Julie Easley

Do current cancer follow-up care practices meet the needs of young adult cancer survivors in Canada? A qualitative inquiry

PURPOSE The purpose of the present study was to assess whether current cancer follow-up care practices meet the needs of young adult cancer survivors in Canada. METHODS This qualitative study used a constructivist grounded theory framework to analyze telephone interviews with cancer survivors from across Canada diagnosed between the ages of 18 and 39 years. The focus was specifically on cancer follow-up care (cfc). RESULTS Interviews were conducted with 55 participants, and 53 interviews were used for the analysis. The overall theme that emerged from the data was the lack of age-specific cfc. Some of the subthemes that emerged were the absence or inadequacy of fertility and infertility treatment options; of psychological services such as family, couples, and sexuality counseling; of social supports such as assistance with entry or re-entry into the education system or workplace; of access to supplemental health insurance; and of survivorship care plans. Based on the data resulting from the interviews, we developed a conceptual model of young-adult cfc incorporating the major themes and subthemes that emerged from our study. The proposed model aims to ensure a more age-appropriate and comprehensive approach to cfc for this group of cancer patients. CONCLUSIONS Current Canadian cfc practices are inadequate and do not provide comprehensive care for young adult cancer survivors in Canada. The conceptual model presented here aims to ensure a more comprehensive approach to cfc that meets the needs of this unique cancer population and reduces further possible physical, psychological, or social cancer sequelae.

Rehabilitation after breast cancer: recommendations from young survivors.

Purpose: Studies show that younger women have a greater physical, psychological, and social morbidity, and poorer quality of life after a breast cancer diagnosis than older women. With improving survival rates, cancer rehabilitation has an increasing role in the cancer care continuum, particularly for younger women who potentially have many productive years ahead of them. The purpose of this study was to assess the cancer rehabilitation needs of young women after breast cancer treatment. Methods: In this qualitative, descriptive study, we purposefully sampled 35 breast cancer survivors diagnosed under the age of 50 in Atlantic Canada to participate in two telephone interviews. Results/Discussion: Recommendations included: improved communication between the various healthcare professionals; healthcare professionals taking on a more proactive approach in recommending rehabilitation after treatment; better insurance coverage or financial assistance for rehabilitation services; and more rehabilitation support for rural populations. Conclusion: Rehabilitation nurses can play an important role in educating patients, recognizing long‐term sequelae, and directing patients to various medical and allied health care professionals to provide proper support and care post‐breast cancer treatment.

Multigene expression profile testing in breast cancer: is there a role for family physicians?

BACKGROUND Family physicians (fps) play a role in aspects of personalized medicine in cancer, including assessment of increased risk because of family history. Little is known about the potential role of fps in supporting cancer patients who undergo tumour gene expression profile (gep) testing. METHODS We conducted a mixed-methods study with qualitative and quantitative components. Qualitative data from focus groups and interviews with fps and cancer specialists about the role of fps in breast cancer gep testing were obtained during studies conducted within the pan-Canadian canimpact research program. We determined the number of visits by breast cancer patients to a fp between the first medical oncology visit and the start of chemotherapy, a period when patients might be considering results of gep testing. RESULTS The fps and cancer specialists felt that ordering gep tests and explaining the results was the role of the oncologist. A new fp role was identified relating to the fp-patient relationship: supporting patients in making adjuvant therapy decisions informed by gep tests by considering the patients comorbid conditions, social situation, and preferences. Lack of fp knowledge and resources, and challenges in fp-oncologist communication were seen as significant barriers to that role. Between 28% and 38% of patients visited a fp between the first oncology visit and the start of chemotherapy. CONCLUSIONS Our findings suggest an emerging role for fps in supporting patients who are making adjuvant treatment decisions after receiving the results of gep testing. For success in this new role, education and point-of-care tools, together with more effective communication strategies between fps and oncologists, are needed.