Evaluating the Implementation of Integrated Proactive Supportive Care Pathways in Oncology: Master Protocol for a Cohort Study.

BACKGROUND: Supportive care (SC) refers to the prevention and management of complications of cancer and its treatment. While it has long been recognized as an important cancer care delivery component, a high proportion of patients face unaddressed SC needs, calling for innovative approaches to deliver SC. OBJECTIVE: The objective of this master protocol is to evaluate the implementation of different integrated proactive SC pathways across the cancer care continuum in our institution (Gustave Roussy, Villejuif, France). Pathways studied in this master protocol may occur shortly after diagnosis to prevent treatment-related burden; during treatment to monitor the onset of toxicities and provide timely symptom management; and after treatment to improve rehabilitation, self-management skills, and social reintegration. METHODS: This study is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. The primary objective is to evaluate the impact of SC pathways on patients' distress and unmet needs after 12 weeks, measured by the National Comprehensive Cancer Network's Distress Thermometer and Problem List. Secondary objectives will focus on the pathways (macrolevel) and each SC intervention (microlevel), evaluating their reach (administrative data review of the absolute number and proportion of clinical and sociodemographic characteristics of patients included in the pathways); short-term and long-term efficacy through their impact on quality of life (EQ-5D-5L and the 30-item European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire) and symptom burden (MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and 22-item European Organization for Research and Treatment of Cancer Sexual Health Questionnaire); adoption by patients and providers (administrative data review of SC referrals and attendance or use of SC strategies); barriers to and leverage for implementation (surveys and focus groups with patients, providers, and the hospital organization); and maintenance (cost-consequence analysis). Pilot evaluations with a minimum of 70 patients per pathway will be performed to generate mean Distress Thermometer scores and SDs informing the calculation of formal sample size needed for efficacy evaluation (cohorts will be enriched accordingly). RESULTS: The study was approved by the ethics committee, and as of February 2024, a total of 12 patients were enrolled. CONCLUSIONS: This study will contribute toward innovative models of SC delivery and will inform the implementation of integrated SC pathways of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT06479057; https://clinicaltrials.gov/study/NCT06479057. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52841.

Conditions for adherence to videoconference-based programs promoting adapted physical activity in cancer patients: a realist evaluation.

BACKGROUND: Although moderate physical activity (PA) during cancer treatment has been associated with improved quality of life, reduced side effects, and even lower mortality, many barriers to successful implementation remain. Digital technology has been perceived as an effective lever for overcoming access and motivational issues but few studies have been performed to confirm this assumption. The "VISIO-AJUST" study explored the factors affecting the conditions of adherence to video-conference-based PA programs in patients undergoing cancer treatment. METHODS: The VISIO-AJUST study was based on a qualitative successive case approach, guided by the principles of the realist evaluation, and applied to two French programs of PA, following three main steps: (1) Identification of factors likely to influence conditions of patients' adherence; (2) Elaboration and testing of explanatory "Context-Mechanism-Outcome (CMO)" configurations; (3) Refinement of CMO configurations, in order to understand what, how, for whom, and under what circumstances video-conference-based PA programs work. RESULTS: Five main CMO configurations were found to be associated with adherence to video-conferencing-based PA programs, promoting (i) accessibility and a supportive environment for adapted physical activity, (ii) a setting conducive to sociability despite distance, (iii) Confidence and security of practice, (iv) a combination of several motivational levers in favor of continuity of effort and progress, (v) regularity of the sessions, progressiveness in the effort and evaluation of progress as a basis for the adoption of a regular physical practice. CONCLUSION: This study provides original insights into the use of videoconferencing to enable patients to improve their PA during cancer treatment. Future research with long-term follow-up would allow for a better understanding of the key conditions promoting sustainable behavior change.

Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer.

PURPOSE: Optimal comprehensive survivorship care is insufficiently delivered. To increase patient empowerment and maximize the uptake of multidisciplinary supportive care strategies to serve all survivorship needs, we implemented a proactive survivorship care pathway for patients with early breast cancer at the end of primary treatment phase. METHODS: Pathway components included (1) a personalized survivorship care plan (SCP), (2) face-to-face survivorship education seminars and personalized consultation for supportive care referrals (Transition Day), (3) a mobile app delivering personalized education and self-management advice, and (4) decision aids for physicians focused on supportive care needs. A mixed-methods process evaluation was performed according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework including administrative data review, pathway experience survey (patient, physician, and organization), and focus group. The primary objective was patient-perceived satisfaction with the pathway (predefined progression criteria for pathway continuation ≥70%). RESULTS: Over 6 months, 321 patients were eligible for the pathway and received a SCP and 98 (30%) attended the Transition Day. Among 126 patients surveyed, 77 (66.1%) responded. 70.1% received the SCP, 51.9% attended the Transition Day, and 59.7% accessed the mobile app. 96.1% of patients were very or completely satisfied with the overall pathway, whereas perceived usefulness was 64.8% for the SCP, 90% for the Transition Day, and 65.2% for the mobile app. Pathway implementation seemed to be positively experienced by physicians and the organization. CONCLUSION: Patients were satisfied with a proactive survivorship care pathway, and the majority reported that its components were useful in supporting their needs. This study can inform the implementation of survivorship care pathways in other centers.

[Feedback on a complementary care program combining physical activity, mindfulness-based meditation and socio-aesthetic care]. / Retour d'expérience sur un programme de soins complémentaires associant activité physique adaptée, méditation basée sur la pleine conscience et soins en socio-esthétique.

INTRODUCTION: Increasing physical activity among cancer patients is one of the priority recommendations in tertiary prevention; the level of physical activity is one of the determining factors in reducing the risk of relapse and mortality. However, many barriers to initiation and maintenance of regular physical activity have been identified. A program combining bi-weekly adapted physical activity sessions, mindfulness-based meditation and socio-aesthetic care was put together in 2015, in a Cancer Center, in order to facilitate adherence and sustainable attendance. METHODS: Data on patient participation of program components, patient satisfaction, and psycho-corporal changes, collected in ecological conditions between 2015 and 2017 from 144 participants, were retrospectively analyzed to provide a first assessment. RESULTS: Nearly 60% of the patients were in treatment, 17% were metastatic. The average participation time was 9 months, with an average of one physical activity session per week. Changes were observed, both quantitatively and qualitatively, in terms of emotional state, sleep and body image. The overall satisfaction rate was 96%. DISCUSSION: The conclusions of the study support the continuation of the program. The methodological limitations of this pilot format may be overtaken in future research, which will allow further in-depth investigations into the effects of combined approaches on sustainable physical activity.

[Physical activity and sports for oncology patients]. / L'activité physique et sportive dans la prise en charge des patients en oncologie.

Physical activity and sport are integrated into support care and their indication is officially recognised. The aim is to improve patients' physical capacities, restore social contact and help improve their psychological condition, by reinforcing in particular their self-esteem. However, patients are not sufficiently well-informed.