Transcript CPCRN Survivorship Workgroup

CPCRN SURVIVORSHIP
WORKGROUP
Co-Leads:
Colorado and Texas A&M
The Challenge and Mission…
The CDC/LAF National Action Plan for Cancer
Survivorship recommends that the Public Health
Community “promote healthy life for cancer survivors
including minimizing preventable pain and distress”
Colorado and Texas A&M highlighted survivorship and
health promotion as the core of their local activities as
grantees within the CPCRN Network
There is great opportunity in cancer control programs to
improve long term health outcomes of cancer survivors
The Survivorship Workgroup formed (Texas
and Colorado collaborating)
A survey monkey was conducted in Spring of 2010;
every CPCRN site responded and noted interest in
at least one activity related to cancer survivorship
10 of the 26 individuals who responded to survey
noted activities currently underway in the area of
cancer survivorship
Based upon enthusiasm and interest, a
Survivorship Workgroup was formed…
SURVIVORSHIP WORKGROUP
PRIMARY ACTIVITIES
Current Activities (Health Promotion):
 Survey
 Scoping Study of Implementation Literature
Potential Future Projects:
o Linkage with CRC Cross Center Projects for
Survivorship Care Planning
o Focus Group Guide for Cancer Survivors
o Chronic Disease Self Management Program
TRANSLATION AND DISSEMINATIONRE-AIM FRAMEWORK
Reach:


What populations are currently being targeted?
Are these populations representative of different cancers? Different age
groups? Different socio-demographics?
Methods: Survey, Scoping study
Effectiveness:

What evaluation measures are being used?

How and where are results reported, and used?
Methods: Key informant interview, Scoping study
TRANSLATION AND DISSEMINATIONRE-AIM FRAMEWORK
Adoption/Implementation:

Who is offering these programs (type of institution/training/etc)?

What are program components?

What are the barriers to program implementation?

How have programs been modified for cancer survivors?
Methods: Key informant interview, Scoping study
Maintenance:
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Are programs designed to achieve long-term benefits at the individual
level?
Are programs sustainable (funding, etc)?
Methods: Key informant interview
ONLINE SURVEY OF HEALTH PROMOTION
The Effort: Conduct an environmental scan to identify health
promotion programs available for cancer survivors throughout
the U.S. (physical activity, nutrition/weight management,
psychosocial support)
To Determine the:
 programs available
 number and type of patients served
 components of programs
 use of evidence-based strategies.
 collect an inventory of resources to identify gaps in services
 inform cancer planning and state-wide comp cancer programs
Why:
 Evidence indicates physical activity and weight management
are important in cancer survivorship


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ACSM has new evidence-based guidelines (May 2010) and ACS
has consensus recommendations (2006) for physical activity,
but it is not known if these are being/have been adopted
Fatigue, physical inactivity, weight gain, distress and
depression are common after cancer but few programs
available (and based on what evidence?)
No one has published a comprehensive snapshot of who is
doing what, and where – and this would help move the field
forward and assist with resource allocation
How:
 Key word search to identify programs conducted
in Spring 2010, including same key words for all
CPCRN states

Internet search to identify entities and
institutions to receive survey

Primary Survey Components:

Description of Program/Entity

Demographics of Patients Served

Program Elements

Structure of Program

Identification of Others to Complete Survey

Contact Information for Key Informant Interview
How (Cont…):
Survey approved by Colorado IRB
 Piloted in Colorado in late August 2010
 38 programs identified; 17 responded thus far
 Sample Respondent Characteristics:

At least one group serving every demographic and cancer type
 Largely Urban but Some Rural Community
 Types of Institutions and Entities:

Hospital Based Programs
NCI Designated and Community Cancer Centers
Physical Rehab/Physical Activity Practice
YMCAs and Recreation Centers
Who:
 Colorado Initiated the Process

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Colorado, Texas A&M, MD Anderson to start –
potentially all CPCRN sites
Medical student in Colorado to conduct key informant
interviews but Colorado open to partnerships
Texas Experience:
 Collaboration between CPCRN sites at Texas
A&M and UT Houston with endorsement from
MD Anderson and the Cancer Alliance of Texas
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Recruitment email and introduction were made
Texas specific, listing partners and endorsements
Partners suggested minor changes to Colorado
version of the survey.
Recruitment email will be sent by Texas A&M,
data will be collected at Colorado
Currently seeking IRB exempt approval in Texas
How Your CPCRN Site Can Participate:
 Preview
Survey (Handout)
 Tailor Survey Intro and Invite Letter
Specifically to Your State
 Colorado Can Provide Key Word Search
Results for each state
 Informant Interview to Be Conducted in
Colorado or Potentially By each Specific State
SCOPING STUDY OF CANCER SURVIVORSHIP
HEALTH PROMOTION
The Effort: Conduct a scoping study* of the
implementation literature regarding health
promotion in cancer survivors. To serve as a
guide to funders, public health professionals,
practitioners, and cancer survivors as a summary
of the state-of-the art when designing,
implementing, and utilizing programs.
*methodology to gather both published and grey literature to identify gaps.
Arksey, H. and O'Malley, L. (2005) Scoping studies: towards a methodological
framework, International Journal of Social Research Methodology, 8, 1, 19-32.
Why:

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Published systematic reviews of exercise and other health
promotion programs include only RCTs, though many
other projects are underway and would be valuable to
learn from them
No summary of state-of-the-art available to guide
implementation
Who:

Colorado, Texas A&M, University of Washington

Colorado Medical Student Internship
Research Questions for the Scoping
Study
What are current physical activity and exercise
interventions that have been implemented and/or
designed in cancer survivor populations?
 Future efforts may include other wellness
interventions (e.g. nutrition, psychosocial
support)
 What are the components and results of these
studies, and do they show positive impact or
significant improvement in their tested
populations?
 How have these interventions been adapted for
use on a large scale or for the cancer survivor
population?

How:
 Key word search (identified over 100 published
articles) using PubMed, Medline, Google Scholar

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Internet search of programs and outreach (by phone
and email) to uncover evaluation reports and other
data not yet published using Google search engine
Reporting rubric to summarize program components
Synthesis of findings (outreach to other CPCRN
investigators to join)
Results of Literature Review
Key Words:
 “cancer survivor evidence based exercise” 36
results on 8/22/2010
 “cancer survivor exercise” 94 results on
8/18/2010
 “cancer survivor exercise health promotion” 46
results on 8/23/2010
 “cancer survivor exercise translation” 3 results on
8/23/2010
 “cancer survivor exercise implementation” 5
results on 8/23/2010
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How Your CPCRN Site Can Participate:
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
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Assist in searching for literature and filling out
the rubric
Assist in searching the gray literature; or
Playing a role in the synthesis of the information
found
PARTNERING WITH CROSS CENTER
PROJECTS

The Chronic Care Model and the PatientCentered Medical Home Initiative, are both of
high interest in the cancer survivorship
community. In particular, issues of care
coordination, patient self-management, and
communication between primary and specialty
care providers are key elements in these
transformative models also relevant to cancer
survivorship.
PARTNERING WITH CROSS CENTER
PROJECTS
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Information about stage and diagnosis/treatment collected in
the CRC screening program could in turn be used to provide
patients with basic information for their Survivorship Care
Plan- what an opportunity to have the evaluation data be used
by the patients themselves!
·Patients consented for the CRC screening program could also
be consented at that time to be included in a survivorship
registry, which is one of the IOM’s recommendations for
advancing survivorship research;
·Adding some important but minimal common
elements/variables to the E-Cast evaluation tool regarding
survivorship (e.g. linkage to state vital status records to track
survivorship, recording primary care physician of record, date
of last contact, survivorship resources/care planning
provided?).
Snowball Sampling Method
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Existing subjects recruit future subjects from within their
own network
Best used where resources or experts may be hidden, such
as in an emerging field
Can identify current and future stakeholders, and facilitate
networking
Results are not fully indicative of all members of target
population, but provide a reasonable snapshot in time
Description of Sampling
Step 1. Identify and contact
key stakeholders
Colorado Activity
 Conduct key word internet
search (see handout)
 Ensured that list
included reputable
programs and experts we
knew of through our own
activities
Sampling

Step 2. Distribute survey
to initial list to start
“snowball” and continue to
gain more contacts.
Colorado Activities
 Included request for new
contacts in the cancer and
exercise “community”.
Description of Sampling

Step 3. Widen the profile
of the sample to gain more
stakeholders.
Colorado Activities (Current)
 Contacted State Cancer
Coalition to send survey to
their listserv
 Reached out to national
contacts at LAF/YMCA for
future survey distribution
 Texas (both CPCRN sites)
will jointly distribute
survey
 Other CPCRN sites obtain
IRB approval?