Efficacy of a survivorship‐focused consultation versus a time‐controlled rehabilitation consultation in patients with lymphoma: A cluster randomized controlled trial

Abstract

Background: Survivors of cancer often describe a sense of abandonment post treatment, with heightened uncertainty, and limited knowledge of what lies ahead. This study examined the efficacy of a survivorship care planning intervention to help physicians address survivorship issues through communication skills training plus a new consultation focused on the use of a survivorship care plan for patients with Hodgkin’s lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL). Methods: This cluster randomized, four-site trial examined the efficacy of a Survivorship Planning Consultation (SPC; physicians received communication skills training and applied these skills in a survivorship-focused office visit using a survivorship care plan) with patients who achieved complete remission after completion of first-line therapy versus a control arm in which physicians were trained to and subsequently provided a time-controlled, manualized Wellness Rehabilitation Consultation (WRC) focused only on discussion of healthy nutrition and exercise as rehabilitation post-chemotherapy. The primary outcomes for patients were changes in knowledge about lymphoma and adherence to physicians’ recommendations for vaccinations and cancer screenings. Results: Forty-two physicians and 198 patients participated across the four sites. Patients whose physicians were in the SPC arm had greater knowledge about their lymphoma (p = 0.01) and had greater adherence to physician recommendations for influenza vaccinations (p = 0.02) and colonoscopy (p = 0.02) than patients whose physicians were in the WRC arm. Conclusions: A dedicated consultation using a survivorship care plan and supported by communication skills training may enhance patient knowledge and adherence to some health promotion recommendations.

Patient and caregiver perceptions of lymphoma care and research opportunities: A qualitative study

“…Future examination of psychosocial factors in survivor and caregiver populations is needed to create effective interventions, especially within vulnerable populations . This is reflective of the overarching trend toward patient‐centered care and survivorship research in oncology . The National Cancer Institute currently is funding research initiatives relevant to this work, including the Cancer Moonshot initiative, to address symptom management, prevention, and early detection.…”

“…6 This is reflective of the overarching trend toward patient-centered care and survivorship research in oncology. 39 The National Cancer Institute currently is funding research initiatives relevant to this work, including the Cancer Moonshot initiative, to address symptom management, prevention, and early detection. In addition, there are current calls for research into the implementation of survivorship care planning, telehealth screening for depression in patients with cancer, and various calls for health disparity studies.…”

Cancer worry and empathy moderate the effect of a survivorship‐focused intervention on quality of life

“…The study was approved by the sites' Institutional Review Boards. Additional details about study design are published elsewhere …”

“…The oncologists assigned to the SPC arm participated in a 5‐hour communication skills training program. The communication skills training program included didactic information about lymphoma survivorship including exemplary videos demonstrating recommended communication strategies as well as survivorship‐themed role‐plays with standardized patients (trained actors); and a discussion about the benefits and barriers to SPC implementation …”

“…The WRC focused only on a discussion of wellness and lifestyle factors. Patients in the SPC arm reported higher knowledge about their cancer and its treatment and had a greater uptake of physician recommendations regarding vaccinations in comparison to patients in the WRC arm . We hypothesized that the intervention was efficacious because, in addition to providing the care plan, it also provided an opportunity for physicians to practice using the care plan to discuss patients' survivorship concerns.…”