bluuebunny/crossref_metadata_2025_split huggingface dataset:
Engaging breast cancer survivors in their survivorship care.
Authors: Chaput Genevieve , DiLalla Vanessa , Barrette Maria , Williams Tristan , Courteau Catherine , Fortier-McGill Blythe 
Published: May 2018

22 Background: In North America, increasing evidence supports including patients’ in managing their own health as a strategy to improve health-related outcomes. Moreover, publications have emphasized the merit of supportive interventions during the survivorship phase, given their association with improvements in overall quality of life. Breast cancer survivors (BCS) are integral stakeholders of their own health, and ensuring their educational needs are met may positively influence them to become actively involved in their survivorship care. This study’s aimed to evaluate BCS activation levels in their care following an end of treatment educational group intervention (EOT) on what to expect after treatment, including self-management tips. Increased activation levels are consistently associated with improved self-management behaviors and utilization of services. Methods: The Patient Activation Measure (PAM), which evaluates one’s knowledge, skills, beliefs, and confidence for managing health and health care, was voluntarily self-administered to BCS shortly before and immediately following the EOT, and interviewer administered by telephone at 1 and 6 months post EOT, respectively. Data were analyzed with parametric (paired t-tests) and non-parametric (Wilcoxon Signed rank tests) comparisons as appropriate to assess EOT impact on BCS’ activation levels. Floor and ceiling effects were considered present if more than 40% of BCS achieved the highest score possible. Results: The pre and post survey response rate was 92.8%, the 1 month and 6 months delayed post survey response rate were 72.4% and 46.4%, respectively (n = 69). Post EOT, BCS significantly increased their activation levels: t(64) = 4.291, p ≤ 0.001, t(50) = 5.982, p ≤ 0.001 to t(32) = 4.664, p ≤ 0.001 for the post, 1 month and 6-month post surveys, respectively. The effect size of the BCS’ increased activation level in their own health increased incrementally with time from small (d = 0.40), medium (d = 0.65) to large (d = 0.84), for the post, 1 month and 6 month surveys, respectively. Conclusions: Our results indicate a large effect size in BCS activation levels at 6 month post EOT, suggesting a significant increase in BCS’s engagement to take part in their survivorship care and overall health.
The impact of a well breast cancer patient transition model of care on oncologists’ practice.
Authors: Nam Seungree , Gilbert Julie , Sussman Jonathan , Forbes Leta , Zwicker Victoria , Doering Paula , Beglaryan Hasmik 
Published: May 2018

39 Background: The transitioning of well breast cancer patients, post-treatment, to family physicians is accepted as a safe and effective model of care. Numerous studies have focused on patients’ experience and health outcomes, but research has not examined the experience of oncologists who are practicing in this model of care. The purpose of this research is to explore the impact of a transition model of care on oncologists’ practice. Methods: Purposive sampling was employed to recruit and interview oncologists who have been transitioning patients to family physicians for two or more years. A total of 15 medical and radiation oncologists practicing in Ontario, Canada were interviewed. Data were analyzed using thematic analysis. Results: Most oncologists interviewed were confident that the transitioning of patients to family physicians is safe for many patients post-treatment. Despite some concerns about the feasibility of the model, namely acceptance of the model among patients and family physicians, oncologists perceived that the model enhances efficiency and sustainability of the cancer system. As the volume of patients in follow-up decreased, oncologists saw a variety of impacts including: a reduction in overbooking in their clinics; more new patients able to be seen in consultation each week; more flexibility in their schedules to accept urgent appointments; and an increased ability to spend more time with patients who are dealing with complex issues. For some oncologists, well patient appointments are a rewarding part of their work. Meanwhile, many experience challenges with increased intensity of workload. Oncologists recognize that some patients and family physicians may be reluctant but they believe that early communication with patients about eventual transition, and improved communication with family physicians can enhance the acceptability of this model of care. Conclusions: Oncologists interviewed in this study reported that the time they used to spend with well follow-up patients can now be spent on other activities that contribute to the enhancement of quality of care for cancer survivors and efficiency in the broader cancer system.
A health system wide approach to the delivery of survivorship care plans.
Authors: Klemp Jennifer R. , Vanbebber Heather , Folker Tanya , Serig Lisa , Metcalf Tim , Roberts Audrey , Cooper Meredith , Fernandez Debbie 
Published: May 2018

42 Background: Survivorship care plans (SCPs) are recognized by organizations including the American Society of Clinical Oncology and the American College of Surgeons Commission on Cancer, as a best practice for improving survivor care. Little evidence supports this and hospitals and cancer centers are scrambling to meet deadlines for SCP development and delivery. The University of Kansas Cancer Center (KUCC) addressed this utilizing electronic health record (EHR) integration, developing a health system wide approach to education and delivery, and building referral workflows to primary care and specialists. We report on this approach to developing and growing a survivorship care program. Methods: KUCC is a NCI designated cancer center within an academic medical center and health system, with 11 outpatient locations across the Kansas City. Under the guidance of a multidisciplinary team: providers, health care informatics, administrators, nursing, tumor registry, quality improvement, and researchers, KUCC developed a step-wise process to deliver comprehensive survivorship care across the health system. This multi-year initiative aligned with institutional accreditation standards and an ongoing focus on expanding evidence based, comprehensive cancer and supportive care. Results: In 2014 a formal survivorship program plan was put into action: Support from leadership, providers, research priority; Staff and patient survivorship education & training; Integrated delivery of survivorship care at all locations with direct interaction and feedback from cancer care teams; Short & long-term programmatic goals; Management and referral of late effects of cancer; EPIC integrated SCP template: auto-populated, customized, personalized; treatment summary uses tools that pull in data stored discreetly in the patient "file"; SCP delivery targeting COC phase-in timeline: 2015: n= 539 (10% projection n= 434); 2016: n= 1,355 (25% projection n=1,253). Conclusions: This step-wise, integrated approach to survivorship care has resulted in a health system wide delivery of SCPs and meeting national accreditation standards. Next steps include the evaluation of cost and clinical/patient reported outcomes.
Impact of survivorship care plan (SCP) document on cancer survivors’ understanding of their cancer care and follow up.
Authors: Imran Farhan Shahzad , Gorea Heather , Heatherington Brittany , Hodes Susan , Pictor Nancy Mary , Reda-Cheplowtiz Cathy , Santelli Jeanine S , Vanzo Alyssa , Jamshed Saad 
Published: May 2018

53 Background: Follow up care for cancer survivors is often sidelined due to the lack of well-defined guidelines. A “Survivorship care plan (SCP)” document has been proposed to summarize key aspects of cancer care and the future follow up plan. Survey results of cancer survivors who had not received an SCP were compared with those who did receive an SCP. Methods: Surveys were mailed to patients who had completed cancer therapy with curative intent over two phases; phase I included patients who did not receive an SCP and phase II included patients who had received an SCP. The survey was designed to test understanding of diagnosis (stage), care team, symptoms of relapse, surveillance plan, and side effects of treatment. Microsoft Excel was used to calculate descriptive statistics on the quantitative data and frequency counts for the qualitative data. Results: During Phase I, 162 cancer survivors completed the survey and reported diagnosis of colon (2%), lung (6%) or breast (90%) cancer. During Phase II, 107 cancer survivors completed the survey and reported diagnosis of colon (2%), lung (8%), breast (44%) or other (44%) cancer. For both phases, only 2% patients could not correctly identify their cancer diagnosis. Only 12% Phase I and 18% Phase II patients were unable to identify the stage of their cancer at diagnosis. Phase I patients were better able to recall discussing their follow up plan with their provider (95%) and which tests should be performed as part of their cancer surveillance (86%) when compared to Phase II patients (90% and 78%, respectively). Phase II patients were better able to identify factors associated with their cancer where 57% accurately listed symptoms suggesting cancer recurrence and 52% correctly listed potential long-term side effects of cancer treatment. Only 20% and 17% Phase I patients correctly listed examples of each, respectively. Conclusions: Although it is intuitive that an SCP would improve patient understanding, we found a less than expected impact. Patients scored similarly or less favorable in most aspects with the distribution of the SCP, but were better able to identify signs and symptoms of disease recurrence and potential side effects of treatment.
Leveraging the electronic health record (EHR) to support survivorship care planning for bone marrow transplant (BMT) survivors.
Authors: Swiecichowski Mandy , Tevaarwerk Amye , Juckett Mark , Haine James Edward , Norslien Kirsten , Becher Jessica , Campbell Bethaney , Mendonca Eneida , Sesto Mary 
Published: May 2018

57 Background: BMT survivors are underrepresented in survivorship research, yet are at high risk for complications. Practice guidelines are vague, non-BMT clinicians are inadequately informed, and communication between BMT and non-BMT clinicians is inconsistent. Our objective is to develop EHR-integrated survivorship care planning that is user-centered, supports non-BMT clinician and survivor needs, but does not adversely impact clinical workflow. Methods: A multidisciplinary team of clinicians (primary care, oncology, BMT), engineers, and EHR analysts used a systems engineering approach to identify barriers and facilitators to BMT survivorship care planning. The team identified patient data categories to include in BMT survivorship care plan (SCP) templates, as well as examined tasks, technology, workflows and individual roles and responsibilities necessary to support care planning. Results: Facilitators include: potential for EHR to discretely capture individual diagnosis and treatment data to create accurate SCPs addressing survivor and primary care information needs. Barriers are: lack of EHR inter-operability which prevents sharing of patient data outside the BMT center’s EHR system, reliance on manual entry of critical data elements into the SCP (i.e. majority of the 88 patient data categories, identified by the team, are non-discrete in the EHR), inefficient or absent survivorship workflows, lack of resources (including time, dedicated clinical staff, space, SCP content), poorly defined roles and responsibilities for survivorship care provision, and lack of evidence-based BMT survivorship guidelines. Conclusions: Work system barriers impede use of the EHR to support survivorship care planning. Steps to overcome barriers: design discrete fields in the EHR to support patient-level data capture, re-engineer existing workflows to support survivorship care planning, obtain BMT program consensus on SCP content, and evaluate user-centeredness of SCPs. This research has the potential to improve feasibility and sustainability of survivorship care planning activities, resulting in improved communication and care coordination for BMT survivors.
Strategic planning for implementation of Commission on Cancer standard 3.3 in a tertiary academic center.
Authors: Klemanski Dori , Scharschmidt Thomas , Ramirez Maria-Teresa , Browning Kristine , Ghosh-Berkebile Rupa , Hatfield Rachée , Schimming Denise , Lustberg Maryam B. 
Published: May 2018

58 Background: The Commission on Cancer (CoC) enacted a new accreditation standard (3.3) in 2012 to ensure cancer survivors treated with curative intent receive a Treatment Summary and Survivorship Care Plan (SCP) upon treatment completion. Accredited institutions reported challenges to meeting the standard such as lengthy completion time, lack of reimbursement, and limited personnel. In 2014, the CoC clarified 3.3 to allow a 5 year phased launch for institutions to be compliant by 2019. Yet, academic cancer centers continued to report difficulty in meeting annual targets. Methods: Annual goals for provision of SCPs to eligible survivors at The James Cancer Hospital were met in 2015 (10%) and 2016 (25%). Existing processes were not sufficient to meet the goal of 50% in 2017. Multiple stakeholders developed a performance improvement plan (PIP) to revise institutional practices to create a sustainable SCP delivery model. The Cancer Registry provided analytic case volumes. Results: Institutional barriers to SCP delivery included inconsistent data collection, multiple versions of a SCP, lack of personnel, a 3+ month wait time for information from Cancer Registry, and lack of provider awareness. Major tenets of the PIP were to: (1) integrate the SCP into the electronic medical record, (2) improve collection and accuracy of data, (3) initiate a hybrid (integrative and consultative) model of SCP delivery in which dedicated Advanced Practice Providers (APPs) are employed through a centralized survivorship center, (4) include provision of SCP as a metric on APP professional practice evaluations, (5) educate disease groups with high volumes of SCP eligible patients, (6) provide a quality scorecard, and (7) review eligibility criteria and the timeliness of Cancer Registry. Implementation of the PIP increased performance as the number of SCPs provided in January to September 2017 (n = 884) surpassed volume from the previous 2 years (2015 n = 617; 2016 n = 786). Conclusions: Academic cancer centers with high volumes of SCP eligible survivors often contend with barriers to meeting CoC standard 3.3. Implementation of the PIP, which improved performance in 2017, will be continually evaluated to meet the standard by 2019.
Creation of an APN-led cancer survivorship clinic in a community cancer center.
Authors: Vetter Pamela Jane 
Published: May 2018

61 Background: The Institute of Medicine (IOM) report From Cancer Patient to Cancer Survivor: Lost in Transition, noted cancer patients often lacked the ability to successfully navigate the transition from patient to survivor (2006). To assist patients with understanding their disease and follow up, managing side effects and connecting with resources, the IOM recommends a survivorship care plan (SCP). The Commission on Cancer (CoC) is requiring accredited cancer programs provide SCPs to curative patients while giving them full discretion on structuring these programs. Methods: After researching survivorship components, a consultative model serving the adult cancer patients curatively treated at my facility was chosen. My goals included increasing patient satisfaction and connection to resources, fulfilling accreditation requirements, as well as financial benefits. I secured champions and procured budgetary approval. An assessment tool was created, a SCP program chosen, and a schedule created with IT. I gathered resources, reviewed side effect management, chose evaluation metrics and created educational materials and a tracking system. Results: 235 patients were seen in the first year of the clinic. Through nine months of 2017, 67.9% of eligible patients were provided with a SCP. Downstream revenue included patients changing to an Aspirus Primary Care Provider and referrals to various providers. Patients were connected to community and facility resources. Side effect assistance given; multiple medical issues addressed; additional Advanced Care Plans completed. Patients and Primary Care Providers are complimentary of the service. Conclusions: Successful start to survivorship clinic; will meet CoC accreditation. Many eligible patients who did not receive a SCP were seen at an unaffiliated Urology clinic. Moving forward, plan to work with their clinic to provide SCPs. Other challenges included time spent tracking patients, which should ease with a newly implemented electronic medical record.
Cluster analysis to demonstrate the need to individualize care for cancer survivors.
Authors: de Rooij Belle Hadewijch , Park Elyse R. , Perez Giselle Katiria , Rabin Julia , Quain Katharine M. , Dizon Don S. , Post Kathryn E. , Chinn Garrett , McDonough Allison , Jimenez Rachel , van de Poll-Franse Lonneke V , Peppercorn Jeffrey M. 
Published: May 2018

62 Background: In efforts to inform clinical screening and development of survivorship care services, we sought to characterize patterns of healthcare needs among cancer survivors by 1) identifying and characterizing subgroups of survivors based on self reported health care needs, and 2) assessing socio-demographic, clinical and psychosocial factors associated with these subgroups. Methods: We conducted a cross-sectional self administered survey among patients presenting for routine follow-up care for early stage cancer (breast, gynecologic, neuro, gastro-intestinal, genito-urinary, thoracic, head and neck, melanoma, sarcoma and hematologic) at our academic medical center. Latent class cluster analysis was used to identify clusters of survivors based on survivorship care needs within 7 domains (side-effects, lifestyle/self-care, emotional coping, social support, sexual health, complementary services and practical support). Multiple logistic regression analyses were used to assess factors associated with these clusters. Results: Among 292 respondents, the highest unmet needs were related to information regarding side effects (53%), lifestyle/self-care (51%) and emotional coping (43%) domains. Our analysis identified 4 clusters of survivors: 1) low needs (N = 123, 42%), 2) mainly physical needs (N = 46, 16%), 3) mainly psychological needs (N = 57, 20%) and 4) both physical and psychological needs (N = 66, 23%). Compared to cluster 1, those in clusters 2, 3, and 4 were younger (P < 0.03); those in clusters 3 and 4 had higher levels of fear of recurrence, anxiety, depression and insomnia (P < 0.05); and those in clusters 2 and 4 reported higher levels of fatigue (P < 0.05). Conclusions: Unmet needs among cancer survivors are prevalent and must be addressed, however a substantial group of survivors report low or no healthcare needs. The wide variation in healthcare needs among cancer survivors suggests a need for screening all patients, followed by tailored interventions in clinical care delivery and research to improve outcomes.
CANKADO PRO-React: E-health solution with dynamic symptom questionnaires and automated recommendations for cancer patients.
Authors: Schinkothe Timo , Praveen Susan , Lal Abhishek , Rahman Baiju 
Published: May 2018

7 Background: It is proven that the online documentation and transmission of symptoms can prolong the overall survival of cancer patients. Recent studies have shown that this advantage exists both in conventional chemotherapy and in oral therapy.Current implementations require a healthcare professional who monitors the data online. In most centers, such kind of human resources is not available except in clinical trials. It was therefore the goal of this project to develop an eHealth procedure, in which no permanent online observation is necessary. Methods: PRO-React, a symptom-based automated feedback or advice feature is integrated into the eHealth platform CANKADO. In the online settings, physician activates medication plans for his patients, documents drug-taking and sets reminders for the patient of future intake times. PRO-React assists the patients daily in global health documentation and dynamic symptom questionnaires. A built-in automated analysis brings forth suitable recommendations for patients like discuss with the physician, visit the physician immediately, visit directly or go to ER. The patient reported outcomes are shared in real-time with the physicians. Results: Trials are ongoing. Interim analysis is planed for January 2018. Results will be presented at the conference. Conclusions: PRO-React helps in the dynamic recognition of events with minimal daily documentation from the patients as well as assist in reacting to the needs of the patients. It also circumvents the need of a mediator group like nurses and thereby increase compliance and improve the doctor-patient-relationship leading to decreased mortality and higher patient satisfaction. PRO-React is available for routine care but also included into several multi-center trials.
Electronic patient-reported outcomes (ePRO) in survivorship practice.
Authors: Corcoran Stacie , Thom Bridgette , Decker Katie 
Published: May 2018

79 Background: Use of patient-reported outcomes (PRO) is a well-recognized method of assessing long-term and late effects in cancer survivors. Our institution incorporated PRO in survivorship clinics in 2007, but to improve care delivery and practice efficiency, paper PRO were adapted to an electronic platform (ePRO) in 2017. This presentation describes our transition to ePRO in the survivorship setting: patient, provider, and administrator experiences are highlighted, and evaluation metrics are presented. Methods: Steps to convert PRO from paper to electronic format included collaborating with informatics staff to construct the ePRO; including institution-wide standardized language for demographic questions and symptom assessment (Common Terminology Criteria for Adverse Events); and customizing the ePRO, with input from oncologists and survivorship nurse practitioners. Patients with an institutional portal account receive a notification with the ePRO link 1 week prior to their visit, and patients without an account complete the survey on their appointment day in the waiting room on a tablet. Patients unable or unwilling to complete the ePRO do so on paper. To evaluate the transition to ePRO, we gathered usage data and administered a satisfaction survey to patients and providers. Results: Since ePRO initiation, 295 patients have completed the PRO: 71% on tablet, 19% on paper, and 11% via patient portal (only 34% of patients had portal accounts). Initial survey results suggest both patients and providers are satisfied using ePRO: complete survey data, along with qualitative descriptions of experiences, will be presented. Conclusions: Clinicians reported a positive experience reviewing post-treatment sequelae electronically in advance of the visit, allowing them to better prepare for the encounter. Based on clinician feedback, report modifications are underway, and next steps include adding symptom trends to the report and working with informatics to increase portal enrollment among survivors. We anticipate that as ePRO use becomes more widespread across the institution, greater assessment capability and improved monitoring and management of late-effects will occur, positively impacting outcomes for cancer survivors.