Evaluating the caregiver experience during neoadjuvant therapy for pancreatic ductal adenocarcinoma

Ruff, Samantha M.; Stevens, Lena; Bressler, Luke; Khatri, Rakhsha; Sarna, Angela; Ejaz, Aslam M.; Dillhoff, Mary; Pawlik, Timothy M.; Rose, Karen; Cloyd, Jordan M.

doi:10.1002/jso.27558

Cited by 2 publications

(1 citation statement)

References 47 publications

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“…Indeed, patients experience significant treatment burden during NT [ 11 ]. This complexity of care and treatment burden on patients also significantly impacts caregivers [ 12 ]. Given this complexity, patients are at increased risk of receiving poorly coordinated care which may interfere with their completion of intended therapy and achieving curative-intent surgery [ 9 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Patient Perceptions of Care Coordination during Neoadjuvant Therapy for Gastrointestinal Cancers: A Mixed Methods Analysis

Bath,

Palettas,

Stevens

et al. 2024

J Gastrointest Canc

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Purpose Effective cancer care coordination (CCC) is an integral component of health care delivery and critical to achieving optimal oncologic outcomes. Neoadjuvant therapy (NT), the delivery of multimodality therapy prior to surgery, is inherently complex and multidisciplinary, but CCC during NT is poorly understood. The objective of this study was to characterize patient perceptions of CCC during NT using a mixed methods approach. Methods This study is a cross-sectional analysis of patients with gastrointestinal cancers receiving NT who participated in a prospective longitudinal cohort study evaluating their real-time experience using a customized smartphone application. Patients completed the Cancer Care Coordination Questionnaire for Patients (CCCQ-P), a 20-item validated measure of care coordination quality, six weeks after initiating NT. Items were scored on a 5-point Likert scale, and subsections on communication (13 questions) and navigation (7 questions) were calculated with higher scores signifying better CCC. Univariate linear regression was used to calculate the impact of fragmented care and other factors on perceived CCC. Semi-structured interviews were conducted among a convenience sample of patients (n = 5); transcribed interviews were then coded using an inductive approach. Results Among 82 participants, mean age was 61 years old, 68% were male, and mean number of comorbidities was 1.68. Overall (mean 76.6 out of 100), communication subsection (48.6 out of 65), and navigation subsection (28.0 out of 35) CCCQ-P scores suggested overall positive perceptions of care coordination. Qualitative analysis of patient interviews highlighted the need for coordination among physicians before communicating the plan to patients as well as the importance of providers communicating plans in verbal and written form. Conclusions Successful completion of NT requires significant care coordination between patients and healthcare professionals. Yet, in this cross-sectional analysis of patients on a prospective cohort study, patient perceptions of CCC during NT were overall positive. Future research should focus on optimizing other aspects of care delivery in order to improve outcomes of NT.

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Section: Introductionmentioning

confidence: 99%

Patient Perceptions of Care Coordination during Neoadjuvant Therapy for Gastrointestinal Cancers: A Mixed Methods Analysis

Bath,

Palettas,

Stevens

et al. 2024

J Gastrointest Canc

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Best Practices for Delivering Neoadjuvant Therapy in Pancreatic Ductal Adenocarcinoma

Cloyd,

Sarna,

Arango

et al. 2024

JAMA Surg

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ImportanceNeoadjuvant therapy (NT) is an increasingly used treatment strategy for patients with localized pancreatic ductal adenocarcinoma (PDAC). Little research has been conducted on cancer care delivery during NT, and the standards for optimal delivery of NT have not been defined.ObjectiveTo develop consensus best practices for delivering NT to patients with localized PDAC.Design, Setting, and ParticipantsThis study used a modified Delphi approach consisting of 2 rounds of voting, and a series of virtual conferences (from October to December 2023) to reach expert consensus on candidate best practice statements generated from a systematic review of the literature and expert opinion. An interdisciplinary panel was formed including 47 North American experts from surgical, medical, and radiation oncology, radiology, pathology, gastroenterology, integrative oncology, anesthesia, pharmacy, nursing, cancer care delivery research, and nutrition as well as patient and caregiver stakeholders.Main Outcome and MeasuresStatements that reached 75% agreement or greater were included in final consensus statements.ResultsOf the 47 participating panel members, 27 (57.64%) were male, and the mean (SD) age was 47.6 (8.2) years. Physicians reported completing training a mean (SD) 14.6 (8.6) years prior and seeing a mean (SD) 110.6 (38.4) patients with PDAC annually; 35 (77.7%) were in academic practice. Final consensus was reached on 82 best practices for delivering NT. Of these, 38 statements focused on pre-NT practices, including diagnosis and staging (n = 15), evaluation and optimization (n = 20), and decision-making (n = 3); 29 statements defined best practices during NT, including initiation (n = 3), delivery of therapy (n = 8), restaging practices (n = 12), and management of complications during NT (n = 6); and 15 best practices were identified to guide treatment post-NT, focusing on surgery (n = 7), pathology (n = 4), and follow-up (n = 3).ConclusionsUsing a modified Delphi consensus technique, best practice guidelines were developed focusing on the optimal standards for delivering NT to patients with localized PDAC. Given the prognostic importance of completing multimodality therapy, efforts to standardize and optimize the delivery of NT represent an immediate opportunity to decrease care variation and improve outcomes for patients with PDAC. Future research should focus on validating and implementing best practice standards into clinical practice.

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Evaluating the caregiver experience during neoadjuvant therapy for pancreatic ductal adenocarcinoma

Cited by 2 publications

References 47 publications

Patient Perceptions of Care Coordination during Neoadjuvant Therapy for Gastrointestinal Cancers: A Mixed Methods Analysis

Patient Perceptions of Care Coordination during Neoadjuvant Therapy for Gastrointestinal Cancers: A Mixed Methods Analysis

Best Practices for Delivering Neoadjuvant Therapy in Pancreatic Ductal Adenocarcinoma

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