MON 2011 - Slide 27 - S. Faithfull - Spotlight session - Survivorship


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MON 2011 - Slide 27 - S. Faithfull - Spotlight session - Survivorship

  1. 1. Survivorship Professor Sara Faithfull Faculty of Healthy and Medical Sciences
  2. 2. Challenges <ul><li>Evidence or opinion? </li></ul><ul><li>What data do we need for decision making? </li></ul><ul><li>Are we ready to implement what we know? </li></ul><ul><li>Can we improve the quality and translation of late effects research into practice? </li></ul>
  3. 3. Survivorship recognition of differing needs over time <ul><li>3 Seasons of survival </li></ul><ul><ul><li>Acute: Completion of initial treatment: </li></ul></ul><ul><ul><li>Extended: completion of initial treatment or remission, watchful waiting, follow up, intermittent therapy </li></ul></ul><ul><ul><li>Permanent: revolves from extended disease survival to low likelihood of recurrence </li></ul></ul> Mullan F (1985) N Engl J Med 313 270-273 Doyle N (2009) Co
  4. 4. Political agenda
  5. 5. National Cancer Survivorship Initiative <ul><li>A cultural shift in the approach to care and support for people affected by cancer- to a greater focus on recovery, health and well-being after treatment </li></ul><ul><li>Assessment and personalised care planning </li></ul><ul><li>Support for self management with the appropriate assessment, support and treatment </li></ul><ul><li>Different models of follow up: individualised </li></ul><ul><li>Measuring patient reported outcomes </li></ul>DoH (2011) Improving outcomes: a strategy for cancer (p50-54)
  6. 6. Patient power: survivorship
  7. 7. Scale of clinical issues <ul><li>The sizeable and growing population of cancer survivors presents significant questions related to future health care provision: </li></ul><ul><ul><li>Number of survivors increasing by 2% a year </li></ul></ul><ul><ul><li>On average cancer pts have a 65% chance of living beyond 5 years </li></ul></ul><ul><ul><li>13% of elderly will have been previously treated for cancer </li></ul></ul><ul><li>Evidence of ill health post cancer treatment </li></ul><ul><ul><li>Impact on longer term HRQOL in older population </li></ul></ul><ul><ul><li>Multiple symptoms, 30% unmet needs </li></ul></ul>Rowland et al (2006) Journal of Clinical Oncology 24(32) 5101-5104 Maddams J et al. (2009) Br J Cancer Armes J et al. (2009) JCO as 10.1200/JCO.2009.22.5151
  8. 8. Extent of the care issues <ul><li>Cancer survivors report health as poor compared to matched controls (31% v 17.9%) </li></ul><ul><li>Lost productivity & employment </li></ul><ul><li>Poorer mental well being (33.5% v 30.3% ) </li></ul><ul><li>Increased reports of co morbid disease </li></ul><ul><ul><li>Moving target of potential therapy risks </li></ul></ul><ul><li>Evolving long term follow up needs </li></ul>Yabroff et al (2004) J Natl Cancer Inst 96 1322-30, Short & Vargo (2006) J Clin Oncol 24: 5160-5165, Keating et al. (2005) J Am Geriatric Soc 53 (12) 2145-52 Corner J (2009) Expert Rev Pharmacoeconomics Outcomes 8(5) 443-451
  9. 9. Patient reported needs <ul><li>40% of survivors are unaware of the late-effects of cancer/its treatment. Amongst those aware of these effects, some do not know which might affect them personally. </li></ul><ul><li>35% of survivors are not aware of the increased importance of a healthy lifestyle. </li></ul><ul><li>33% do not have all of the information and 42% all of the support they need to make decisions about their lifestyle. </li></ul><ul><li>In the last 6-12-months, 78% of survivors had physical conditions and 2% psychological conditions that could have been side-effects/late-effects. </li></ul><ul><li>40% of those with a psychological condition did not seek help for their condition(s); 19% of those with a physical condition did not seek help. </li></ul>
  10. 10. Follow up after cancer GP or nurse at GP’s surgery
  11. 11. The proportion of respondents having a specialist check-up (62) (48) * * *
  12. 12. If faced with health concerns relating to cancer what do you do? The specialist nurse they have contact details for, not one they see for check-ups
  13. 13. Understanding adjustment <ul><li>Health beliefs influence perceptions </li></ul><ul><li>Biographical disruptions </li></ul><ul><li>Beliefs strongly influence quality of life scores </li></ul><ul><li>Dysfunctions are not always perceived as health problems </li></ul><ul><li>Bother not necessarily related to symptom severity </li></ul><ul><li>Social limitations </li></ul><ul><li>Response shift over time </li></ul>Korfage I et al. (2006) Patients’ perceptions of the side effects of prostate cancer treatment- a qualitative study Soc Sci & Med 63 911-919 Sharpe L & Curran L, (2006) Understanding the process of adjustment to illness, Soc Sci & Med 62 1153-1166 Hubbard G et al. (2010) Disrupted Lives and threats to identity: . Health 14(2) 131-146
  14. 14. Self management: what is it? <ul><li>Self care refers to individuals generated actions or behaviour is the individual staying fit and staying healthy to enhance well being </li></ul><ul><li>Self-management, encompasses an interactive process </li></ul><ul><ul><li>individual responses and behaviour aimed at managing physical and psychosocial consequences of symptoms and treatment, </li></ul></ul><ul><ul><li>are guided by a clinician, </li></ul></ul><ul><ul><li>often involving therapeutic approaches </li></ul></ul><ul><li>Adjustment focused interventions not as effective </li></ul><ul><li>Important to target interventions to men's needs </li></ul>Cockle Hearne J & Faithfull S (2010) Psycho oncology : DOI 10.102.pon
  15. 15. Physical training programme (54 RCTs) Van Weert E (2008) The development of an evidence-base physical self management rehabilitation programme for cancer survivors Patient Education and Counselling 71 169-190 Intervention components Outcome measures Evidence for improvement Aerobic exercise : cycling, walking heart rate of 50-80% maximal 10-30 min 3 x weekly Aerobic exercise capacity Effect size of 0.51 during and 0.65 after cancer txt Resistance training Muscle strength Some benefit not significant Aerobic exercise Fatigue Effect size of 0.11 Physical exercise, stretching Quality of life Effect size of 0.30
  16. 16. Smoking cessation <ul><li>Smoking is a risk factor in recurrence </li></ul><ul><li>Smoking during and after RT prolonged the period of oral mucositis for H&N cancer patients (p = 0.014) Rugg et al 1990 </li></ul><ul><li>Significant increase in severe mucosal reactions for H&N patients who smoked during RT (p = 0.03) Porock et al 2004 </li></ul><ul><li>Intervention studies are feasibility/ pilots </li></ul>
  17. 17. Summary of benefits for patients  Possible benefit  Probable benefit  Convincing benefit CBT Exercise Smoking Cessation Depression   Fatigue   Adverse Body Composition  Functional QOL  Physical QOL   Progression  
  18. 18. Cancer Survivors’ interest in health related programs Denmark-Wahnefried et al. (2000) Cancer 88: 674-684, Greenhalgh T (2009) BMJ , 338-349
  19. 19. Using effectively what we already know <ul><li>Assessment </li></ul><ul><li>Raising awareness </li></ul><ul><li>Collecting routine data of long term effects </li></ul><ul><li>Using evidence from multi-disciplinary fields </li></ul><ul><li>Targeting interventions </li></ul><ul><li>Recognizing not everyone has a problems </li></ul><ul><li>Defining therapeutic strategies and resulting outcomes </li></ul><ul><li>Working with primary care and existing providers </li></ul>Greenfield D et al. (2009) Follow up for cancer survivors: the views of clinicians BJC , 1010 568-574 Khan, N et al (2010) Quality of care for chronic diseases in a British cohort of long term cancer Annals of Family Med . 8 (5) 418-424
  20. 20. Parting words