriers regarding the provision of survivorship care for cancer patients. Results revealed discrepancies between oncology nurses' perceptions of responsibility and practices, with high levels of perceptions of various survivorship care as their responsibility but low levels in delivery of such care. Despite that discussing and managing pain was agreed by most oncology nurses as their responsibility (95.1%), 34.6% of them have never managed survivors' pain. Besides, 33.3% of nurses have never discussed and managed survivors' sexuality issues. Lack of time (79.0%), inadequate educational resources for family members (59.3%), and lack of knowledge and skills (54.4%) were major factors that impeded survivorship care provision. This study provides further evidence for inadequacies of oncology nurses in delivering survivorship care and their perceived barriers. Further studies are required to enhance our understanding of the strategies for improving the quality of cancer survivorship care. Results underscore the need to develop educational resources and enhance training in survivorship care for oncology nurses.

Survivorship Care Training and Education Among Radiation Oncologists: Results from a Nationally-Distributed Survey

Survivorship Care Training and Education Among Radiation Oncologists: Results from a Nationally-Distributed Survey

Implementation of a Novel Medical School Multidisciplinary and Interprofessional Oncology Curriculum: a Mixed Method Study

As the population of patients with cancer and survivors grows, physician knowledge of oncology clinical care and research is increasingly important. Despite this patient population growth, medical students and non-oncology physicians report insufficient oncologic and survivorship care training. First-year students at a single US medical school completing a summer research experience were invited to participate in integrated Scholars in Oncology-Associated Research (SOAR) program. SOAR seeks to broaden students' understanding of multidisciplinary and interprofessional oncology clinical care and research. SOAR consists of three components: structured didactics, multidisciplinary tumor board attendance, and interprofessional shadowing. A mixed-methods approach investigated whether student knowledge improved after SOAR. Thirty-three students enrolled in SOAR (20 in 2015, 13 in 2016) and completed pre-assessments. Twenty-five (75.8%) students completed SOAR and post-assessments. Self-reported understanding of clinical (2[2, 3] vs. 4[4], p<0.01) and research oncology (2[2, 3] vs. 4[4], p<0.01) improved after SOAR. Understanding of individual disciplines also significantly improved. When describing clinical oncology, responses written post-SOAR were more comprehensive, averaging 3.7 themes per response vs. 2.8 on pre-assessments (p=0.03). There were more references to "survivorship" as a component of oncology on post-assessments (0[0.0%] vs. 7[28.0%], p<0.01) and "screening/prevention" (2[6.1%] vs. 7[28.0%], p=0.03). Additionally, students more often described cancer care as a continuum on post-assessments (4[12.1%] vs. 11[44.0%], p=0.01). A structured didactic and experiential introduction to oncology, SOAR, was successfully piloted. SOAR improved participant understanding of oncology and its distinct clinical and research disciplines. Future work will focus on expanding SOAR into a longitudinal oncology curriculum.

Training a survivorship care workforce with a novel web-based training curriculum.

16 Background: The Commission on Cancer (CoC) standard 3.3 requires survivorship care plan (SCP) delivery to patients who complete treatment with curative intent. The Coleman Supportive Oncology Collaborative (CSOC) is focused on improving supportive and survivorship care through tools, processes and training of health professionals. Methods: A collaborative of 30+ clinicians (faculty) from 25 institutions (academic, community and safety net), funded by The Coleman Foundation, reviewed existing supportive oncology and survivorship care training for content, availability, and cost. They developed a unique fundamental survivorship care training curriculum. Results: Although SCP dissemination training is available, it lacks 1+ attributes: &lt;15 minutes to complete; online access; and CME/CEU credit at no cost. Utilizing existing guidelines and literature, the CSOC identified survivorship (9), palliative (11) and distress (6) modules supporting CoC requirements developed by 2+ expert faculty. Standardized modules include references and a slide presentation with links to additional training, guidelines and literature. Modules were reviewed by The National Comprehensive Cancer Network (NCCN) scientists, and edited. Audio was recorded by faculty. Tech assistance aligned video, graphics and narrated audio into a MP4 (movie) format. Survivorship modules include: Cancer Survivorship Defined, Patient Needs at Survivorship Visit and Coc Requirements for SCPs; Cancer Survivor Care; Survivorship Factors (Lifestyle &amp; Behavior, Psychosocial Challenges and Late and Long Term Effects); Cancer Survivors’ Screening and Prevention Strategies; and Genetic Testing for Patients, Families and Survivors. The NCCN Education Portal published the training (https://education.nccn.org/supportive-oncology-care) available publicly (w CME/CEU) for no charge. Conclusions: Various forms of survivorship training for health professionals exist, but they lack needed attributes. The CSOC developed 9 concise survivorship training modules for NCCN’s education portal, with CME/CEU credit available at no cost to participants. CSOC will collect feedback from training enrollees to determine effectiveness and future training needs.

The Need for Survivorship Care in Genitourinary Cancers: Considerations from SUO and LUGPA

IntroductionA quarter of American cancer survivors have genitourinary malignancies that are largely managed by urologists. We explored urologist perceptions about survivorship care for genitourinary malignancies. MethodsA total of 701 SUO (Society of Urologic Oncology) and 1,746 LUGPA (Large Urology Group Practice Association) members were invited to complete a web based survey composed of 5 domains, including 1) demographics, 2) current survivorship care practices, 3) perceived barriers, 4) accessibility to survivorship resources and 5) perceptions of advocacy groups. ResultsOf 191 respondents 137 (72%) had no training in survivorship care. Of the 174 respondents 129 (74%) practiced shared care models while 45 (26%) preferred pure specialized followup care. Only 39 of 129 respondents (30%) with a shared care model always provided a written care plan. These plans infrequently included information on lifestyle modifications and educational resources. Routine patient referral to advocacy organizations was highest for prostate cancer at 40% followed by bladder, testicular and kidney cancers at 17%, 10% and 8%, respectively. Lack of time/resources and practice guidelines were considered the 2 most important barriers to survivorship care by 31% and 30% of participants, respectively. Web based information on advocacy groups and best practice guidelines were selected as the most important initiatives to promote survivorship care. ConclusionsDespite the low response rate this study highlights important practice gaps in survivorship care for patients with genitourinary malignancies. In collaboration with advocacy organizations professional societies should initiate programs to better educate and train their members in survivorship care guidelines and consensus best practices.

Health-related quality of life is associated with physical activity levels among colorectal cancer survivors: a longitudinal, 3-year study of the PROFILES registry.

The present study aims to examine the longitudinal relation between physical activity (PA) and health-related quality of life (HRQoL) among colorectal cancer (CRC) survivors. Individuals diagnosed with CRC between 2000 and 2009 as registered by the Dutch population-based Eindhoven Cancer Registry, and who were eligible for the study, received a questionnaire on three time points with 1-year intervals. Generalized linear mixed models were used to estimate the independent effects of PA on HRQoL over time. Response rates were 73% (n = 2625), 83% (n = 1643), and 82% (n = 1458) at T1, T2, and T3, respectively. PA behavior was relatively stable over time with 82% of the patients meeting the Dutch PA guidelines (at least 150 min of moderate to vigorous PA per week) at all assessment periods. Multivariate analyses showed that patients who met the PA guidelines scored, on average, 13.7 points higher on the global quality of life, 26.0 on physical, 24.2 on role, 9.0 on cognitive, 10.4 on emotional, and 14.8 on social functioning over time compared to patients not meeting the guidelines (interindividual effects; all p < 0.01). Small intraindividual effects were found for physical (2.9) and role functioning (4.0) and global quality of life (2.1), indicating that patients who went from not meeting to meeting the guidelines over time improved on these scales (p < 0.05). There is a substantial positive association between PA and HRQoL, which is consistent over time for CRC survivors >2 years since diagnosis. Our results underline the importance to focus upon training in survivorship care and strategies to get inactive cancer survivors physically active.

Caring for cancer survivors

The number of long-term US cancer survivors is expected to double by the year 2050. Although primary care physicians (PCPs) provide the majority of care for long-term cancer survivors, to the authors' knowledge, few data to date have detailed PCP practice patterns, attitudes, and challenges in caring for long-term cancer survivors. Self-administered surveys were mailed to 406 community- and academic-based general internal medicine physicians in Denver, Colorado. Survey development included in-depth physician interviews and pretesting. Of the 299 responses, 72 were ineligible; an analysis of the data from 227 surveys is presented. The response rate was 76%. Community-based PCPs comprised 70% of completed surveys. Reported care patterns were assessed to create a multidimensional care score reflecting levels of attention to 4 areas of survivorship care: monitoring for cancer recurrence, management of late effects, sexual functioning, and mental health. Only 24% of PCPs met criteria for routinely providing more multidimensional survivorship care. More recent medical school graduates reported providing less multidimensional survivorship care when compared with their more experienced colleagues. Approximately 82% of PCPs believed that primary care guidelines for adult cancer survivors are not well defined, and 47% of PCPs cited inadequate preparation and lack of formal training in cancer survivorship as a problem when delivering care to long-term survivors. Although PCPs provide the bulk of care for long-term survivors within the survivorship phase of the cancer trajectory, only a small subset have reported providing multidimensional survivorship care. Results underscore a need for substantially increased training in survivorship care to support the delivery of multidimensional primary care for long-term survivors.

Preparedness for Caring of Cancer Survivors: A Multi-Institutional Study of Medical Students and Oncology Fellows

Despite recent advances in cancer survivorship knowledge and care, most medical schools lack a comprehensive survivorship curriculum, potentially leaving students ill-prepared for caring of survivors. A total of 211 students and 22 oncology fellows in 3 institutions completed a questionnaire assessing knowledge and experience in survivorship care. Medical students and oncology fellows lack knowledge in key survivorship issues. Students were exposed to cancer survivors frequently in medical school but only half received instruction or practiced critical components of survivorship care. Improvement of both undergraduate and postgraduate training in survivorship care is urgently warranted.

Medical and Nursing Education and Training Opportunities to Improve Survivorship Care

Improving the quality of care for cancer survivors is contingent on having physicians, nurses, and other professionals with adequate training in survivorship care. Previous literature has documented the deficiencies in existing formal education programs regarding the complex needs of this growing population. Continuing education programs and basic curricula need to incorporate the expanding body of knowledge regarding the physiologic and psychosocial sequelae of survivorship. This article reviews the current status of survivorship education and provides direction for essential content in future education. Topics such as prevention of secondary cancers, long-term complications, rehabilitation services, quality-of-life issues, pain and symptom management, and treatment of recurrent cancer are critical competencies of education that should then become routine care for cancer survivors.