Weight management and physical activity throughout the cancer care continuum.

Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.

IOM and DHHS meeting on making clinical practice guidelines appropriate for patients with multiple chronic conditions.

BACKGROUND: The increasing prevalence of Americans with multiple (2 or more) chronic conditions raises concerns about the appropriateness and applicability of clinical practice guidelines for patient management. Most guidelines clinicians currently rely on have been designed with a single chronic condition in mind, and many such guidelines are inattentive to issues related to comorbidities. PURPOSE: In response to the need for guideline developers to address comorbidities in guidelines, the Department of Health and Human Services convened a meeting in May 2012 in partnership with the Institute of Medicine to identify principles and action options. RESULTS: Eleven principles to improve guidelines' attentiveness to the population with multiple chronic conditions were identified during the meeting. They are grouped into 3 interrelated categories: (1) principles intended to improve the stakeholder technical process for developing guidelines; (2) principles intended to strengthen content of guidelines in terms of multiple chronic conditions; and (3) principles intended to increase focus on patient-centered care. CONCLUSION: This meeting built upon previously recommended actions by identifying additional principles and options for government, guideline developers, and others to use in strengthening the applicability of clinical practice guidelines to the growing population of people with multiple chronic conditions. The suggested principles are helping professional societies to improve guidelines' attentiveness to persons with multiple chronic conditions.

Role of public-private partnerships in tackling the tobacco and obesity epidemics.

In response to the illness and death caused by preventable chronic diseases, the US Department of Health and Human Services created Communities Putting Prevention to Work to support community efforts in tackling tobacco use and obesity through policy, systems, and environmental change. As part of this program, 10 national nonprofit organizations with prevention expertise were funded and matched with specific community objectives. Most tobacco and obesity-related matched objectives were successfully accomplished by communities. Public-private partnerships should be considered when addressing chronic disease prevention.

Defining and measuring chronic conditions: imperatives for research, policy, program, and practice.

Current trends in US population growth, age distribution, and disease dynamics foretell rises in the prevalence of chronic diseases and other chronic conditions. These trends include the rapidly growing population of older adults, the increasing life expectancy associated with advances in public health and clinical medicine, the persistently high prevalence of some risk factors, and the emerging high prevalence of multiple chronic conditions. Although preventing and mitigating the effect of chronic conditions requires sufficient measurement capacities, such measurement has been constrained by lack of consistency in definitions and diagnostic classification schemes and by heterogeneity in data systems and methods of data collection. We outline a conceptual model for improving understanding of and standardizing approaches to defining, identifying, and using information about chronic conditions in the United States. We illustrate this model's operation by applying a standard classification scheme for chronic conditions to 5 national-level data systems. Although the literature does not support a single uniform definition for chronic disease, recurrent themes include the non-self-limited nature, the association with persistent and recurring health problems, and a duration measured in months and years, not days and weeks--Thrall. So far, many different approaches have been used to measure the prevalence and consequences of chronic diseases and health conditions in children, resulting in a wide variability of prevalence estimates that cannot be readily compared--van der Lee et al.

Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life.

The escalating problem of multiple chronic conditions (MCC) among Americans is now a major public health and medical challenge, associated with suboptimal health outcomes and rising health-care expenses. Despite this problem's growth, the delivery of health services has continued to employ outmoded "siloed" approaches that focus on individual chronic diseases. We describe an action-oriented framework--developed by the U.S. Department of Health and Human Services with additional input provided by stakeholder organizations--that outlines national strategies for maximizing care coordination and for improving health and quality of life for individuals with MCC. We note how the framework's potential can be optimized through some of the provisions of the new Patient Protection and Affordable Care Act, and through public-private partnerships.

The HHS Strategic Framework on multiple chronic conditions: genesis and focus on research.

Among the 21st century's major emerging health issues, one of the most critical is the increasing prevalence of individuals with comorbidities, or multiple chronic conditions (MCCs), and the myriad challenges this poses for public health, healthcare, social services, and other sectors. Given the increasing prevalence of individuals with MCCs and the paramount role of MCCs as a healthcare cost driver, in 2008 the U.S. Department of Health and Human Services (HHS) launched an initiative to strengthen efforts by the HHS to address the effects of MCCs on health status, quality of life, and cost. In this paper, we first provide an overview of the HHS initiative with a particular focus on the approach used in developing the initiative's centerpiece, the HHS Strategic Framework on Multiple Chronic Conditions; we next describe progress in implementing one of the framework's four major goal areas (Goal 4) on facilitating research to fill knowledge gaps about, and interventions and systems to benefit, individuals with MCCs; and we conclude by suggesting additional potential priorities for research on MCCs. Although considerable research on MCCs has been reported over the past decade, the HHS Strategic Framework's goal on research provides a set of priority areas and a plan for systematically strengthening the evidence and information foundation necessary to address the challenges of MCCs in the USA. More broadly, the Strategic Framework provides a roadmap to help improve coordination between HHS operating divisions and enhance collaboration with external stakeholders to improve the quality of life for those with MCCs. Journal of Comorbidity 2013;3:22-29.