S1 | Meeting the needs of individuals on oral anti-cancer therapy: Toward a multifaceted person-centred supportive approach | Moderator
Driven by patient convenience, quality-of-life improvements and cost-effectiveness, oral anti-cancer therapy – defines as chemotherapy, targeted therapy, or immunotherapy taken by mouth to treat cancer - is increasingly being prescribed. Whereas oral therapy is considered less invasive and easier to administer, its handling and day-to-day management often require intensive involvement of patients and informal caregivers. Patients often report feeling ill prepared and unsure about therapy adherence issues as well as what should be done in the event of significant treatment side effects.
This symposium addresses the various components involved in supporting individuals on oral anti-cancer therapy. Recognizing the importance of complementary roles, the panel includes perspectives from nursing, social work, and a patient representative. As the use of oral agents to treat cancer continues to grow, a more integrated approach is key to ensuring optimal engagement and high-quality outcomes for all involved.
S1-82 | Testing the feasibility, acceptability and potential effects of a comprehensive oral chemotherapy self-management support program
Carmen Gisele Loiselle
McGill, Montreal, Canada
Background/rationale or Objectives/purpose: In this pilot randomized controlled trial (RCT) called ON-BOARD (Oncology – Bolstering Oral Agent Reporting related to Distress), we address information and support needs of individuals on oral chemotherapy while testing a more accessible intervention. We examine the feasibility, acceptability, and potential effects of the intervention on key health-related outcomes including physical and psychosocial issues, and treatment adherence. Components of the intervention are based on prior feedback from patients and caregivers, healthcare providers, a Quebec's health ministry representative and a non-profit cancer organization. The intervention components include: (1) online symptom management tip-sheets presenting information and supportive resources; (2) innovative videos on oral therapy management and professional services; and, (3) supportive phone calls from trained patient partners/volunteers and/or pivot nurses.
Methodology or Methods: The study is taking place at two University-affiliated hospitals in Montreal, Quebec. Participants (N = 80) with cancer at any stage, aged 18 to 69 and within their first cycle of oral chemotherapy are recruited and randomized to either the experimental intervention or usual care. Health-related outcomes are assessed, online, at baseline, then every two weeks for five months or until oral therapy is completed.
Impact on practice or Results: The protocol and content of the intervention were adjusted based on initial feedback from multiple stakeholders including patients. The process of intervention development was very informative as it involves various clinical and non clinical experts.
Discussion or Conclusions: In terms of study implementation, a key challenge was to meet institutional research ethic board requirements regarding the electronic data capture components.
S1-83 | A social work perspective pertaining to a multidisciplinary person-centered approach to assisting patients on oral anti-cancer therapy
McGill University Health Centre, Montreal, Canada
Background/rationale or Objectives/purpose: Individuals with cancer and their families often face barriers related to care, long illness trajectories and challenging treatment side effects. The growing use of oral anti-cancer therapy is impacting the treatment paradigm in oncology.
Methodology or Methods: With increased convenience and patient autonomy, home-based oral therapies create complex self-management challenges for patients, caregivers and health care professionals. To address these challenges, social workers often act as a liaison agent for the team, patients and caregivers. They seek to assess, advocate for resources and support via educational and problem-solving interventions. Oncology social work interventions therefore are geared toward aiding individuals cope with practical and psychosocial treatment-related issues.
Impact on practice or Results: This presentation explores the impact of this trend on the service delivery environment and service recipients. Issues of self-management are explored as a dynamic process that promotes cognitive, behavioral and emotional responses as social workers can play a key role in this process. More specifically, attention is given to socio-demographic, material/financial and logistical barriers, health literacy issues and cultural characteristics that impact on the management of oral anti-cancer therapy.
Discussion or Conclusions: There is a need to document adherence issues and complex factors that may affect sub optimal adherence to oral therapy. These may include social support, availability of community support services and quality of life concerns. The unmet needs of vulnerable groups are also discussed including the elderly, living alone, younger adults as well as caregivers.
S2 | Addressing Symptom Burden among Children, Adolescents and Young Adults (AYA) Diagnosed with Cancer: A Pediatric/AYA Special Interest Group Symposium | Moderator
University of Calgary
Children, adolescents and young adults (AYAs) who have been diagnosed with cancer are at risk of significant short and long-term symptoms following their diagnosis and treatments. The vulnerable stage of development these unique groups are in can exacerbate symptoms. Symptoms span physical and psychosocial domains and may include cognitive dysfunction, pain, fatigue, anxiety, and depression. As survival rates increase, the number of child and AYA survivors dramatically increases too. Indeed, there are now more than 30,000 pediatric cancer survivors in Canada and approximately 1 in every 530 young adults is a cancer survivor. Given their age at diagnosis this population often has decades of survival ahead of them. Thus, understanding and addressing the symptom burden in both the short- and long-term is critical.
This symposium will begin with a discussion of findings from a pediatric population and demonstrate how a screening tool designed to assess psychosocial risk was associated with symptom burden among survivors of childhood cancer. Next, it will describe symptom burden among a sample of AYA diagnosed with cancer between ages 15-39 from Princess Margaret and online, with a focus on cognitive dysfunction which was the most commonly reported symptom. Finally, it will explore physical activity interventions as a means to reduce the symptom burden among children and adolescents with cancer. The symposium will conclude with an interactive discussion including priorities for future research in this field.
S2-97 | Physical Activity to Reduce Symptom Burden and Enhance Well-Being for Children and Adolescents Affected by Cancer: From Evidence to Practice
Emma McLaughlin, Amanda Wurz, S. Nicole Culos-Reed
University of Calgary, Calgary, Canada
Background/rationale or Objectives/purpose: Physical activity (PA) is one strategy that can address many symptoms (e.g., fatigue, nausea, pain) and late effects (mobility restrictions, deconditioning) experienced by children and adolescents affected by cancer. Despite the compelling evidence-based impact of PA, the pediatric oncology population is often not active enough to receive these benefits. Thus, implementation science projects, moving evidence to practice, are needed.
Methodology or Methods: A literature synthesis on PA interventions for children and adolescents affected by cancer, a consensus-building project using the Delphi technique, and resource development project have been undertaken. PA programming is moving evidence to practice.
Impact on practice or Results: Evidence from the literature synthesis (n=23 systematic reviews, n=82 experimental articles) supports PA for this population. The consensus-building project resulted in a team of international experts (n=130) and nine guideline and recommendation statements indicating the importance of moving more for this population. Implementation resources being developed include infographics, brief videos, posters and brochures for healthcare providers, fitness professionals, children and adolescents affected by cancer and their families. A PA program being offered is the Pediatric Cancer Survivors Engaging in Exercise for Recovery (PEER) program, and it includes symptom measurement.
Discussion or Conclusions: PA can help manage symptoms during and after pediatric cancer treatment. Appropriate literature synthesis and expert guidance, following consensus-building methodology, ensures safe, appropriate, and beneficial PA guideline and recommendation statements. Supporting resources are important to ensure those who need guideline information receive it, while dissemination and implementation efforts are required to mobilize this knowledge to practice.
S2-99 | Familial Psychosocial Risk Predicts Symptom Burden in Youth with Cancer
K Brooke Russell, Michaela Patton, Courtney Charnock, Hailey Zwicker, Fiona Schulte
University of Calgary, Calgary, Canada
Background/rationale or Objectives/purpose: The Psychosocial Assessment Tool (PAT-Rev) screens for family-level risk factors in pediatric oncology and stratifies families into three risk categories (universal, targeted, and clinical). Psychosocial risk factors may be associated with varying health outcomes, including greater symptom burden. Because children may not seek help for symptoms until they become severe, it is important that we screen for and identify unmanaged symptoms. We sought to examine if PAT-Rev risk category was associated with symptom burden of children with cancer.
Methodology or Methods: Patients (n=68, aged 8-18) were recruited from the Alberta Children's Hospital and were eligible to participate if they were on active treatment for cancer, or ≥2 years after treatment completion. Children completed the Edmonton Symptom Assessment System (ESAS). Parents completed the PAT-Rev and a parent-proxy ESAS. Multilevel modeling was used to evaluate associations between PAT-Rev risk category and ESAS scores, accounting for treatment status.
Impact on practice or Results: PAT-Rev risk category (universal=62.4%; targeted=25.8%; clinical=5.4%) was significantly associated with child self-reported ESAS F(2,64.11)=4.31, p=.018 as well as parent-proxy ESAS F(2,45.47)=14.62, p<.001, such that children in the highest PAT-Rev risk categories (targeted; clinical) had significantly higher symptom burden than those in the lowest PAT-Rev risk category (universal).
Discussion or Conclusions: Findings suggest that PAT risk category is associated with symptom burden of children undergoing treatment for, or in survivorship from cancer. Those families at higher psychosocial risk also report higher symptom burden. The PAT may be a helpful indicator of symptom burden, allowing care teams to better identify children at increased risk for unmanaged symptoms.
S2-100 | Perceived Symptom Burden and Cognitive Impairment in Young Adults with Cancer
Jackie Bender1, Sarah Salih1, Norma D’Agostino1, Emily Drake2, Sheila Garland3, Abha Gupta1, Fucshia Howard4, Zhihui-Amy Li1, Laura Mitchell1, Argerie Tsimicalis5
1Princess Margaret Cancer Centre, Toronto, Canada.2Dalhousie University, Halifax, Canada.3Memorial University, St. John's, Canada.4University of British Columbia, Vancouver, Canada.5McGill University, Montreal, Canada
Background/rationale or Objectives/purpose: Objective: Young adults (YA) are at risk of significant short and long-term symptoms following cancer treatment. This cross-sectional study explored perceived symptom burden in YA and possible associations with cognitive impairment.
Methodology or Methods: Methods: Canadian YA diagnosed with cancer between ages 15-39 were surveyed at Princess Margaret Cancer Centre and online; patients with a brain cancer diagnosis were excluded from this analysis. They completed the 12-item AYA HOPE Health and Social Issues scale (symptoms experienced in past 4 weeks). A descriptive analysis of symptom burden, demographic and disease characteristics and psychosocial measures was conducted.
Impact on practice or Results: Results: The most prevalent symptom in this sample (n=402) of YA, who were on average 3.24 years post-diagnosis, was problems with memory, attention or concentration, reported by 52%. In chi-squared tests, this was found to be associated with sex (p<0.001), cancer type (p=0.001), chemotherapy (p=0.002) and hormonal (p=0.012) treatments, and overall health rating (p<0.001). T-tests revealed that patients reporting cognitive symptoms were slightly older (31.90 vs. 30.07, p=0.005) and had higher anxiety (GAD-7: 8.20 vs. 3.30, p<0.001), depression (PHQ-9: 9.22 vs. 3.37, p<0/001), and loneliness (UCLA loneliness: 20.25 vs. 10.61, p<0.001). They reported lower perceived social support (SPS: 33.99 vs. 36.34, p<0.001) and coping (CBI:124.66 vs. 148.16, p<0.001). Differences in time since diagnosis were not significant.
Discussion or Conclusions: Conclusion: Cognitive symptoms were the most frequently reported in YA with cancer. They are associated with age, sex, cancer type, chemotherapy and hormonal therapy. They are related to subjective health and psychosocial wellbeing. Targeting psychosocial wellbeing could reduce cognitive symptom burden.
S3 | Partnering to Improve Cancer Survivorship: Supporting Transitions In Care, Return to Life and Work | Moderator
Canadian Partnership Against Cancer
A recent study of over 13,000 Canadian cancer survivors found that more than 8 in 10 survivors had unmet needs one to three years after treatment, and a high percentage of survivors continue to experience mental health and practical challenges long afterward. Fragmented transitions back to primary care and a lack of knowledge about survivors’ needs has left many patients unclear about where to seek support for mental health and the challenges that cancer survivorship presents.
The Canadian Partnership Against Cancer in partnership with the Mental Health Commission of Canada hosted a full day workshop with a multi-sectoral group of stakeholders in October 2019 with the intention of unpacking these gaps and developing a collaborative action plan to improve access to mental health supports for cancer survivors post-treatment.
A three-pronged approach to address these gaps was developed: (1) increase awareness among primary care providers about the mental health and psychosocial needs of cancer survivors to enable their successful return to work and life, (2) enhance coordination of transitions to primary care by supporting the change management of a quality improvement project in one jurisdiction, and (3) improve coordination and availability of existing mental health and return to work/life resources.
Multi-sectoral partnerships are required to increase awareness, support these important transitions and design new solutions that draw from the expertise of cancer, mental health, community and primary care, and the workforce. This session will feature panelists from various organizations and sectors discussing learnings from the workshop, research and the field.
S3-149 | Building Capacity for Cancer Survivorship in the Patient's Medical Home: A Collaborative Effort
Linda Watson1, Mona Delisle2, Andrea DeIure1
1Alberta Health Services, Calgary, Canada.2Alberta Health Service, Calgary, Canada
Background/rationale or Objectives/purpose: Cancer survivors require ongoing physical and mental health follow-up and support which currently is not adequately available for all survivors. Building capacity in Primary Care has been identified as an option for improving this type of support in the patient's medical home. Over the past several years CancerControl Alberta (CCA) has developed survivorship guidelines and after treatment resources for patients and family physicians to improve the flow of relevant information from the cancer system. The guidelines and knowledge tools have been co-created with the CCA provincial tumour teams, but no programmatic efforts to support uptake of these resources in primary care has occurred.
Methodology or Methods: With support from the Canadian Partnership Against Cancer, a new collaborative project between CCA and the AHS Primary Healthcare Integration Network has been created to focus directly on supporting change management efforts in Primary Care settings across the province.
Impact on practice or Results: Within this project, work will be done to support gap identification and creation of additional knowledge mobilization tools and resources for primary care providers to wrap around the guidelines and the existing knowledge products. This project will feed into a larger AHS wide initiative to support improved transitions (Home to Hospital to Home) as a unique stream of content specific to cancer patient transitions post treatment and survivorship.
Discussion or Conclusions: The Partnership will leverage learnings from this provincial implementation project over the next two years to share lessons and resources with key stakeholders across other jurisdictions to advance cancer survivorship transition opportunities across Canada.
S3-151 | Increasing Capacity Among Primary Care Providers to Support Survivors Return to Life and Work
Jessica Kitchen1, Corinne Daly1, Alexandra Ginty2, Christine Maheu3, Maureen Parkinson3
1Canadian Partnership Against Cancer, Toronto, Canada.2Dorval Medical FHT, Oakville, Canada.3Cancer and Work, Vancouver, Canada
Background/rationale or Objectives/purpose: A recent environmental scan of approaches for addressing mental health and return to work needs of cancer survivors found that despite increasing recommendations and guidelines for interventions that address cancer survivors’ unique physical, psychosocial and mental health needs, many survivors do not receive adequate support as they transition back to their daily lives and many of their needs remain unmet. In addition, there is little knowledge and guidance to support the transition back to work and the long-term effects that survivors’ experience post-treatment.
Primary care providers play an important role in the cancer care continuum, but there are several patient, provider and health system barriers to transitioning effectively to primary care, including the flow of information, coordination and continuity of care, varied guidelines, and the readiness and capacity of primary care to support survivors. Numerous cancer survivorship programs have been developed to support survivors with mild to moderate mental health concerns; however, despite the high rate of mental health concerns and availability of resources, many primary care providers are not aware that cancer survivors have unmet psychosocial, mental health and vocational needs, while many others feel unequipped to support them. This gap in care has left many survivors unclear about where to seek support for mental health and the challenges that cancer survivorship presents including return to work and life.
Methodology or Methods: Targeted knowledge mobilization (KMB) initiatives will be pursued in partnership with various stakeholders aimed to a) increase primary care provider awareness and/ or knowledge of the mental health needs of cancer survivors, to support cancer survivors successful return to life and work and b) increase primary care provider use of the numerous existing mental health, psychosocial, and vocational tools and resources available to support cancer survivors.
Impact on practice or Results: Targeted KMB will equip primary care providers with knowledge and tools to better support cancer survivors after they transition from the cancer system back to primary or community care. This includes increased awareness among primary care providers about the mental health, psychosocial and vocational needs of cancer survivors, and increased knowledge of where to go for existing information and supports.
Discussion or Conclusions: Multi-sectoral partnerships that draw from the expertise of cancer, mental health, vocational rehabilitation, community and primary care, and the workforce are required to increase primary care provider awareness of the mental health, psychosocial, and vocational rehabilitation needs of cancer survivors, and the resources available to support survivors’.
S3-152 | Supporting Navigation in the Community and Improving Coordination and Access to Mental Health Resources
Sandra Krueckl1, Laura Burnett2, Ed Mantler3, Sandra Koppert3
1Canadian Cancer Society, Vancouver, Canada.2Canadian Cancer Society, Hamilton, Canada.3Mental Health Commission of Canada, Ottawa, Canada
Background/rationale or Objectives/purpose: The number of Canadians diagnosed with cancer is being projected to grow by 40% from 2015 to 2030. The consequential impact on cancer care services will be significant and the need for mental health and psychosocial and information services will continue to expand. The unique, national infrastructure of the Canadian Cancer Society (CCS) cancer information and support programs function as an important adjunct to the healthcare system, supporting navigation in the community. With over 4000 programs and services, its peer support network and online chat service, CCS is set up to help clients and caregivers navigate the cancer experience and transition to the community by linking them with information, programs and resources to address their identified needs. All CCS information and peer support programs operate free of charge and are available remotely to all Canadians, regardless of their geographic location. Despite the widely accepted importance of cancer information and support, awareness of these support services remains sub-optimal and as a result, patients and caregivers continue to miss out on the positive impacts associated with the services and continue to live with unresolved needs.
Methodology or Methods: With support from the Canadian Partnership Against Cancer, CCS aims to improve the ability of those with cancer to navigate to the key resources that can support their cancer experience, as well as build relationships with key stakeholders like the Mental Health Commission of Canada and others to improve coordination and availability of existing mental health and return to life and work resources for both cancer survivors directly and as means of referral pathways for primary care providers.
This includes (1) building relationships with key stakeholders and developing plans to integrate referral pathways across resources in ready jurisdictions, (2) increasing awareness about the mental health and psychosocial supports and resources available to assist clients with navigating through transitions from the cancer system back to primary or community care, and (3) building evidence-based roadmaps to make programs and services more relevant, appropriate and accessible to populations who may be underserved and/or experience barriers to reaching cancer information and support services.
Impact on practice or Results: The result of this work will improve the ability of Canadians with cancer to navigate key information and support resources to improve their cancer experience by addressing unmet information and support needs at periods of transition.
Discussion or Conclusions: This initiative presents an opportunity for community-based services to work collaboratively alongside the healthcare system to develop new models and referral patterns to support patients, caregivers and families affected by cancer. This collaboration is more important than ever in a post COVID-19 environment where healthcare systems will be forced to face unprecedented challenges and demand.