Health care use during cancer survivorship

Kelly M. Kenzik | Health care use during cancer survivorship: Review of 5 years of evidence | Cancer | First published: 18 December 2018

Abstract

Improvements in treatment strategies have resulted in increasing survival rates among patients diagnosed with cancer but also result in a growing population of individuals who have greater health care needs. These needs will persist from diagnosis throughout the continuing phase of care, or the survivorship phase.

To better define models of survivorship care, there must be a strong evidence base in survivor health care use patterns. The objective of this review, which covers studies from 2012 to January 2018, was to evaluate the available evidence on patterns of health care visits among survivors of adult cancers and to understand what is known about the rate of health care visits, the physician specialties associated with these visits, and/or the types health care settings (eg, outpatient, emergency room).

The findings underscore the importance of primary care, with the majority of studies reporting that more than 90% of survivors visited a primary care provider in the prior year. Visits to oncologists and/or other physician specialties were positively associated with receiving cancer screenings and obtaining quality care for noncancer‐related conditions. High care density/low care fragmentation between physician specialties had lower costs and a lower likelihood of redundant health care utilization.

The follow‐up in almost all studies was 3 years, providing short‐term evidence; however, as the survivorship period lengthens with improved treatments, longer follow‐up will be required. The long‐term patterns with which survivors of cancer engage the health care system are critical to designing long‐term follow‐up care plans that are effective in addressing the complex morbidity that survivors experience.

Boosting confidence after breast cancer

A case study showing how cancer survivors in Salisbury feel more confident and less fatigued after enhanced support to live better after cancer | via NHS England

A new breast cancer stratified follow-up pathway, to increase the support given to breast cancer survivors, was rolled out at Salisbury Hospital in 2016.

The pathway includes a Holistic Needs Assessment (HNA) followed by a two-hour Moving Forward group. Hosted by a Consultant and a nurse, it addresses immediate health and wellbeing concerns. Offered to everyone on the patient initiated follow up, the average rating on session usefulness is 4.45 out of five. The average self-reported confidence score is 4.65. However the support does not stop there, patients identified as requiring more support are referred to the Cancer wellbeing group.

This group meets once a week for seven weeks. Hosted by a Clinical Psychologist and Gym Instructor qualified in rehabilitation, each two hour session starts with wellbeing advice, such as finance and benefits, diet or mindfulness and ends with a suitable rehabilitation exercise session. Group members unable to participate in group exercise receive a personal rehabilitation exercise programme. Members can also access weekly swimming sessions in the hospital pool. The average satisfaction rating for the group is 4.5 out of five, while on average, members report fatigue on daily life scores reduced by one third.

Full detail at NHS England

The C-Word: How we react to cancer today

Being diagnosed with cancer is now one of the most common life-changing events in people’s lives | Macmillan 

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Image source: Macmillan

There are more new cases of cancer each year than marriages in the UK, according to a new report from Macmillan Cancer Support.

The report, The C-Word: How we react to cancer today, reveals being diagnosed with cancer is one of the most common life-changing events in people’s lives. New analysis reveals:

  • Cancer is more common than new marriages: Latest figures show there are over 70,000 more new cases of cancer each year in UK than new marriages
  • Cancer is more common than women having their first child: Latest figures show there are almost 50,000 more new cases of cancer each in year in England and Wales than women giving birthto their first child
  • Cancer is as common as graduating: Latest figures show there are a similar number of undergraduate degrees awarded each year in the UK, compared with new cases of cancer.
  • Cancer affects many people at the “prime” of their life: More than 1.2 million people have been diagnosed with cancer under the age of 65 in the past 10 years, including more than 340,000 diagnosed in their 20s, 30s and 40s.

Full report here

Web-based stress management for newly diagnosed cancer patients (STREAM-1)

Grossert, A. et al. BMC Cancer. Published online: 3 November 2016

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Background: Being diagnosed with cancer causes major psychological distress, yet the majority of newly diagnosed cancer patients lack psychological support. Internet interventions overcome many barriers for seeking face-to-face support and allow for independence in time and place. We assess efficacy and feasibility of the first web-based stress management intervention (STREAM: STREss-Aktiv-Mindern) for newly diagnosed, German-speaking cancer patients.

Methods/design: In a prospective, wait-list controlled trial 120 newly diagnosed cancer patients will be included within 12 weeks of starting anti-cancer treatment and randomized between an immediate (intervention group) or delayed (control group) 8-week, web-based intervention. The intervention consists of eight modules with weekly written feedback by a psychologist (“minimal-contact”) based on well-established stress management manuals including downloadable audio-files and exercises. The aim of this study is to evaluate efficacy in terms of improvement in quality of life (FACT-F), as well as decrease in anxiety and depression (HADS), as compared to patients in the wait-list control group. A sample size of 120 patients allows demonstrating a clinically relevant difference of nine points in the FACT score after the intervention (T2) with a two-sided alpha of 0.05 and 80 % power. As this is the first online stress management intervention for German-speaking cancer patients, more descriptive outcomes are equally important to further refine the group of patients with the largest potential for benefit who then will be targeted more specifically in future trials. These descriptive endpoints include: patients’ characteristics (type of cancer, type of treatment, socio-demographic factors), dropout rate and dropout reasons, adherence and satisfaction with the program.

Discussion: New technologies open new opportunities: minimal-contact psychological interventions are becoming standard of care in several psychological disorders, where their efficacy is often comparable to face-to-face interventions. With our study we open this field to the population of newly diagnosed cancer patients. We will not only assess clinical efficacy but also further refine the target population who has the most potential to benefit. An internet-based minimal-contact stress management program might be an attractive, time- and cost-effective way to effectively deliver psychological support to newly diagnosed cancer patients and an opportunity to include those who currently are not reached by conventional support.

Read the full article here

Delivering world class cancer services

NHS pushes forward with ambition to create world class cancer services

The NHS in England has set out its plans to deliver world class cancer services, which includes a fund to find new ways of speeding up diagnosis with the potential to save thousands more lives every year.

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image source: http://www.england.nhs.uk

The National Cancer Transformation Board has published a wide ranging plan designed to increase prevention, speed up diagnosis, improve the experience of patients and help people living with and beyond cancer.

This follows the release last year of the report of the NHS’s Independent Cancer Taskforce  which identified how the NHS can achieve world-class cancer outcomes and save 30,000 lives a year by 2020.

Read more from NHS England here

Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

Lo, C. et al. BMJ Supportive & Palliative Care. Published Online First: 19 January 2016

Background: Managing Cancer And Living Meaningfully (CALM) is a brief individual psychotherapy for patients with advanced cancer. In an intervention-only phase 2a trial, CALM showed promising results, leading to the present 2b pilot, which introduces procedures for randomisation and improved rigour in preparation for a phase 3 randomised controlled trial (RCT).

Aims: To test trial methodology and assess feasibility of a confirmatory RCT.

Design: A parallel-arm RCT (intervention vs usual care) with 3 and 6-month follow-ups. Assessment of feasibility included rates of consent, randomisation, attrition, intervention non-compliance and usual care contamination. Primary outcome: depressive symptoms (Patient Health Questionnaire-9; PHQ-9). Secondary outcomes: major depressive disorder (MDD), generalised anxiety, death anxiety, spiritual well-being, attachment anxiety and avoidance, self-esteem, experiential avoidance, quality of life and post-traumatic growth. Bayesian conjugate analysis was used in this low-powered setting.

Setting/participants: 60 adult patients with advanced cancer from the Princess Margaret Cancer Centre.

Results: Rate of consent was 32%, randomisation 78%, attrition 25%, non-compliance 37% and contamination 17%. There was support for potential treatment effects on: PHQ-9, OR=1.48, 95% Credible Interval (CRI.95) (0.65, 3.38); MDD, OR=1.56, CRI.95 (0.50, 4.84); attachment anxiety, OR=1.72, CRI.95 (0.73, 4.03); and attachment avoidance, OR=1.58, CRI.95 (0.67, 3.71). There was no support for effects on the seven remaining secondary outcomes.

Conclusions: A phase 3 CALM RCT is feasible and should aim to detect effect sizes of d=0.40, with greater attention to issues of compliance and contamination.

Read the full article here