All.Can Roundup # 3
A regular roundup of cancer policy, research and opinion from around the world #AllCanRoundup
Policy and initiatives roundup
Survey aims to improve survivorship care
A new survey seeks to reveal the challenges faced by both patients and doctors in the phase of care after cancer. The survey has been launched online by the European Society of Medical Oncology (ESMO) and the European Cancer Patient Coalition (ECPC). The results will be used to inform a better framework for survivorship care.
Take the survey: Patient Guide on Survivorship Survey
The need for criteria and guidance in rationing cancer care
Oncologists face limited resources and rising costs in cancer care, and may need to make decisions daily around prioritisation and rationing.
In a survey of German Society of Hematology and Oncology members, 72% of the 345 respondents felt that cost considerations and negotiations negatively affected their job satisfaction and raised concerns about the quality of care they could provide. However, almost half of respondents still thought decisions around resource rationing should be made by physicians. Most respondents agreed that limits for costly procedures should be set by a commission.
Radiotherapy records should be kept beyond patient’s lifetime
Recommendations have been made for best practice in maintenance and retention of radiotherapy records. Based on a literature review and expert interviews and consensus-building in six countries, the recommendations include:
- Health records should be retained beyond the patient’s lifetime +5 years.
- Technical information should be retained beyond the patient’s lifetime +5 years.
- Appropriate data retention practices are essential to patient safety and care.
Read the article: Best Practice Recommendations for the Retention of Radiotherapy Records
Specialist palliative care nurses in oncology clinics improve hospice referral rates
This study tested a palliative care model with 2,829 patients. Palliative care nurse practitioners were embedded in oncology clinics and a variety of interventions were implemented. These interventions included team meetings, psychological support and structured referral mechanisms.
Hospice referral was significantly higher in the intervention group. However, analysis showed that the specialist nurses’ task and time allocation could be improved, as many of their tasks could have been completed by other, less qualified staff.
Reducing social inequalities in cancer screening uptake
Despite free colorectal cancer screening in France, participation rates are low and are associated with socioeconomic status. This cluster randomised controlled trial aimed to assess the impact of a screening navigation programme on participation and reducing inequalities.
The trial enrolled more than 14,000 participants in each arm (control and intervention). Participants who did not attend screening after invitation were contacted by a screening navigator, who tried to remove potential barriers.
Participation rates increased, though significantly more among more affluent groups. The authors conclude that, to reduce social inequalities, deprived populations should be first to receive interventions.
An editorial in the Journal of Oncology Practice discusses problems around the integration of specialised palliative care in cancer care. It explores three factors challenging implementation:
- Due to the different areas within oncology, the specialisation itself is fragmented. The author describes this as tribalism: each oncology ‘tribe’ has its own behaviours, rituals and – most importantly – language. If palliative care staff lack an overall understanding of cancer medicine, they will not be understood or taken seriously by the respective specialist oncology team with whom they work.
- In the USA, where most oncology practices operate as private businesses, palliative care must be embedded into existing businesses. Otherwise, patients will have to familiarise themselves with another cost centre, structure and management.
- Palliative care staff need to work well with all staff at an oncology practice. The author suggests that all staff should be involved selecting palliative care staff.
Read the editorial: Palliative Care in Special Settings of Cancer Care
Improving care for cancer survivors
A letter has been published in the Journal of Clinical Oncology in response to the article ‘Going Beyond Being Lost in Transition: A Decade of Progress in Cancer Survivorship’, published in June. The letter praises the overview provided by the article, and comments on some of the issues it raised.
The authors note that, though advocacy for survivorship care has gained momentum, little has changed in the reality of clinical care. Cancer survivors struggle with physical and psychological repercussions and potential relapse.
The letter also responds to issues around terminology. The authors criticise the use of the term ‘survivor’. They argue that it labels people who have had cancer, rather than describing it as just one aspect of their identity.
As a priority for survivorship care, the authors identify stratification of survivors according to their risk. This would allow care to be personalised in response to recurrence and thus ‘match services with needs’.
Read the letter: http://ascopubs.org/doi/10.1200/JCO.2017.74.3450