Toward a health-promoting system for cancer survivors: Patient and provider multiple behavior change.

Abstract

Objective: This paper examines how and why to improve care systems for disease management and health promotion for the growing population of cancer survivors with cardiovascular multi-morbidities. Method: We reviewed research characterizing cancer survivors' and their multiple providers' common sense cognitive models of survivors' main health threats, preventable causes of adverse health events, and optimal coping strategies. Results: Findings indicate that no entity in the health care system selfidentifies as claiming primary responsibility to address longstanding unhealthy lifestyle behaviors that heighten survivors' susceptibility to both cancer and cardiovascular disease (CVD) and whose improvement could enhance quality of life. Conclusions: To address this gap, we propose systems-level changes that integrate health promotion into existing survivorship services by including behavioral risk factor vital signs in the electronic medical record, with default proactive referral to a health promotionist (a paraprofessional coach adept with mobile technologies and supervised by a professional expert in health behavior change). By using the patient's digital tracking data to coach remotely and periodically report progress to providers, the health promotionist closes a gap, creating a connected care system that supports, reinforces, and maintains accountability for healthy lifestyle improvement. No comparable resource solely dedicated to treatment of chronic disease risk behaviors (smoking, obesity, physical inactivity, treatment nonadherence) exists in current models of integrated care. Integrating health promotionists into care delivery channels would remove burden from overtaxed PCPs and instantiate a comprehensive, actionable systems-level schema of health risks and coping strategies needed to have preventive impact with minimal interference to clinical work flow.

Harnessing consumer smartphone and wearable sensors for clinical cancer research

“…Two recent reviews of studies using wearable devices to promote activity among cancer survivors found that interventions using wearable activity monitors had a positive impact on physical activity as well as symptoms and quality of life 33 , 34 . Moreover, real-time wearable device data may allow for tailored or just-in-time physical activity interventions 35 that may be further enhanced by the support of a coach who can review a patient’s real-time data and provide individualized support for behavior change 36 .…”

Cancer survivorship in hematologic malignancies: Lifestyle changes after diagnosis

“…A collaborative model integrating technology to deliver behavioral interventions along with routine survivorship services has been suggested to manage healthcare promotion and care coordination between the primary care provider and specialist. 16 Our patients identified common themes such as current health status, treatment side effects, social support, finances, motivation, and access to education/research materials as among factors influencing health behavior change. Similar attitudes and challenges have been identified in other patient populations including endometrial cancer survivors 17 and adolescent/young adult cancer survivors.…”

“…Understanding the rationale behind positive and negative changes made by these patients is of great importance as this will enable healthcare staff to identify factors that facilitate or impede positive change. A collaborative model integrating technology to deliver behavioral interventions along with routine survivorship services has been suggested to manage healthcare promotion and care coordination between the primary care provider and specialist 16 …”

Smoking cessation prolongs survival in female cancer survivors - the Danish nurse cohort

“…This despite a growing body of research showing that smoking cessation in cancer survivors improves non-surgical and surgical treatment effects and reduces the risk of cancer recurrence, secondary cancer, morbidity and mortality (Parsons et al, 2010;Toll et al, 2013;Warren et al, 2014). Smoking cessation in cancer survivors is further suggested to reduce both the sequelae related to long term cancer survival as well as the risk of competing chronic diseases such as cardiovascular disease (Overholser and Callaway, 2018;Rowland, 2008;Spring et al, 2019). Nonetheless, quit rates among cancer survivors are low and vary largely between cancer sites; from 4% in patients with breast cancer to 46% up to 96% among patients with https://doi.org/10.1016/j.ejon.2020.101796 Received 22 November 2019; Received in revised form 29 June 2020; Accepted 30 June 2020 T tobacco-related cancers such as lung, head and neck (Demark-Wahnefried et al, 2005;Penfold et al, 2018).…”