Maria Hewitt

Cancer Survivorship: A New Challenge in Delivering Quality Cancer Care

“After my very last radiation treatment for breast cancer, I lay ona cold steel table hairless, half-dressed and astonished by the tearsstreaming down my face. I thought I would feel happy about finallyreaching the end of treatment, but instead I was sobbing. At the time,Iwasn’tsurewhatemotionsIwasfeeling.Lookingback,IthinkIcriedbecause this body had so bravely made it through 18 months ofsurgery, chemotherapy, and radiation. Ironically, I also cried be-cause I would not be coming back to that familiar table where I hadbeen comforted and encouraged. Instead of joyous, I felt lonely,abandoned and terrified. This was the rocky beginning of cancersurvivorship for me.”—Elizabeth D. McKinley, MD, MPH

Perspectives on Post-Treatment Cancer Care: Qualitative Research With Survivors, Nurses, and Physicians

PURPOSE Cancer survivors have many medical and psychosocial needs that are unaddressed in the post-treatment period. Qualitative research was carried out to assess how a survivorship care plan created by oncologists could improve the quality of survivorship care. PARTICIPANTS AND METHODS Focus groups and interviews conducted with cancer survivors, nurses, primary care physicians, and oncologists provide insights into post-treatment follow-up practices and the acceptability and feasibility of providing survivors and referring physicians with a cancer survivorship care plan. RESULTS Cancer survivors reported satisfaction with post-treatment medical care, but felt that their psychosocial needs were not met. Survivors expressed enthusiastic support for receipt of a follow-up care plan. Primary care physicians viewed themselves as playing an important role during the post-treatment period and indicated that a written care plan for follow-up would help them improve their survivorship practices. Nurses recognized the need to improve the care of cancer survivors and suggested that they could play an active role in creating and implementing cancer survivorship plans. Physicians providing oncology care acknowledged the value of survivorship care plans, but were not inclined to complete them because such plans would not reduce other reporting and communication requirements and would be burdensome to complete given their busy schedules. CONCLUSION Survivorship care planning is viewed favorably by consumers, nurses, and physicians, however there are several barriers to its adoption. Barriers may be overcome with: electronic medical records, changes in reporting requirements of insurers, advocacy on the part of patients, and incorporation of care planning in education and training programs.

Fulfilling the Potential of Cancer Prevention and Early Detection

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Meeting Psychosocial Needs of Women with Breast Cancer

In Meeting Psychosocial Needs of Women with Breast Cancer, the National Cancer Policy Board of the Institute of Medicine examines the psychosocial consequences of the cancer experience. The book focuses specifically on breast cancer in women because this group has the largest survivor population (over 2 million) and this disease is the most extensively studied cancer from the standpoint of psychosocial effects. The book characterizes the psychosocial consequences of a diagnosis of breast cancer, describes psychosocial services and how they are delivered, and evaluates their effectiveness. It assesses the status of professional education and training and applied clinical and health services research and proposes policies to improve the quality of care and quality of life for women with breast cancer and their families. Because cancer of the breast is likely a good model for cancer at other sites, recommendations for this cancer should be applicable to the psychosocial care provided generally to individuals with cancer. For breast cancer, and indeed probably for any cancer, the report finds that psychosocial services can provide significant benefits in quality of life and success in coping with serious and life-threatening disease for patients and their families.

Cancer Quality Alliance: Blueprint for a Better Cancer Care System†

The Cancer Quality Alliance (CQA), a national alliance advocating for improvements in the quality of cancer care in America, presents a set of 5 case studies that depict a vision of quality cancer care and a “Blueprint” for actions to realize this vision. The CQA Blueprint case studies feature patients with soft tissue sarcoma, breast cancer, rectal cancer, and Hodgkin disease and focus on key phases in the cancer care trajectory: detection, diagnosis, treatment, post‐treatment/survivorship, and end of life. Each case study begins with a patient summary, follows with a worst‐ and a best‐case scenario, and concludes with a discussion section identifying “what went right” in the best case and “what went wrong” in the worst case. Steps to be taken by key stakeholders, for example, health care providers, insurers/payers, policy makers, and patients and families, are then outlined. By juxtaposing a worst‐ and best‐case scenario, the cancer care case studies elucidate the origins of complex health care problems and clarify the actions needed to overcome them. The CQA will make the case studies available for use as teaching tools to give health care providers and patients themselves descriptions of how the health care system should work to achieve the ultimate benefit for an individual living with, through, and beyond a diagnosis of cancer. The CQA adopted the definition of quality health care of the Institute of Medicine, and the analysis of care provided in the discussion section of each case study is framed using 6 quality improvement aims identified in the Institute of Medicines report, Crossing the Quality Chasm: A New Health System for the 21st Century. Health care quality may be judged according to its safety, effectiveness, patient‐centeredness, timeliness, efficiency, and equity.

Childhood Cancer Survivorship

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