Perceptions and Barriers of Survivorship Care in Asia: Perceptions From Asian Breast Cancer Survivors.

PurposeWith the long-term goal to optimize post-treatment cancer care in Asia, we conducted a qualitative study to gather in-depth descriptions from multiethnic Asian breast cancer survivors on their perceptions and experiences of cancer survivorship and their perceived barriers to post-treatment follow-up.MethodsTwenty-four breast cancer survivors in Singapore participated in six structured focus group discussions. The focus group discussions were voice recorded, transcribed verbatim, and analyzed by thematic analysis.ResultsBreast cancer survivors were unfamiliar with and disliked the term "survivorship," because it implies that survivors had undergone hardship during their treatment. Cognitive impairment and peripheral neuropathy were physical symptoms that bothered survivors the most, and many indicated that they experienced emotional distress during survivorship, for which they turned to religion and peers as coping strategies. Survivors indicated lack of consultation time and fear of unplanned hospitalization as main barriers to optimal survivorship care. Furthermore, survivors indicated that they preferred receipt of survivorship care at the specialty cancer center.ConclusionBudding survivorship programs in Asia must take survivor perspectives into consideration to ensure that survivorship care is fully optimized within the community

Qualitative results from a phase II pilot randomised controlled trial of a lymphoma nurse-led model of survivorship care

Purpose: To explore and describe lymphoma survivors’ thoughts and perceptions of the components of a nurse led lymphoma survivorship clinic intervention. Methods: An exploratory, qualitative descriptive study using interviews from 10 participants who had transitioned post-treatment into the survivorship phase via a nurse-led lymphoma survivorship clinic intervention. Results: Thematic analysis revealed three major themes: Reassurance and individualised care; Information and support; and Empowerment. Participants described the reassurance they gained from having contact with a health professional post-treatment who individualised information and support. A survivorship care plan and treatment summary was developed for this study and was believed to be very patient-centred and helpful. This enabled participants to take back control of their health and well-being and to rebuild confidence. Conclusions: In this study, participants expressed a need for patient-centred follow-up care that addressed their concerns and supported them in the survivorship phase to get their life back on track. Nurse-led follow-up may offer a viable model of post-treatment survivorship care to lymphoma cancer survivors

Breast Cancer Survivorship Rehabilitation Initiative: Community Report

The Breast Cancer Survivorship Rehabilitation Initiative (BCSRI) conducted an assessment of breast cancer survivorship services in the Greater Birmingham area, including Blount, Jefferson, Shelby, St. Clair, and Walker counties, over the course of four (4) months. Project staff disseminated surveys and conducted one-on-one interviews with self-identifying respondents. Following the conclusion of both the surveys and interviews, discussion groups were held. An Ad Hoc Committee was then formed from a group of community leaders and experts in the field of cancer survivorship to review the data and provide feedback. The BCSRI also conducted interviews with the directors of 12 cancer survivorship programs throughout the country. The aggregated data was presented in monthly meetings to a leadership team consisting of executive level hospital administrators in the Greater Birmingham area.This report will summarize the data and serve as a resource to develop programs throughout the community to provide breast cancer survivorship care and patient advocacy. Next steps include developing the infrastructure needed to build a survivorship program that will meet the needs of breast cancer survivors in the Greater Birmingham area, and potentially become a model that can be replicated for other cancer types and diseases or for breast cancer survivors in other communities

Living with multiple myeloma: A focus group study of unmet needs and preferences for survivorship care

Purpose: To describe the unmet informational, psychological, emotional, social, practical, and physical needs and preferences for posttreatment survivorship care of individuals living with multiple myeloma to inform the development of relevant, personcentered, survivorship services. Methods: An exploratory, descriptive study using 2 focus groups with 14 participants, 6 to 49 months postdiagnosis. Results: Thematic analysis revealed 7 key themes: information needs, experience with health-care professionals, coping with side effects, communicating with family and friends, dealing with emotions, support needs, and living with the chronicity of myeloma. Participants described key characteristics of survivorship care relevant to their needs and indicated they would like a more whole of person approach to follow-up when the main treatment phases had completed. Conclusion: Participants in this study described unmet needs across a breadth of domains that varied over time. The development of flexible, person-centered approaches to comprehensive survivorship care is needed to address the considerable quality-of-life issues experienced by people living with multiple myeloma. Nurse-led care may offer 1 viable model to deliver enhanced patient experience—providing the vital “link” that people described as missing from their survivorship care

Impact of Flower Harvesting on the Salt Marsh Plant \u3cem\u3eLimonium carolinianum\u3c/em\u3e

Because of the potentially detrimental effects of seed production on adult survivorship and growth, moderate flower harvesting may have little negative impact on population growth of long-lived perennial plants such as Limonium carolinianum (Walter) Britton. We examined this by collecting data on survivorship, growth, and fecundity of an unharvested population over a period of 5 years and conducted a controlled experiment to examine the effect of harvesting on adult survivorship and growth over a 3-year period. Data were summarized in the form of a stage structured matrix population model with a stochastic element that incorporated year-to-year variation in transition probabilities. Contrary to our original hypothesis, we found that preventing seed set through removal of flowers did not increase adult survivorship or growth. By determining the harvest level that reduced population growth rate to 1.0, we estimated the maximum sustainable harvest level to be 16%, a value that is approximately half that of reported harvest levels on accessible marshes in the study area. In spite of this, the reported harvest levels are unlikely to drive local populations to extinction in the foreseeable future. Providing the adult population size is \u3e100 and harvest levels are \u3c90%, time to local extinction will exceed 100 years. This is a function of the very high survivorship of adults in this species and the fact that harvesting has no negative impact on adult survivorship or growth. However, because of the long preadult phase in this species (8–9 years) and the fact that fecundity of young adults is low, recovery from overharvesting is extremely slow. Adult population size can be reduced to 25% of its original value in 7 years at high harvest levels, but it will take 34 years on average to recover once harvesting is terminated

Improvement in survivorship: The key for population recovery?

In northern Patagonia, commercial harvesting of South American sea lions, Otaria flavescens, from 1920 to 1960, decimated its population abundance. Population recovery was not immediate after hunting ceased in 1962. The population was stable until 1989, and since then has grown at an annual rate of increase of 5.7%. Along with this growth there was an increase of the juvenile fraction and changes in the social composition of colonies, which could be related to changes in some population vital rates. The aim of this study was to analyze changes in the survivorship pattern of Otaria flavescens through time. The ultimate goal was to contribute to a better understanding of changes that could have operated on the ecosystem after the decline and recovery of one of the main marine top-predators in the southern South Atlantic Ocean. The comparisons of survivorship curves of males and females, obtained from the life tables of two periods with different population trends: 1981-1987 (stationary) and 2000-2008 (recovering), showed that there were differences in survivorship between sexes, where recent female age-specific survival was higher than that of males at any age. The comparison of survivorship between periods showed differences in both sexes. Both juveniles and adults, both male and female, from the recent period showed higher survival than those of the 1980’s decade. This improvement in survivorship could be one of the essential factors that drove population recovery in the last decades. Here we discuss the possible hypotheses of which factors could have changed in the ecosystem to favour juvenile and adult survivorship, such as an increase in the availability of food recourses, a decrease of exogenous mortality causes, or a combination of both factors.Fil: Grandi, Maria Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Nacional Patagónico; ArgentinaFil: Dans, Silvana Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Nacional Patagónico; Argentina. Universidad Nacional de la Patagonia; ArgentinaFil: Crespo, Enrique Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Nacional Patagónico; Argentina. Universidad Nacional de la Patagonia; Argentin

Comparative mortality levels among selected species of captive animals

We present life tables by single year of age and sex for groups of animals and for 42 individual mostly mammalian species. Data are derived from the International Species Information System. The survivorship of most of these species has never been mapped systematically. We demonstrate that, in most of the groups, female survivorship significantly exceeds that of males above age five. Wild-born animals do not have mortality that differs significantly from captive-born animals. While most species have mortality that rises with age above the juvenile stage, there are several groups for which the age pattern of mortality is nearly level.ISIS, longevity, mortality, survivorship

Spiritual Wellbeing in Breast and Cervical Cancer Survivors: Differences in Each Stage of Survivorship

Spiritual needs in cancer survivors are underappreciated compared to physical and psychological needs. This study aimed to: 1) compare and analyze the differences in spiritual wellbeing (SWB) between breast and cervical cancer survivors (BCS and CCS) generally, and between stages of survivorship specifically, and 2) determine the best predictor of SWB in both cases. This cross-sectional study involved 58 BCS and 47 CCS (n=105). Questionnaire of QOL-CS part IV was used in data collection. Various statistical tests were used in data analysis (α<0.05). SWB was significantly different between BCS and CCS (p=0.002), which influenced by significant differences in religious activity, spiritual activity, uncertainty, positive life changes, life goals, and hope (all p<α). In BCS, overall SWB was not significantly different between survivorship stages (p=0.179); but religious activity, life goals, and hope were significantly different (p=0.043, p=0.022, and p=0.036 respectively) which indicate that these three aspects change overtime along with the survivorship stages. While in CCS, SWB and all of its aspects were not significantly different between survivorship stages (all p>α) which indicate that SWB is stable/stagnant across the survival life span in CCS. Spiritual life changes and religious activity are the best predictors of SWB in both cases and were accounted for 70.3% (R2=0.703) and 69.7% (R2=0.697) variance of SWB in BCS and CCS respectively

Optimizing Survivorship Care Services for Asian Adolescent and Young Adult Cancer Survivors: A Qualitative Study.

Purpose: With an increasing focus on developing survivorship services tailored for adolescent and young adult (AYA) cancer survivors, incorporation of viewpoints from both survivors and health care professionals (HCPs) is important. This study aims to explore the perceptions of current and prospective survivorship services from both groups in Singapore to propose service design and delivery strategies. Methods: Focus group discussions with 23 AYA cancer survivors between the ages of 16 and 39 years at diagnosis and 18 HCPs were conducted in National Cancer Centre Singapore (NCCS) and Singapore Cancer Society (SCS). All focus group discussions were transcribed verbatim. Deductive thematic analysis was performed according to the components of a design thinking model: empathizing with AYA survivors, defining care gaps, proposing services, and implementation strategies. Results: AYA survivors preferred age-specific services that are aligned with their personal goals. Current survivorship care failed to address the needs of survivors' dependents (caregivers and children) and to consider the utility of each service temporally. Prospective services should clarify disease disclosure obligation in job search and introduce a care navigator. Key implementation strategies included (1) training HCPs on communication techniques with AYA, (2) selecting engagement platforms that complement survivors' information-seeking behavior, (3) improving outreach to survivors through appropriate branding and publicity, and (4) consolidating services from multiple providers. Conclusions: The design of survivorship care services for AYA survivors should be systematic in its conceptualization process and employ implementation strategies. The coordination of the wide spectrum of services warrants a concerted effort by cancer centers, community partners, and the government