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.

Mindfulness-Based Interventions and Sleep Among Cancer Survivors

The purpose of this critical examination is to present results from a critical analysis of randomised controlled trials and provide a synthesis of this body of work | Current Oncology Reports

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Sleep problems among cancer survivors are gaining research attention. To our knowledge, there have been six randomized control trials published from 2013 to 2015 that test the effects of mindfulness-based interventions (MBIs) on sleep as a primary or secondary outcome.

Our examination of the literature highlights important methodological issues and variability among trials. We conclude our review by offering solutions to facilitate more scientific rigor in future studies.

Full reference: Christodoulou, G. & Black , D.S. (2017) Mindfulness-Based Interventions and Sleep Among Cancer Survivors: a Critical Analysis of Randomized Controlled Trials. Current Oncology Reports. Vol. 19 (Issue 09)
Article 60.

Many young cancer patients do not receive adequate fertility information and support

All cancer patients of reproductive age should be provided with fertility information and referrals for fertility preservation, researchers urge | ScienceDaily

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In the analysis of 23 relevant studies, investigators found that many clinicians are broadly informed about the risk to their patients’ fertility brought about by cancer treatment, but many factors hinder the appropriate discussions and referrals needed to provide adequate fertility support to patients of reproductive age. For example, some oncology clinicians may lack appropriate fertility knowledge and be unsure whose role it is to provide fertility support.

Young adult cancer survivors struggle to get back to normal

Cancer survivors often talk about wanting to get back to normal, but a new study indicates many young adults who survived the disease struggle with attaining this goal two years after their initial diagnosis |ScienceDaily

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Researchers collected data from 215 cancer patients aged 14 to 39 years who visited five medical facilities nationwide between March 2008 and April 2010. Patients completed a self-report measure of social functioning within the first four months of diagnosis, and again at 12 months and 24 months later. They also answered questions about their social interactions with family and friends, psychological needs and mental health.

Thirty-two percent of the survivors reported consistently low social functioning over time — and some had been off treatment. Zebrack and colleagues say this could stem from the transition from treatment to off-treatment survivorship, a time fraught with new challenges to a cancer survivor, including the negative impact on finances, body image, work plans, relationship with spouse/significant other and plans for having children.

In addition, those reporting low scores on social functioning also had high levels of distress, possibly reflecting an impaired ability to reintegrate into social activities due to the effects of cancer, the study showed.

Computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors

Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems | BMC Cancer

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Background: Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands

Discussion: Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored.

Full reference: Golsteijn, R.H.J. et al. (2017) Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive. BMC Cancer. 17:446

Return to work of cancer patients

To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy | BMJ Open

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Objectives: The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes.

Conclusions: RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme. A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW, reduced fatigue and increased importance of work, work ability, and quality of life.

Full reference: Leensen, M.C.J. et al. (2017) Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands. BMJ Open 7:e014746.

Cancer as a stressful life event: Perceptions of children with cancer and their peers

Howard Sharp, K.M. Cancer. Published online: 4 May 2017

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Background: The medical traumatic stress model is commonly applied to childhood cancer, assuming that the diagnosis of cancer is a traumatic event. However, to the authors’ knowledge, little is known regarding what specifically children perceive as stressful about cancer or how it compares with other stressful events more often experienced by children.

 

Conclusions: Children do not necessarily view their cancer experience as their most stressful life event. The findings of the current study suggest that the diagnosis of cancer might be better viewed as a manageable stressor rather than a major trauma, and are consistent with the change in the fifth edition of the DSM to eliminate the diagnosis of a life-threatening illness as a qualifying trauma for PTSD.

Read the full abstract here