Trends in the receipt of guideline care and survival for women with ovarian cancer: A population-based study.

BACKGROUND: We assessed trends in the receipt of guideline care and 2-year cause-specific survival for women diagnosed with ovarian cancer. METHODS: This retrospective cohort analysis used National Cancer Institute's Patterns of Care studies data for women diagnosed with ovarian cancer in 2002 and 2011 (weighted n=6427). Data included patient characteristics, treatment type, and provider characteristics. We used logistic regression to evaluate the association of year of diagnosis with receipt of guideline surgery, multiagent chemotherapy, or both. Two-year cause-specific survival, 2002-2013, was assessed using SEER data. RESULTS: The adjusted rate of women who received stage-appropriate surgery, 48%, was unchanged from 2002 to 2011. Gynecologic oncologist (GO) consultations increased from 43% (2002) to 78% (2011). GO consultation was a significant predictor for receipt of guideline care, although only 40% of women who saw a GO received guideline surgery and chemotherapy. The percent of women who received guideline surgery and chemotherapy increased significantly from 32% in 2002 to 37% in 2011. From 2002 to 2011, 2-year cause-specific ovarian cancer survival was unchanged for Stages I-III cancers, with slight improvement for Stage IV cancers. CONCLUSION: Receipt of guideline care has improved modestly from 2002-2011 for women with ovarian cancer. Current treatment is far below clinical recommendations and may explain limited improvement in 2-year cause-specific survival. Most women consulted a GO in 2011 yet did not receive guideline care. There needs to be a better understanding of the decision-making process about treatment during the consultation with GOs and other factors precluding receipt of guideline care.

Recommendations for Research and Practice to Improve Work Outcomes Among Cancer Survivors.

Major knowledge gaps limit the development and implementation of interventions to improve employment outcomes among people with cancer. To identify research priorities to improve employment outcomes after cancer, the National Cancer Institute sponsored the meeting "Evidence-Based Approaches for Optimizing Employment Outcomes among Cancer Survivors." This article describes research recommendations stemming from the meeting. At the patient level, longitudinal studies are needed to better understand how patient sociodemographic and clinical characteristics and their experiences at work shape employment outcomes. Interventions that mitigate the impact of cancer and its treatment on employment are critical. At the provider-level, future research is needed to characterize the extent to which physicians and other healthcare providers talk to their patients about employment concerns and how that information is used to inform care. Additionally, there is a need to test models of care delivery that support routine screening of employment concerns, the capture of employment outcomes in electronic health records, and the effective use of this information to improve care. At the employer level, evidence-based training programs are needed to prepare supervisors, managers, human resources staff, and occupational health professionals to address health issues in the workplace; and future interventions are needed to improve patient -employer communication and facilitate workplace accommodations. Importantly, research is needed that reflects the perspectives and priorities of patients and their families, providers and healthcare systems, and employers. Transdisciplinary partnerships and stakeholder engagement are essential to ensure that employment-focused interventions and policies are developed, implemented, and sustained in real-world healthcare delivery and workplace settings.

Making Cancer Rehabilitation Services Work for Cancer Patients: Recommendations for Research and Practice to Improve Employment Outcomes.

Cancer and its treatment can result in impairments that limit physical, psychosocial, and cognitive functioning, interfering with patients' ability to perform work-related functions. Because these work limitations can carry significant personal and societal costs, there is a timely need to identify and refer patients to cancer rehabilitation services to manage adverse consequences of treatment and to preserve employment. Coordinated efforts in 3 key areas will better connect patients to rehabilitation interventions that will help optimize employment. These include the following: planning for the impact of cancer on the ability to work; implementing routine screening for impairments and facilitating referrals to cancer rehabilitation specialists; and focusing rehabilitation interventions on preserving employment. Coordinated strategies are presented to achieve these 3 goals, including the following: implementing changes to clinical practice to routinely screen for impairments; working with oncology providers and patients to better understand the benefits of cancer rehabilitation to facilitate referrals and uptake; training more cancer rehabilitation providers to handle the increased need; better coordination of care across providers and with employers; and filling research gaps needed to proactively anticipate how cancer treatment would affect work for a given patient and deploy personalized interventions to preserve the ability to work.