Evolving Landscape of Metastatic Cancer Survivorship: Reconsidering Clinical Care, Policy, and Research Priorities for the Modern Era

Lai-Kwon, Julia; Heynemann, Sarah; Hart, Nicholas; Chan, Raymond Javan; Smith, Thomas J.; Nekhlyudov, Larissa; Jefford, Michael

doi:10.1200/jco.22.02212

Cited by 18 publications

(31 citation statements)

References 54 publications

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“…Whereas past reviews found survivorship topics covered included financial burden, disparity (e.g., race and ethnicity, rural, access to care), health care delivery, and communication, the present review found these survivorship topics were infrequently addressed in studies of patients with advanced gynecological cancer. Similar gaps in metastatic cancer survivorship research have been identified 59 . Additional issues that may impact survivorship and therefore require attention includes nutritional status and physical condition; indeed, in the identified papers there was a lack of objective outcomes reported relating to these factors.…”

Section: Discussionmentioning

confidence: 63%

Survivorship research in advanced gynecological cancer: A scoping review of cohort studies

DiSipio,

Pearse,

Jordan

2023

Cancer Medicine

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BackgroundRecent calls to action highlight the need to address gaps in our understanding of survivorship for those living with advanced gynecological cancer to support optimal care. To ensure future research fills these knowledge gaps, we need to understand the breadth of existing survivorship research in this patient group, including the outcomes assessed, the populations included and the duration and retention in follow‐up.MethodsWe conducted a systematic scoping review searching PubMed, PsychINFO, and CINAHL during the month of November 2022 to identify prospective cohort studies measuring survivorship outcomes among participants with advanced (stage III–IV) gynecological cancer, or in cohorts in which ≥50% of participants had advanced cancer, or which provide results separately for patients with advanced cancer. Articles were screened, and data extracted using a standard form.ResultsWe assessed 33 articles from 21 unique studies, which overall included 6023 participants with gynecological cancer. Of these, 45% had cervical cancer, 44% ovarian, 10% endometrial/uterine, and 1% vaginal/vulvar cancer. The most frequently measured survivorship outcome was quality of life. Of the 33 articles, most reported on participant age (n = 31), but relatively few reported on comorbidities (n = 10), physical status (n = 6), ethnic background (n = 4), the country of birth (n = 2), or the area of participant residence (n = 2). None included details on indigenous status. Recruitment proportions ranged from 48% to 100%. Retention proportions ranged from 15% to 97%.ConclusionOur findings highlight gaps in survivorship research for advanced gynecological cancers and emphasize the need for future studies to include and describe the experiences of diverse and underrepresented groups.

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Section: Discussionmentioning

confidence: 63%

Survivorship research in advanced gynecological cancer: A scoping review of cohort studies

DiSipio,

Pearse,

Jordan

2023

Cancer Medicine

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“…19,[24][25][26][27][28] The definition of healing and patients' healing needs can evolve over time as evidenced in this study, which has implications for cancer survivorship-as patients live longer with multiple treatments and toxicities, the symptom burdens and unmet needs accumulate. [29][30][31] There are also important implications for promoting interpersonal communication training for clinicians to become more effective healers in their therapeutic interactions with patients. [32][33][34][35][36] This study has limitations to consider.…”

Section: Discussionmentioning

confidence: 99%

Cancer Patient Perspectives on the Meaning of Healing and the Clinician as a Healer

Yang

Smith

Knowlton

2023

Am J Hosp Palliat Care

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Background The experience of living with cancer is marked by suffering and loss, which creates a need for healing. Understanding what healing means to patients and how clinicians can play a role in the healing process is essential to holistic cancer care. Objective The aim of this study was to explore the perspectives of cancer patients on the meaning and experiences of healing and the qualities of a clinician and the clinician-patient relationship that are healing. Methods A qualitative study was conducted using semi-structured interviews with 14 cancer patients. Participants were asked about their illness experience, definition of healing, qualities of a healer, and relationships with clinicians that were healing. Interview transcripts were coded, and qualitative analysis was conducted to identify major themes. Results Participants defined the nature of healing as comprising aspects of physical, mental, emotional, and spiritual well-being. Participants described healing as alleviating pain and symptoms; promoting mental strength, emotional comfort, and spiritual connection; restoring and adapting to losses; and improving quality of life. The qualities of a clinician that contributed to a healing relationship included listening, empathy and compassion, understanding patients’ values and goals, and caring for the patient as a whole person. Conclusion Participants viewed healing as physical, psychosocial, and spiritual in nature and an important part of their cancer experience with an emphasis on quality of life. Clinicians played an important role beyond treating the cancer by helping in the healing process through their humanistic qualities and holistic approach to patient care.

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“…There is an emerging population of people with advanced or metastatic cancer [ 1 , 2 ] (i.e., solid or hematological malignancies that are treatable yet predominantly incurable [ 3 , 4 ]) who are likely to have different care goals and face unique care challenges compared to those with early-stage or localized disease or those nearing the end-of-life [ 5 – 7 ]. The complex nature of advanced or metastatic cancers and their treatment sequelae is exemplified by varied disease trajectories that includes periods of disease stability, disease progression with the potential for further therapy, and possibility of sudden transition to end-of-life care [ 7 , 8 ]. Significantly higher physical, financial, spiritual, and psychosocial symptom burden results, with advanced or metastatic cancer survivors and caregivers thus engaging with the healthcare system at a higher frequency and intensity than those with early-stage disease [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…The complex nature of advanced or metastatic cancers and their treatment sequelae is exemplified by varied disease trajectories that includes periods of disease stability, disease progression with the potential for further therapy, and possibility of sudden transition to end-of-life care [ 7 , 8 ]. Significantly higher physical, financial, spiritual, and psychosocial symptom burden results, with advanced or metastatic cancer survivors and caregivers thus engaging with the healthcare system at a higher frequency and intensity than those with early-stage disease [ 8 , 9 ]. Despite continually improving outcomes, people with advanced or metastatic cancer may be intentionally or inadvertently denied quality survivorship care that has become emphasized for those living with and beyond curable cancers.…”

Section: Introductionmentioning

confidence: 99%

“…There have been recent calls to advance clinical care, research, policy, and practice in advanced or metastatic cancer survivorship, as well as the establishment of key priority areas to improve care and outcomes for cancer survivors and caregivers [ 5 – 8 ]. In 2011, the American Society of Clinical Oncology (ASCO) released a statement [ 17 ] advocating for an individualized approach to clinical discussions and the provision of care for people affected by advanced cancer, emphasizing the need for improved communication, disease-directed and supportive care options, and further research in advanced cancer care.…”

Section: Introductionmentioning

confidence: 99%

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Survivorship care for people affected by advanced or metastatic cancer: MASCC-ASCO standards and practice recommendations

Hart,

Nekhlyudov,

Smith

et al. 2024

Support Care Cancer

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Purpose People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared to those with early-stage disease or those nearing the end-of-life. These MASCC-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer. Methods An expert panel comprising MASCC and ASCO members was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting: (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process. Results A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including 8 people with lived experience) across 33 countries (33% were low-to-middle resource countries) participated in the Delphi study and achieved ≥ 94.8% agreement for seven standards (1. Person-Centred Care; 2. Coordinated and Integrated Care; 3. Evidence-Based and Comprehensive Care; 4. Evaluated and Communicated Care; 5. Accessible and Equitable Care; 6. Sustainable and Resourced Care; 7. Research and Data-Driven Care) and ≥ 84.2% agreement across 45 practice recommendations. Conclusion Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards will support optimization of health outcomes and care experiences by providing guidance to stakeholders in cancer care (healthcare professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers. Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts.

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Evolving Landscape of Metastatic Cancer Survivorship: Reconsidering Clinical Care, Policy, and Research Priorities for the Modern Era

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 18 publications

References 54 publications

Survivorship research in advanced gynecological cancer: A scoping review of cohort studies

Survivorship research in advanced gynecological cancer: A scoping review of cohort studies

Cancer Patient Perspectives on the Meaning of Healing and the Clinician as a Healer

Survivorship care for people affected by advanced or metastatic cancer: MASCC-ASCO standards and practice recommendations

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