RESUMO
PURPOSE: Describe the development and evolution of a primary-care-based, multidisciplinary clinic to support the ongoing care of adult survivors of childhood cancer. METHODS: A consultative clinic for adult survivors of childhood cancer has been developed that is located in an adult, academic internal medicine setting and is based on a long-term follow-up clinic model available at Children's Hospital Colorado. RESULTS: The clinic opened in July 2008. One hundred thirty-five patients have been seen as of April 2014. Referrals and clinic capacity have gradually increased over time, and a template has been developed in the electronic medical record to help facilitate completion of individualized care plan letters. CONCLUSIONS: A primary care-based, multidisciplinary consultative clinic for adults with a history of childhood cancer survivor is feasible and actively engages adult primary care resources to provide risk-based care for long-term pediatric cancer survivors. This model of care planning can help support adult survivors of pediatric cancer and their primary care providers in non-academic, community settings as well.
Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Planejamento em Saúde/organização & administração , Neoplasias/terapia , Atenção Primária à Saúde/organização & administração , Transição para Assistência do Adulto/organização & administração , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica/terapia , Colorado , Gerenciamento Clínico , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Neoplasias/diagnóstico , Inovação Organizacional , Avaliação de Resultados em Cuidados de Saúde , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Sobreviventes , Adulto JovemRESUMO
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment. This portion of the guidelines describes recommendations regarding screening for the effects of cancer and its treatment. The panel created a sample screening tool, specifically for use in combination with the NCCN Guidelines for Survivorship, to guide providers to topics that require more in-depth assessment. Effective screening and assessment can help providers deliver necessary and comprehensive survivorship care.
Assuntos
Neoplasias/diagnóstico , Neoplasias/mortalidade , Detecção Precoce de Câncer/métodos , Humanos , Neoplasias/terapia , Taxa de Sobrevida , SobreviventesRESUMO
Healthy lifestyle habits have been associated with improved health outcomes and quality of life and, for some cancers, a reduced risk of recurrence and death. The NCCN Guidelines for Survivorship therefore recommend that cancer survivors be encouraged to achieve and maintain a healthy lifestyle, with attention to weight management, physical activity, and dietary habits. This section of the NCCN Guidelines focuses on recommendations regarding physical activity in survivors, including assessment for the risk of exercise-induced adverse events, exercise prescriptions, guidance for resistance training, and considerations for specific populations (eg, survivors with lymphedema, ostomies, peripheral neuropathy). In addition, strategies to encourage health behavioral change in survivors are discussed.
Assuntos
Estilo de Vida , Sobreviventes , Comportamento , Exercício Físico , HumanosRESUMO
Healthy lifestyle habits have been associated with improved health outcomes and quality of life and, for some cancers, a reduced risk of recurrence and death. The NCCN Guidelines for Survivorship therefore recommend that cancer survivors be encouraged to achieve and maintain a healthy lifestyle, including attention to weight management, physical activity, and dietary habits. This section of the NCCN Guidelines focuses on recommendations regarding nutrition, weight management, and supplement use in survivors. Weight management recommendations are based on the survivor's body mass index and include discussions of nutritional, weight management, and physical activity principles, with referral to community resources, dietitians, and/or weight management programs as needed.
Assuntos
Recidiva Local de Neoplasia/prevenção & controle , Dieta , Humanos , Sobreviventes , Programas de Redução de PesoRESUMO
Sleep disorders, including insomnia and excessive sleepiness, affect a significant proportion of patients with cancer and survivors, often in combination with fatigue, anxiety, and depression. Improvements in sleep lead to improvements in fatigue, mood, and quality of life. This section of the NCCN Guidelines for Survivorship provides screening, diagnosis, and management recommendations for sleep disorders in survivors. Management includes combinations of sleep hygiene education, physical activity, psychosocial interventions, and pharmacologic treatments.
Assuntos
Neoplasias/complicações , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/terapia , Sobreviventes , HumanosRESUMO
Cancer survivors are at an elevated risk for infection because of immune suppression associated with prior cancer treatments, and they are at increased risk of complications from vaccine-preventable diseases. This section of the NCCN Guidelines for Survivorship provides recommendations for the prevention of infections in survivors through education, antimicrobial prophylaxis, and the judicious use of vaccines. These guidelines provide information about travel and gardening precautions and safe pet care/avoidance of zoonosis, and include detailed recommendations regarding vaccinations that should be considered and encouraged in cancer and transplant survivors.
Assuntos
Doenças Transmissíveis/terapia , Imunização , Neoplasias/complicações , Vacinação , Doenças Transmissíveis/induzido quimicamente , Doenças Transmissíveis/imunologia , Doenças Transmissíveis/patologia , Guias como Assunto , Humanos , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Neoplasias/patologia , Medição de Risco , Taxa de Sobrevida , SobreviventesRESUMO
Many posttreatment cancer survivors experience chronic pain, often leading to psychological distress; decreased activity, motivation, and personal interactions; and an overall poor quality of life. This section of the NCCN Guidelines for Survivorship provides screening and management recommendations for pain in survivors. A multidisciplinary approach is recommended, with a combination of pharmacologic treatments, psychosocial and behavioral interventions, physical therapy and exercise, and interventional procedures.
Assuntos
Dor Crônica , Neoplasias , Sobreviventes/psicologia , Dor Crônica/etiologia , Dor Crônica/psicologia , Dor Crônica/terapia , HumanosRESUMO
Many cancer survivors report that fatigue is a disruptive symptom even after treatment ends. Persistent cancer-related fatigue affects quality of life, because individuals become too tired to fully participate in the roles and activities that make life meaningful. Identification and management of fatigue remains an unmet need for many cancer survivors. This section of the NCCN Guidelines for Survivorship provides screening, evaluation, and management recommendations for fatigue in survivors. Management includes education and counseling, physical activity, psychosocial interventions, and pharmacologic treatments.
Assuntos
Fadiga/reabilitação , Atividade Motora , Taxa de Sobrevida , Fadiga/complicações , Fadiga/patologia , Humanos , Neoplasias/complicações , Neoplasias/reabilitação , Educação de Pacientes como AssuntoRESUMO
Cognitive impairment is a common complaint among cancer survivors and may be a consequence of the tumors themselves or direct effects of cancer-related treatment (eg, chemotherapy, endocrine therapy, radiation). For some survivors, symptoms persist over the long term and, when more severe, can impact quality of life and function. This section of the NCCN Guidelines for Survivorship provides assessment, evaluation, and management recommendations for cognitive dysfunction in survivors. Nonpharmacologic interventions (eg, instruction in coping strategies; management of distress, pain, sleep disturbances, and fatigue; occupational therapy) are recommended, with pharmacologic interventions as a last line of therapy in survivors for whom other interventions have been insufficient.
Assuntos
Adaptação Psicológica , Neoplasias Encefálicas/patologia , Transtornos Cognitivos/terapia , Manejo da Dor , Qualidade de Vida , Compostos Benzidrílicos/uso terapêutico , Neoplasias Encefálicas/mortalidade , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtornos Cognitivos/tratamento farmacológico , Fadiga/terapia , Humanos , Metilfenidato/uso terapêutico , Modafinila , Terapia Ocupacional , Transtornos do Sono-Vigília/terapia , Taxa de Sobrevida , Resultado do Tratamento , Promotores da Vigília/uso terapêuticoRESUMO
BACKGROUND: Sexual health is an important quality-of-life issue for many cancer survivors; however, this issue remains inadequately discussed by healthcare providers (HCPs) and patients. OBJECTIVES: The purpose of this study is to explore whether clinical oncology HCPs have adequate knowledge and are comfortable addressing sexual health issues, and to explore and describe patients' attitudes, beliefs, and informational needs regarding sexual health. METHODS: A survey was completed by HCPs and three patient focus groups were conducted to learn more about sexual health. Survey data were analyzed using descriptive statistics, and qualitative responses were analyzed using content analysis. FINDINGS: The majority of survey respondents reported on the importance of discussing sexual concerns with patients, lacked sexual health training, and were uncomfortable discussing sexual health with patients. Focus group participants wanted access to timely information during treatment, online educational resources, and brochures and handouts; involvement of significant others; support from providers, peers, and survivors; and expert consultation.