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Optimizing Integrated Cancer Care from Diagnosis to Survivorship

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A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Palliative and Supportive Care".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 30768

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Special Issue Editors

Dr. Carol Townsley

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Guest Editor

After Cancer Treatment Transition (ACTT) Program, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
Interests: cancer; health care; health economics

Dr. Afshan Zahedi

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Guest Editor

Thyroid Program, Women’s College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada
Interests: cancer; health care; health economics

Dr. Patricia Nguyen

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Guest Editor

Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
Interests: cancer; health care; health economics

Special Issue Information

Dear Colleagues,

There continues to be a focus on optimizing cancer care particularly to improve patient outcomes and experiences, reduce inefficiencies and extraneous use of resources, and implement sustainable models of delivery of care. There has been growing support for integrated cancer care and ongoing explorations into models of care which combine the services and expertise of different disciplines and health professionals. Previous research and literature have strongly suggested that cancer care must extend beyond diagnosis and treatment. It is evident there is also a need for patient education, psychosocial assessment and support, health promotion, community resources, post-treatment management, and survivorship care. Although cancer care can vary a great deal between cancer types, integrated cancer care has potential benefits across all cancer types. Thus, it is of interest to explore the different research studies conducted to evaluate and examine different components of integrated cancer care, its impact on different cancer types and at different cancer phases from diagnosis to survivorship, and models of implementation and sustainability. Gathering studies and descriptive publications in a Special Issue on integrated cancer care may better inform healthcare providers, hospitals, and other health organizations on how to effectively initiate and sustain integrated cancer care.

Potential topics include but are not limited to the following:

Model of care comparisons;
Patient needs during various cancer care stages;
Transitioning care from specialist to primary care;
Accessible psychosocial support such as comparing in-person vs. virtual approaches;
Health economics analysis of integrated of different cancer types.

Dr. Carol Townsley
Dr. Afshan Zahedi
Dr. Patricia Nguyen
Guest Editors

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Keywords

model of care comparisons
patient needs during various cancer care stages
transitioning care from specialist to primary care
accessible psychosocial support such as comparing in-person vs. virtual approaches
health economics analysis of integrated of different cancer types

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Published Papers (11 papers)

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16 pages, 518 KiB

Open AccessArticle

Perspectives on Ease of Use and Value of a Self-Monitoring Application to Support Physical Activity Maintenance among Individuals Living with and beyond Cancer

by Manuel Ester, Meghan H. McDonough, Mannat Bansal, Julianna Dreger, Julia T. Daun, Margaret L. McNeely, Thompson Luu and S. Nicole Culos-Reed

Curr. Oncol. 2024, 31(3), 1572-1587; https://doi.org/10.3390/curroncol31030120 - 19 Mar 2024

Viewed by 1600

Abstract

Background: Physical activity (PA) can improve the physical and psychosocial health of individuals with cancer, yet PA levels remain low. Technology may address PA maintenance barriers in oncology, though the intervention effectiveness to date remains mixed. Qualitative research can reveal the nuances of using technology-based PA maintenance tools. The present study aimed to understand the perspectives of individuals with cancer on using an app to support PA maintenance. Methods: Individuals were interviewed after using a self-monitoring app for 24 weeks, asking about their app use, ease of use, and perceived value for supporting PA. Analyses were guided by an interpretive description. Results: Eighteen individuals were interviewed. The participants were 37–75 years old; lived in seven Canadian provinces/territories; identified as White, South Asian, or Indigenous; and had eight different cancers. Four themes were developed: some did not need the app to stay physically active, some valued the app for helping them maintain their PA, the user experience ranged from intuitive to confusing, and the time burden of app use ranged from acceptable to overwhelming. Conclusions: The participants provided insights on using a self-monitoring app to improve PA maintenance in oncology. Work is needed to capture additional perspectives and apply findings to the development of technology-based PA maintenance tools. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

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12 pages, 645 KiB

Open AccessArticle

In-Clinic versus Hybrid Cancer Rehabilitation Service Delivery during the COVID-19 Pandemic: An Outcome Comparison Study

by Kelley C. Wood, Smith Giri, Tiffany D. Kendig and Mackenzi Pergolotti

Curr. Oncol. 2023, 30(10), 8916-8927; https://doi.org/10.3390/curroncol30100644 - 29 Sep 2023

Cited by 1 | Viewed by 1930

Abstract

Diminished health-related quality of life (HRQOL) is common among cancer survivors but often amendable to rehabilitation. However, few access real-world rehabilitation services. Hybrid delivery modes (using a combination of in-clinic and synchronous telehealth visits) became popular during the COVID-19 pandemic and offer a promising solution to improve access beyond the pandemic. However, it is unclear if hybrid delivery has the same impact on patient-reported outcomes and experiences as standard, in-clinic-only delivery. To fill this gap, we performed a retrospective, observational, comparative outcomes study of real-world electronic medical record (EMR) data collected by a national outpatient rehabilitation provider in 2020–2021. Of the cases meeting the inclusion criteria (N = 2611), 60 were seen to via hybrid delivery. The outcomes evaluated pre and post-rehabilitation included PROMIS^® global physical health (GPH), global mental health (GMH), physical function (PF), and the ability to participate in social roles and activities (SRA). The patient experience outcomes included the Net Promoter Survey (NPS^®) and the Select Medical Patient-Reported Experience Measure (SM-PREM). A linear and logistic regression was used to examine the between-group differences in the PROMIS and SM-PREM scores while controlling for covariates. The hybrid and in-clinic-only cases improved similarly in all PROMIS outcomes (all p < 0.05). The association between the delivery mode and the likelihood of achieving the minimal important change in the PROMIS outcomes was non-significant (all p > 0.05). No between-group differences were observed in the NPS or SM-PREM scores (all p > 0.05). Although more research is needed, this real-world evidence suggests that hybrid rehabilitation care may be equally beneficial for and acceptable to cancer survivors and supports calls to expand access to and reimbursement for telerehabilitation. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

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15 pages, 259 KiB

Open AccessArticle

Cancer Survivors Living in Rural Settings: A Qualitative Exploration of Concerns, Positive Experiences and Suggestions for Improvements in Survivorship Care

by Irene Nicoll, Gina Lockwood and Margaret I Fitch

Curr. Oncol. 2023, 30(8), 7351-7365; https://doi.org/10.3390/curroncol30080533 - 2 Aug 2023

Cited by 1 | Viewed by 1492

Abstract

In Canada, the number of cancer survivors continues to increase. It is important to understand what continues to present difficulties after the completion of treatment from their perspectives. Various factors may present barriers to accessing help for the challenges they experience following treatment. Living rurally may be one such factor. This study was undertaken to explore the major challenges, positive experiences and suggestions for improvement in survivorship care from rural-dwelling Canadian cancer survivors one to three years following treatment. A qualitative descriptive analysis was conducted on written responses to open-ended questions from a national cross-sectional survey. A total of 4646 individuals living in rural areas responded to the survey. Fifty percent (2327) were male, and 2296 (49.4%) were female; 69 respondents were 18 to 29 years (1.5%); 1638 (35.3%) were 30 to 64 years; and 2926 (63.0%) were 65 years or older. The most frequently identified major challenges (n = 5448) were reduced physical capacity and the effects of treatment. Positive experiences included family and friend support and positive self-care practices. The suggestions for improvements focused on the need for better communication and information about self-care, side effect management, and programs and services, with more programs available locally for practical and emotional support. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

14 pages, 290 KiB

Open AccessArticle

Assessing the Comprehensive Training Needs of Informal Caregivers of Cancer Patients: A Qualitative Study

by Janet Papadakos, Mohamed Ugas, Naa Kwarley Quartey, Christine (Tina) Papadakos and Meredith Elana Giuliani

Curr. Oncol. 2023, 30(4), 3845-3858; https://doi.org/10.3390/curroncol30040291 - 29 Mar 2023

Cited by 4 | Viewed by 2135

Abstract

Introduction: The increasing demand for cancer services is projected to overwhelm the cancer care system, leading to a potential shortfall in human resource capacity. Informal caregivers (unpaid family/friend caregivers of cancer patients) provide a significant amount of care to patients and the cancer care system could not cope without them. The aim of this study was to analyze the needs of informal caregivers (CGs) through interviews with cancer patients and CGs, and to assess the content and utility of a comprehensive caregiver training course. Methods: Cancer patients and CGs were recruited from an academic cancer centre to elicit their thoughts and perceptions of cancer CG education needs through a qualitative, phenomenological design using semi-structured interviews and a curriculum review activity. Results: Six patients and seven CGs were interviewed. Patients averaged 53.8 years of age and CGs averaged 53.1 years. Caregiver participants reported that they were unprepared for their caregiving role. Depending on the severity of the disease, CGs reported significant emotional strain. Most participants wanted more practical information, and all expressed the desire for greater social support for CGs. While there were differences in terms of desired modality (e.g., online, in-person), support for greater CG education was strong. Discussion: CGs experience a significant learning curve and receive little to no direct training or education to help them acquire the knowledge and skills they need to support a cancer patient. This is especially challenging for new CGs, for whom emotional and informational needs are particularly acute. Participants shared a great deal of endorsement for a comprehensive training course for new CGs. Given the multiple demands on their time, some participants suggested that consideration be made to establish synchronous classes. Participants held that having the course take place (online or in-person) at a specific time, on a specific date could help CGs prioritize their learning. Participants also endorsed the idea of “required” learning because even though CGs may recognize that a course could be beneficial, some may lack the motivation to participate unless it was “prescribed” to them by a healthcare provider. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

15 pages, 1116 KiB

Open AccessArticle

Future of Artificial Intelligence Applications in Cancer Care: A Global Cross-Sectional Survey of Researchers

by Bernardo Pereira Cabral, Luiza Amara Maciel Braga, Shabbir Syed-Abdul and Fabio Batista Mota

Curr. Oncol. 2023, 30(3), 3432-3446; https://doi.org/10.3390/curroncol30030260 - 16 Mar 2023

Cited by 14 | Viewed by 6886

Abstract

Cancer significantly contributes to global mortality, with 9.3 million annual deaths. To alleviate this burden, the utilization of artificial intelligence (AI) applications has been proposed in various domains of oncology. However, the potential applications of AI and the barriers to its widespread adoption remain unclear. This study aimed to address this gap by conducting a cross-sectional, global, web-based survey of over 1000 AI and cancer researchers. The results indicated that most respondents believed AI would positively impact cancer grading and classification, follow-up services, and diagnostic accuracy. Despite these benefits, several limitations were identified, including difficulties incorporating AI into clinical practice and the lack of standardization in cancer health data. These limitations pose significant challenges, particularly regarding testing, validation, certification, and auditing AI algorithms and systems. The results of this study provide valuable insights for informed decision-making for stakeholders involved in AI and cancer research and development, including individual researchers and research funding agencies. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

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12 pages, 532 KiB

Open AccessArticle

The Anatomy of a Hybrid In-Person and Virtual Sexual Health Clinic in Oncology

by Andrew Matthew, Steven Guirguis, Taylor Incze, Elisa Stragapede, Sarah Peltz, Gideon Yang, Leah Jamnicky and Dean Elterman

Curr. Oncol. 2023, 30(2), 2417-2428; https://doi.org/10.3390/curroncol30020184 - 17 Feb 2023

Viewed by 3349

Abstract

Sexual health is compromised by the diagnosis and treatment of virtually all cancer types. Despite the prevalence and negative impact of sexual dysfunction, sexual health clinics are the exception in cancer centers. Consequently, there is a need for effective, efficient, and inclusive sexual health programming in oncology. This paper describes the development of the innovative Sexual Health Clinic (SHC) utilizing a hybrid model of integrated in-person and virtual care. The SHC evolved from a fusion of the in-person and virtual prostate cancer clinics at Princess Margaret. This hybrid care model was adapted to include six additional cancer sites (cervical, ovarian, testicular, bladder, kidney, and head and neck). The SHC is theoretically founded in a biopsychosocial framework and emphasizes interdisciplinary intervention teams, participation by the partner, and a medical, psychological, and interpersonal approach. Virtual visits are tailored to patients based on biological sex, cancer type, and treatment type. Highly trained sexual health counselors facilitate the virtual clinic and provide an additional layer of personalization and a “human touch”. The in-person visits complement virtual care by providing comprehensive sexual health assessment and sexual medicine prescription. The SHC is an innovative care model which has the potential to close the gap in sexual healthcare. The SHC is designed as a transferable, stand-alone clinic which can be shared with cancer centers. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

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13 pages, 1563 KiB

Open AccessArticle

Social Wellbeing in Cancer Survivorship: A Cross-Sectional Analysis of Self-Reported Relationship Closeness and Ambivalence from a Community Sample

by Chiara Acquati, Ellen Miller-Sonet, Anao Zhang and Elena Ionescu

Curr. Oncol. 2023, 30(2), 1720-1732; https://doi.org/10.3390/curroncol30020133 - 31 Jan 2023

Cited by 4 | Viewed by 2352

Abstract

Improvements in early screening and treatment have contributed to the growth of the number of cancer survivors. Understanding and mitigating the adverse psychosocial, functional, and economic outcomes they experience is critical. Social wellbeing refers to the quality of the relationship with partners/spouses, children, or significant others. Close relationships contribute to quality of life and self-management; however, limited literature exists about social wellbeing during survivorship. This study examined positive and negative self-reported changes in a community sample of 505 cancer survivors. Fourteen items assessed changes in communication, closeness with partner/children, stability of the relationship, and caregiving burden. An exploratory factor analysis was conducted using a robust weighted least square procedure. Differences by sociodemographic and clinical characteristics were investigated. Respondents were mostly male, non-Hispanic white, and ≥4 years since diagnosis. Two factors, labeled Relationship Closeness and Ambivalence, emerged from the analysis. Women, younger survivors, individuals from minority groups, and those with lower income experienced greater negative changes in social wellbeing. Variations by treatment status, time since diagnosis, and institution were also reported. This contribution identifies groups of cancer survivors experiencing affected social wellbeing. Results emphasize the need to develop interventions sustaining the quality of interpersonal relationships to promote long-term outcomes. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

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9 pages, 474 KiB

Open AccessArticle

Evaluation of Current Antiemetic Therapy Response in Patients Undergoing MEC or HEC Regimens in Portugal

by António Araújo, Nuno Tavares, Ana Luísa Faria, Rosa Gomes, Joana Carvalho Mendonça, Bárbara Parente, Andreia Capela, Fernando Barata and Ana Macedo

Curr. Oncol. 2023, 30(2), 1529-1537; https://doi.org/10.3390/curroncol30020117 - 24 Jan 2023

Cited by 1 | Viewed by 2199

Abstract

Chemotherapy-induced nausea and vomiting (CINV) negatively impact cancer patients’ quality of life and treatment outcomes. This study evaluated the achievement of complete response to CINV prophylaxis during the first five days after chemotherapy in adult outpatient cancer clinics with solid malignant tumours receiving Moderate or Highly Emetogenic Chemotherapy (MEC or HEC) in Portugal. During the study, patients completed three evaluations, and nausea severity and CINV impact on patients’ daily life was assessed. A complete response (no emetic episodes, no use of rescue antiemetic medication, and no more than mild nausea) was observed in 72% of the cycles (N = 161) throughout the five days after chemotherapy. Amongst the patient population, 25% classified their CINV episodes as severe. Though more than half of the patients achieved a complete response, suggesting that a therapeutic effort is being made to minimise this side effect, the overall scenario is barely optimistic. Significantly, new CINV-control measures in MEC/HEC patients should be adopted, specifically avoiding the single use of dexamethasone and 5-HT3 and raising awareness of using NK1-RAs. Thus, it is critical to improve CINV prophylactic treatment and implement practical international antiemetic guidelines in Portuguese clinical practice, envisaging the improvement of supportive care for cancer patients. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

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11 pages, 8418 KiB

Open AccessArticle

Association between Consultation by a Comprehensive Integrated Palliative Care Program and Quality of End-of-Life Care in Patients with Advanced Cancer in Edmonton, Canada

by Cara Robertson, Sharon M. Watanabe, Aynharan Sinnarajah, Alexei Potapov, Viane Faily, Yoko Tarumi and Vickie E. Baracos

Curr. Oncol. 2023, 30(1), 897-907; https://doi.org/10.3390/curroncol30010068 - 9 Jan 2023

Cited by 1 | Viewed by 2252

Abstract

Literature assessing the impact of palliative care (PC) consultation on aggressive care at the end of life (EOL) within a comprehensive integrated PC program is limited. We retrospectively reviewed patients with advanced cancer who received oncological care at a Canadian tertiary center, died between April 2013 and March 2014, and had access to PC consultation in all healthcare settings. Administrative databases were linked, and medical records reviewed. Composite score for aggressive EOL care was calculated, assigning a point for each of the following: ≥2 emergency room visits, ≥2 hospitalizations, hospitalization >14 days, ICU admission, and chemotherapy administration in the last 30 days of life, and hospital death. Multivariable logistic regression was adjusted for age, sex, income, cancer type and PC consultation for ≥1 aggressive EOL care indicator. Of 1414 eligible patients, 1111 (78.6%) received PC consultation. In multivariable analysis, PC consultation was independently associated with lower odds of ≥1 aggressive EOL care indicator (OR 0.49, 95% CI 0.38–0.65, p < 0.001). PC consultation >3 versus ≤3 months before death had a greater effect on lower aggressive EOL care (mean composite score 0.59 versus 0.88, p < 0.001). We add evidence that PC consultation is associated with less aggressive care at the EOL for patients with advanced cancer. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

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24 pages, 1778 KiB

Open AccessSystematic Review

Mistletoe Extracts during the Oncological Perioperative Period: A Systematic Review and Meta-Analysis of Human Randomized Controlled Trials

by Elise Cogo, Mohamed Elsayed, Sukriti Bhardwaj, Kieran Cooley, Christilynn Aycho, Vivian Liang, Peter Papadogianis, Athanasios Psihogios and Dugald Seely

Curr. Oncol. 2023, 30(9), 8196-8219; https://doi.org/10.3390/curroncol30090595 - 6 Sep 2023

Cited by 1 | Viewed by 2804

Abstract

Background: We aim to evaluate the safety and efficacy of mistletoe extract (ME) use during the oncological perioperative period. Methods: Details registered a priori on PROSPERO (CRD42018086168). Results: Seven RCTs (comprising 663 participants in nine reports) and three nonrandomized studies were included. In five RCTs, ME was evaluated as adjunctive care and the control group had no additional intervention, whereas in two RCTs, ME was compared head-to-head against common cancer treatments (i.e., etoposide or bacillus Calmette-Guérin) with the intervention groups not receiving standard care. Meta-analyses found no evidence for a difference between ME and no added therapy for mortality and recurrence (RR, 95% CI: 1.00, 0.79–1.27; and 1.03, 0.79–1.33, respectively). Two RCTs reported beneficial effects of ME on immune cells, specifically natural killer cells, in colorectal cancer, and one RCT reported quality of life improvement. Two RCTs reported ME discontinuations due to adverse events and grade 3/4 toxicities. Nevertheless, no safety signals were detected from these 10 studies. Quality appraisal revealed a substantial risk of bias. Conclusions: Preliminary data are encouraging for mistletoe extracts, particularly in the context of colorectal cancer. However, the evidence is limited by the number of studies, an evaluation of different outcomes, and methodological limitations. Further high-quality research is warranted. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

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6 pages, 189 KiB

Open AccessCommentary

Experiences and Lessons Learned from Implementing the RELIEF Digital Symptom Self-Reporting App in a Palliative Home Care Setting

by Jehanara Chagani, Donny Li, Bonnie Keating and Martin Chasen

Curr. Oncol. 2022, 29(12), 9401-9406; https://doi.org/10.3390/curroncol29120738 - 1 Dec 2022

Cited by 1 | Viewed by 2330

Abstract

The majority of Canadians agree they have the right to end-of-life care in their own homes. While a palliative approach to care in the home setting has been demonstrated to be beneficial for patients and the healthcare system, it has rarely been well-integrated through an eHealth approach. Thus, in 2018, we piloted the RELIEF app, a digital symptom self-reporting tool for patients with palliative care needs. This was followed by the initiation of an extension phase of RELIEF in the home care setting. In this commentary, we share the implementation perspectives and experiences of the researchers and healthcare workers involved in this home care phase. It was mainly expressed that there were challenges with nurses feeling involved, supporting the research program, and using the technology, while patients and family caregivers had challenges using the app and cooperating with staff. We describe our lessons learned from these experiences and future changes to be enacted. A detailed report of this trial will be made available in future publications. Full article

(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)

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