Jeff Kendall

Working without a net: Leukemia and lymphoma survivors' perspectives on care delivery at end-of-treatment and beyond

This study explored survivors’ perspectives on care delivery and supportive care needs during reentry. Fifty-one individual interviews were conducted with adult leukemia and lymphoma survivors, 3 to 48 months from treatment cessation. Survivors reported poor continuity of care across the patient–survivor transition, difficulty finding appropriate information/services, lack of preparation, lack of support for survivorship issues, and inadequate or poorly timed follow-up as factors contributing to adjustment difficulties at end of treatment and beyond. Improved care coordination is needed after active treatment, including use of an exit interview and delivery of services that are more congruent and better timed to meet ongoing and emergent survivorship needs.

Neuropsychological functioning in patients with borderline personality disorder

Although results have been variable, studies suggest that individuals with borderline personality disorder (BPD) exhibit cognitive deficits suggestive of frontal- and temporal-lobe dysfunction. Patients diagnosed with BPD (n = 18) using two structured interviews, and who were carefully screened for neurological and substance-use disorders, were compared to depressed patients (n = 18) and a nonpsychiatric control group (n = 18) on a series of neuropsychological tasks. The role of emotion on cognitive functioning was assessed by including emotional stimuli and interference on several of the tasks. Little support was found for the neurobehavioral hypothesis of BPD. The BPD group performance did not differ from the normal group on most tasks of executive functioning or memory, and the introduction of emotional stimuli did not impair performance. The depressed group performed less effectively than the other groups. Reasons for variable findings and factors affecting the cognitive functioning of patients with BPD are discussed. There may be considerable heterogeneity in the cognitive functioning of BPD patients, with those exhibiting significant cognitive deficits comprising only a subgroup.

What do 1281 distress screeners tell us about cancer patients in a community cancer center

Objective: The 2008 Institute of Medicines Report, Cancer Care for the Whole Patient (IOM, 2008), recommends screening cancer patients for distress. Cancer programs throughout the United States are struggling to achieve this standard. The IOM report indicates that only 14% of 1000 randomly selected American Society of Clinical Oncology (ASCO) members and eight of 15 National Comprehensive Cancer Network (NCCN) centers reported screening for distress in at least some of their patients [J Natl Compr Cancer Netw 2007;5:99–103]. Without adequate screening, distress often goes unnoticed by cancer professionals and there is little information about the prevalence of distress. The main objective of this article is to present data from 1281 distress screenings completed by patients treated within a community cancer center. Specifically, this article reports the intensity of distress, frequency of problem endorsement, and requests for specific psychosocial providers by cancer patients.

Affective differentiation in breast cancer patients

Fifty-three breast cancer patients completed an Internet-based diary measuring daily negative affect and positive affect and daily negative and positive events for seven consecutive evenings shortly after surgery. The authors used Hierarchical Linear Modeling (Raudenbush and Bryk in Hierarchical linear models: applications and data analysis methods. Sage, Thousand Oaks, CA, 2002) to examine moderators of affective differentiation, or the daily relationship between the patients’ negative affect and positive affect. Strong affective differentiation is characterized by the relative independence of negative and positive affect. There were no significant Level 1 (within-subject) moderators of affective differentiation. However, at Level 2 (between-subject), as predicted, increased age was associated with stronger affective differentiation, as was greater use of planning to cope with breast cancer. Also as predicted, increased anxiety and greater use of behavioral disengagement and denial coping were associated with weaker affective differentiation. The results suggest the value of the affective differentiation construct, and a daily diary methodology, for research on the daily lives of breast cancer patients.

Oncology Distress Screening: Distress Prevalence, New Standards, and Implementation

The diagnosis and treatment of cancer can generate significant levels of distress for cancer patients and their families. Although often considered a normal reaction, symptoms of distress should not be considered benign. Psychosocial distress can lead to disruptions in medical care and negatively influence all aspects of daily life. Recognizing the importance of addressing the emotional and social concerns of oncology patients, the National Comprehensive Cancer Network (NCCN) issued a consensus statement recommending distress screening and management as a standard of care within oncology health services delivery.1 The label “distress” is used because it: • Is less stigmatizing to patients and families than psychiatric diagnoses or psychological jargon • Facilitates an understanding that distress is a normal process which ranges from mild to debilitating • Facilitates an understanding that distress severity can change across the cancer continuum. Oncology Distress Screening

Building a Menu of Integrative Therapies within a Community Cancer Center

Oncology Issues July/August 2011 Providing complementary and alternative medicine (CAM) modalities raises a number of issues for community cancer centers, including funding, staff credentialing, space allocation, and utilization of cancer center staff for CAM practices. The Exempla Saint Joseph Hospital Cancer Center opened in July 2008 with an established menu of integrative therapy offerings for patients. Here’s how this community cancer center developed its integrative therapies program and overcame common barriers to the provision of CAM services.

Patient and Family Focused Transitional Care

I n 2010 and 2011, the ambulatory programs at Simmons Cancer Center, Dallas, Texas, experienced a double digit increase in new patient appointments. During the same period, the inpatient unit average daily census grew from 4 to 15+ patients. Because of this growth, Simmons Cancer Center evaluated its program and determined that it was not providing comprehensive seamless care across oncology treatment settings. These findings provided the cancer center with an opportunity to develop a transitional care program to better meet the needs of its patients and families. Coordinating care across healthcare settings involved multiple components of collaboration and communication with the goal of creating a seamless process for the patients and their families.

Building a Nutrition Program within a New Comprehensive Cancer Center

Oncology Issues November/December 2010 The Exempla Saint Joseph Hospital Comprehensive Cancer Center (ESJH CCC) was officially established on July 1, 2008, when two simultaneous events occurred. First, Saint Joseph Hospital signed a contract with a cancer center management group. Second, Saint Joseph Hospital purchased a private medical oncology practice consisting of four medical oncologists to complement its existing radiation oncology department of five radiation oncologists. We estimate that ESJH CCC will see 1,600 new cancer diagnoses and generate approximately 80,000 outpatient appointments annually. The four primary cancer diagnoses treated are breast, prostate, lung, and colorectal cancers. In September 2009 medical oncology, psychosocial oncology, the infusion center, surgical oncology offices, and the breast center moved to a 26,000-square-foot interim building adjacent to the ESJH campus while a new outpatient cancer center is built as part of a larger hospital building project. Radiation oncology remained within Saint Joseph Hospital, but is expected to be included within the new outpatient cancer center when completed. The executive team’s vision was an outpatient cancer center that would provide comprehensive care that addresses all of the needs of patients and their families throughout the cancer continuum. This comprehensive view not only included all of the relevant medical disciplines but also psychosocial oncology disciplines, including nutrition. To ensure that all of the skills of the registered dietitians (RDs) are accessed, the executive team chose to place nutrition services within the purview of the psychosocial oncology department. Many programs are structured so that RDs are forced to focus only on the clinical aspects of care and are unable to put their educational, program development, and research talents to use. For our new cancer center, we decided that nutritional services would be best supported and fully utilized within the psychosocial oncology department.