scholarly journals Tailoring Therapies: Improving the Outcome of Breast Cancer in a Comprehensive Cancer Center in West Africa—The University of Nigeria Teaching Hospital Experience

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 163s-163s
Author(s):  
N. Lasebikan ◽  
N. Iloanusi ◽  
T. Onyeka ◽  
C. Ilo ◽  
K. Nwankwo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Cancer Care ◽  
Multidisciplinary Approach ◽  
Treatment Options ◽  
Management Strategies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Continuum ◽  
Cancer Care Continuum

Background and context: Early detection and improved treatments are associated with a reduction in breast cancer mortality and morbidity. UNTH is a leading comprehensive cancer center in Nigeria with referrals from the entire southeast and south south regions. Our goal is to offer high quality comprehensive cancer care services across the cancer care continuum from public health awareness campaigns and provision of screening services all the way to palliative care and survivorship. This is the first attempt by any institution in the country to standardize and harmonize available treatment options for breast cancer. Aim: To optimize, standardize and harmonize treatment options and management strategies for breast cancer using a multidisciplinary approach by developing guidelines adapted to our peculiar infrastructure and health system. Strategy/Tactics: The practice guideline was specifically developed for UNTH using a multidisciplinary approach and taking into consideration circumstances peculiar to UNTH, including the following: UNTH's specific patient population; UNTH's services and structure; and UNTH's clinical information. Program/Policy process: The process used recognized methods that are robust, objective, scientifically valid, consistent and adaptable to UNTH and engaged all identified multisectoral and multidisciplinary stakeholders involved in the care of patients with breast cancer. Outcomes: We reviewed substantial evidence on documented and proven strategies for community screening and prevention, less expensive and only marginally less effective diagnostic tools, locoregional and systemic therapies for the management of breast cancer. The team also recommended all patients receive psycho-oncology support through a dedicated team and through the breast cancer support group. It was agreed that palliative care be incorporated within the first 8 weeks of commencing treatment in line with the current ASCO guidelines and receive consultation from the exercise immunology unit. What was learned: Institutionalized care offers better management strategies and standardized treatment in line with best global practices of care for patients with breast cancer across the cancer care continuum which will ultimately translate to better treatment outcomes.

scholarly journals The Emergence of a Sustainable Tobacco Treatment Program across the Cancer Care Continuum: A Systems Approach for Implementation at the University of California Davis Comprehensive Cancer Center

2020 ◽  
Vol 17 (9) ◽  
pp. 3241 ◽  
Author(s):  
Elisa K. Tong ◽  
Terri Wolf ◽  
David T. Cooke ◽  
Nathan Fairman ◽  
Moon S. Chen
Keyword(s):  
Treatment Program ◽  
Cancer Care ◽  
University Of California ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Centers ◽  
Care Continuum ◽  
Tobacco Treatment ◽  
Cancer Care Continuum ◽  
The University

Tobacco treatment is increasingly recognized as important to cancer care, but few cancer centers have implemented sustainable tobacco treatment programs. The University of California Davis Comprehensive Cancer Center (UCD CCC) was funded to integrate tobacco treatment into cancer care. Lessons learned from the UCD CCC are illustrated across a systems framework with the Cancer Care Continuum and by applying constructs from the Consolidated Framework for Implementation Research. Findings demonstrate different motivational drivers for the cancer center and the broader health system. Implementation readiness across the domains of the Cancer Care Continuum with clinical entities was more mature in the Prevention domain, but Screening, Diagnosis, Treatment, and Survivorship domains demonstrated less implementation readiness despite leadership engagement. Over a two-year implementation process, the UCD CCC focused on enhancing information and knowledge sharing within the treatment domain with the support of the cancer committee infrastructure, while identifying available resources and adapting workflows for various cancer care service lines. The UCD CCC findings, while it may not be generalizable to all cancer centers, demonstrate the application of conceptual frameworks to accelerate implementation for a sustainable tobacco treatment program. Key common elements that may be shared across oncology settings include a state quitline for an adaptable intervention, cancer committees for outer/inner setting infrastructure, tobacco quality metrics for data reporting, and non-physician staff for integrated services.

scholarly journals Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis (Preprint)

2019 ◽  
Author(s):  
Kerstin Kalke ◽  
Tamar Ginossar ◽  
Joshua M Bentley ◽  
Hannah Carver ◽  
Sayyed Fawad Ali Shah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Best Practices ◽  
Behavior Change ◽  
Goal Setting ◽  
Cancer Care ◽  
Screening Process ◽  
Behavior Change Techniques ◽  
Systematic Analysis ◽  
Care Continuum ◽  
Cancer Care Continuum

BACKGROUND Theoretically designed mobile health (mHealth) breast cancer interventions are essential for achieving positive behavior change. In the case of breast cancer, they can improve the health outcomes of millions of women by increasing prevention and care efforts. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public. OBJECTIVE Given that theories may strengthen mHealth interventions, this study aimed to identify breast cancer apps designed to support behavior change, to assess the extent to which they address content along the cancer care continuum and contain behavior change techniques, and to assess the degree to which star rating is related to theory-based design. METHODS Using a criteria-based screening process, we searched 2 major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer care continuum and analyzed for behavior change techniques. The Mann-Whitney <i>U</i> test was used to examine the relationship between star ratings and the use of behavior change techniques in apps with star ratings compared to those without ratings. RESULTS The search resulted in a total of 302 apps, of which 133 were identified as containing breast cancer content. Only 9.9% (30/302) of apps supported behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, whereas only a few apps supported care management, treatment, and posttreatment behaviors. Regarding theories, 63% (19/30) of apps customized content to users, 70% (21/30) established a health-behavior link, and 80% (24/30) provided behavior change instructions. Of the 30 apps, 15 (50%) prompted intention formation whereas less than half of the apps included goal setting (9/30, 30%) and goal reviewing (7/30, 23%). Most apps did not provide information on peer behavior (7/30, 23%) or allow for social comparison (6/30, 20%). None of the apps mobilized social norms. Only half of the apps (15/30, 50%) were user rated. The results of the Mann-Whitney <i>U</i> test showed that apps with star ratings contained significantly more behavior change techniques (median 6.00) than apps without ratings. The analysis of behavior change techniques used in apps revealed their shortcomings in the use of goal setting and social influence features. CONCLUSIONS Our findings indicate that commercially available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior change along the cancer care continuum. These shortcomings are likely limiting the effectiveness of apps and their ability to improve public health. More attention needs to be paid to the involvement of professionals in app development and adherence to theories and best practices in app design to support individuals along the cancer care continuum.

scholarly journals Implementing a Multidisciplinary Approach for Older Adults with Cancer: Geriatric Oncology in Practice

2019 ◽  
Author(s):  
Carolyn Presley ◽  
Jessica Krok-Schoen ◽  
Sarah Wall ◽  
Anne Noonan ◽  
Desiree Jones ◽  
...  
Keyword(s):  
Older Adults ◽  
Cancer Care ◽  
Multidisciplinary Approach ◽  
Geriatric Oncology ◽  
Clinic Visit ◽  
Sensory Loss ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Multiple Chronic Conditions ◽  
Care Clinic

Abstract Background: Evidence-based practice in geriatric oncology is growing, and national initiatives have focused on expanding cancer care and research to improve health outcomes of older adults. However, there are still gaps between knowledge and practice for older adults with cancer. Methods: The Cancer and Aging Resiliency (CARE) clinic is a multidisciplinary approach for implementing geriatric-driven health care for older adults with cancer. The CARE clinic was developed as a direct response to recommendations targeting key multifactorial geriatric health conditions (e.g. falls, nutritional deficits, sensory loss, cognitive impairment, frailty, multiple chronic conditions, and functional status). We review the influence of these factors across the cancer care trajectory, including at screening, diagnosis, and treatment and discuss ways in which these conditions may be targeted to improve cancer care in older adults. Results: The CARE clinic was implemented at The Ohio State University Comprehensive Cancer Center (OSUCCC) and targets modifiable risk factors affecting outcomes in older adults with cancer: weight loss, polypharmacy, physical impairments, social support, and mood symptoms. The multidisciplinary team at the CARE clinic discusses and delivers a comprehensive set of recommendations, all in one clinic visit, to minimize burden on the patient and the caregiver. The CARE clinic is part of a set of initiatives that feature education of future leaders in geriatric oncology, survivorship care for an aging population, and outcomes research. Conclusions: Older adults with cancer have a unique set of needs that need to be taken into account throughout their cancer care. The CARE clinic model is an important example of an approach that may combat these difficulties and lead to better outcomes among older adults with cancer.

Referral patterns among patients with metastatic breast cancer in an integrated palliative care program.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 163-163 ◽  
Author(s):  
Rebecca Small ◽  
Jeffrey Belkora ◽  
Melanie Catherine Majure ◽  
Amy Jo Chien ◽  
Michelle E. Melisko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Metastatic Breast Cancer ◽  
Metastatic Disease ◽  
Psychosocial Support ◽  
Metastatic Breast ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Patient Acceptance ◽  
Referral Patterns

163 Background: ASCO recommends palliative care (PC) concurrently with oncologic treatment for patients with metastatic disease and there is emerging data about the benefits of early PC. However, little is known about referral patterns to specialty PC among patients who die of metastatic breast cancer. Methods: After years of offering a stand-alone outpatient PC consult service in our comprehensive cancer center, we established an integrated PC program in breast oncology (the “Advanced Breast Cancer (ABC) Program”) with a care coordinator, PC physician, and co-location with oncology. Among patients who died, we analyzed referral patterns, program participation, and end-of-life quality outcomes from October 2014 through May 2015. Results: 38 of 108 patients (35.2%) referred to and seen in ABC died, with an average of 2.9 PC visits (range 1-17) and 7 months (range 0-20) between referral and death. Reasons for referral among ABC patients who died included: symptom management (15 patients, 39.5%); goals of care discussions (12, 31.6%); psychosocial support (5, 13.2%); discharge referral from the inpatient PC team (4, 10.5%); and new diagnosis of metastatic disease (3, 7.9%). At the time of referral, average time since metastatic diagnosis was 23.6 months (range: 0-106); 10 patients (26.3%) had received > 3 lines of treatment. 15 referred patients (13.9%) died but were not seen by ABC: of those, 6 initiated hospice before they could be seen; 5 initially declined or deferred the referral but then were too sick to be seen in clinic by the time they agreed; and 4 were unwilling to accept extra appointments or did not follow-up to repeated outreach. 24 ABC patients who died (63.2%) were seen early (> 90 days before death), whereas in the year prior to the ABC clinic, among patients who died, only 11 of 44 (25%) who had received PC consultation received it early. 19 of 33 (57.6%) ABC patients for whom data was available utilized hospice, with only 2 (5.3%) using hospice < 3 days. Conclusions: Embedding and integrating a PC practice in breast oncology resulted in patients being seen earlier. Future efforts should be directed at further increases in earlier referrals by oncologists and in facilitating patient acceptance of early referrals.

scholarly journals Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis

10.2196/14082 ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. e14082 ◽  
Author(s):  
Kerstin Kalke ◽  
Tamar Ginossar ◽  
Joshua M Bentley ◽  
Hannah Carver ◽  
Sayyed Fawad Ali Shah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Best Practices ◽  
Behavior Change ◽  
Goal Setting ◽  
Cancer Care ◽  
Screening Process ◽  
Behavior Change Techniques ◽  
Systematic Analysis ◽  
Care Continuum ◽  
Cancer Care Continuum

Background Theoretically designed mobile health (mHealth) breast cancer interventions are essential for achieving positive behavior change. In the case of breast cancer, they can improve the health outcomes of millions of women by increasing prevention and care efforts. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public. Objective Given that theories may strengthen mHealth interventions, this study aimed to identify breast cancer apps designed to support behavior change, to assess the extent to which they address content along the cancer care continuum and contain behavior change techniques, and to assess the degree to which star rating is related to theory-based design. Methods Using a criteria-based screening process, we searched 2 major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer care continuum and analyzed for behavior change techniques. The Mann-Whitney U test was used to examine the relationship between star ratings and the use of behavior change techniques in apps with star ratings compared to those without ratings. Results The search resulted in a total of 302 apps, of which 133 were identified as containing breast cancer content. Only 9.9% (30/302) of apps supported behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, whereas only a few apps supported care management, treatment, and posttreatment behaviors. Regarding theories, 63% (19/30) of apps customized content to users, 70% (21/30) established a health-behavior link, and 80% (24/30) provided behavior change instructions. Of the 30 apps, 15 (50%) prompted intention formation whereas less than half of the apps included goal setting (9/30, 30%) and goal reviewing (7/30, 23%). Most apps did not provide information on peer behavior (7/30, 23%) or allow for social comparison (6/30, 20%). None of the apps mobilized social norms. Only half of the apps (15/30, 50%) were user rated. The results of the Mann-Whitney U test showed that apps with star ratings contained significantly more behavior change techniques (median 6.00) than apps without ratings. The analysis of behavior change techniques used in apps revealed their shortcomings in the use of goal setting and social influence features. Conclusions Our findings indicate that commercially available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior change along the cancer care continuum. These shortcomings are likely limiting the effectiveness of apps and their ability to improve public health. More attention needs to be paid to the involvement of professionals in app development and adherence to theories and best practices in app design to support individuals along the cancer care continuum.

scholarly journals Breast Cancer Care in Jordan

2020 ◽  
pp. 260-268 ◽  
Author(s):  
Hikmat Abdel-Razeq ◽  
Asem Mansour ◽  
Dima Jaddan
Keyword(s):  
Breast Cancer ◽  
Treatment Outcomes ◽  
Cancer Care ◽  
Multimodality Treatment ◽  
Current Status ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Breast Cancer Care ◽  
Quality Cancer Care ◽  
Treatment Facilities

Breast cancer is the most common malignancy in Jordan and the third leading cause of cancer death after lung and colorectal cancers. Although the incidence of breast cancer in Jordan is lower than that in industrialized nations, the number of new cases has been significantly increasing, and women present with breast cancer at a younger age and with more advanced disease than women in Western countries. Jordan is a medium-income country with limited resources and a young population structure. Therefore, breast cancer poses a particularly challenging burden on the country’s health care system. Despite ongoing endeavors to improve breast cancer care at both public and private levels, more work is needed to achieve downstaging of the disease and improve access, awareness, and participation in early detection. Multimodality treatment facilities and supportive care are available; however, the quality of care varies widely according to where the patient is treated, and most treatment facilities remain located centrally, thus, creating access difficulties. The King Hussein Cancer Center, the only comprehensive cancer center in Jordan, has changed the practice of oncology in the country via implementation of a multidisciplinary approach to treatment, monitoring of treatment outcomes, and investments in ongoing cancer research. However, there remains no national system for ensuring provision of high-quality cancer care nationwide. Here, we review the epidemiology of breast cancer and the current status of breast cancer care in Jordan, we compare our treatment outcomes with international ones, and we highlight challenges and improvement opportunities.

scholarly journals Gap between desired and self-determined roles of general practitioners: a multicentre questionnaire study in Japan

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Takashi Chinen ◽  
Yusuke Sasabuchi ◽  
Kazuhiko Kotani ◽  
Hironori Yamaguchi
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Cancer Care ◽  
Primary Care Physicians ◽  
Survivorship Care ◽  
Web Based ◽  
Care Continuum ◽  
Cancer Care Continuum ◽  
Cancer Specialists

Abstract Background Primary care physicians have diverse responsibilities. To collaborate with cancer specialists efficiently, they should prioritise roles desired by other collaborators rather than roles based on their own beliefs. No previous studies have reported the priority of roles such clinic-based general practitioners are expected to fulfil across the cancer care continuum. This study clarified the desired roles of clinic-based general practitioners to maximise person-centred cancer care. Methods A web-based multicentre questionnaire in Japan was distributed to physicians in 2019. Physician roles within the cancer care continuum were divided into 12 categories, including prevention, diagnosis, surgery, follow-up with cancer survivors, chemotherapy, and palliative care. Responses were evaluated by the proportion of three high-priority items to determine the expected roles of clinic-based general practitioners according to responding physicians in similarly designated roles. Results Seventy-eight departments (25% of those recruited) from 49 institutions returned questionnaires. Results revealed that some physicians had lower expectations for clinic-based general practitioners to diagnose cancer, and instead expected them to provide palliative care. However, some physicians expected clinic-based general practitioners to be involved in some treatment and survivorship care, though the clinic-based general practitioners did not report the same priority. Conclusion Clinic-based general practitioners prioritised involvement in prevention, diagnoses, and palliative care across the cancer continuum, although lower expectations were placed on them than they thought. Some additional expectations of their involvement in cancer treatment and survivorship care were unanticipated by them. These gaps represent issues that should be addressed.

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