BackgroundThis study reports long‐term head and neck cancer (HNC) patient‐reported symptoms using the MD Anderson Symptom Inventory Head and Neck Cancer Module (MDASI‐HN) in a large cohort of HNC survivors.MethodsMDASI‐HN results were prospectively collected from an institutional survivorship database. Associations with clinicopathologic data were analyzed using χ2, Mann‐Whitney, and univariate regression.ResultsNine hundred and twenty‐eight patients were included. Forty‐six percent had oropharyngeal primary tumors. Eighty‐two percent had squamous cell carcinoma. Fifty‐six percent of patients had ablative surgery and 81% had radiation therapy as a component of treatment. The most severe symptoms were xerostomia and dysphagia. Symptom scores were worst for hypopharynx and varied by subsite. Patients treated with chemoradiation or surgery followed by radiation ± chemotherapy reported the worst symptoms while patient treated with surgery plus radiation ± chemotherapy reported the worst interference.ConclusionHNC survivors describe their long‐term symptom burden and inform efforts to improve care many years into survivorship.
Purpose: To assess providers’ concordance with surveillance and risk reduction recommendations for colorectal cancer (CRC) survivors after completion of their curative treatment. Patients and Methods: This was a longitudinal study of survivors who met the following eligibility criteria: diagnosed with a primary colon or rectal cancer before their first visit (V) to the CRC Survivorship Clinic, adult survivor ≥ 18 years old, no evidence of disease, alive at the time of data abstraction, and 1-3 clinic visits between 9/01/2011 and 8/31/2014. Data were collected at V1 scheduled between 9/1/2011 and 8/31/2012. V2 was scheduled 9-15 months after the first visit. V3 was also scheduled 9-15 months after V2. Data sources were survivorship care plans, electronic medical records, and CRC survivorship algorithms. For an annual visit, CRC algorithms recommended history/physical exams (H & PEs), carcinoembryonic antigen (CEA) testing when previously elevated, and colonoscopies for surveillance of cancer recurrence. Concordance rates (CR) were measured as the percent of yes/no responses to whether the providers followed minimum standards for the 3 procedures. Demographic and clinical characteristics were also collected. Descriptive statistics were used to summarize all data. Results: 81 of 117 CRC survivors who met all eligibility criteria were included in this sub-analysis. The number of survivors visits varied across time, V1 = 81, V2 = 56, and V3 = 36. Most survivors were male (51.9%) and Caucasian (66.7%). 67.9% reported being 5-8 years post-treatment. 58% were diagnosed with colon cancer and of those 61.7% were Stage IIIA-IV compared to 55.8% of rectal cancer survivors with advanced disease. Table 1 summarizes the percentage of CR rates across the 3 visits. Conclusion: CRs for H & PEs and colonoscopies remained high across the 3 visits. CRs were lowest for CEA recommendations. These low rates suggest further work is needed to determine barriers in clinical practice that limit use of CEA tumor marker monitoring in CRC survivors. Percent of Providers ConcordanceAlgorithm RecommendationVisit 1Visit 2Visit 3H & PE100100100CEA53.338.322.2Colonoscopy97.598.2100 Citation Format: Guadalupe Palos, Katherine R. Gilmore, Patricia Chapman, Paula Lewis-Patterson, Weiqi Bi, Maria Alma Rodriguez. Low concordance with CEA tumor marker monitoring in colorectal cancer survivors. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3464.
11560 Background: Disease specific Survivorship Care Clinics (SCs) have been established within a comprehensive cancer center. Clinics are staffed by Advanced Practice Providers (APPs), Physician Assistants and Advanced Practice Registered Nurses, with experience in the management of each disease type. To determine the sustainability of this model of survivorship care, we analyzed the professional fees’ revenue generated by APPs’ billings for 6 clinics and then compared the APPs’ salaries across all clinics. Methods: A retrospective analysis was conducted of 6 survivorship clinic’s patient volumes and clinic days supported by APPs from 9/1/16-4/30/17. The full FTE salary of the APPs, including benefits were prorated to the time dedicated to each of the SCs. Institutional financial data was used to align professional fees to actual reimbursements received. Salary recovery percentage was calculated as the ratio of reimbursement received to prorated FTE salary. Results: Table shows variation in APPs’ salary commensurate to FTE proportion. Results also indicate there was an average of 99% professional fee recovery. Clinics with an FTE proportion > 0.5 had recovery higher than the anticipated prorated salary, suggesting there is a threshold to maximize efficacy and sustainability. Conclusions: APPs professional fees for care provided to cancer survivors are reimbursable, across disease types or payers, and proportionally supports their salaries. Our findings suggest delivery models based on APPs to manage care of long-term survivors can be self-supporting.[Table: see text]
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