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The coronavirus disease 2019 (COVID-19) pandemic has severely affected cancer care and research by disrupting the prevention and treatment paths as well as the preclinical, clinical, and translational research ecosystem. In Italy, this has been particularly significant given the severity of the pandemic's impact and the intrinsic vulnerabilities of the national health system. However, whilst detrimental, disruption can also be constructive and may stimulate innovation and progress. The Italian Association of Medical Oncology (AIOM) has recognized the impact of COVID-19 on cancer care continuum and research and proposes the '2021 Matera statement' which aims at providing pragmatic guidance for policymakers and health care institutions to mitigate the impact of the global health crisis on Italian oncology and design the recovery plan for the post-pandemic scenario. The interventions are addressed both to the pillars (prevention, diagnosis, treatment, follow-up, health care professionals) and foundations of cancer care (communication and care relationship, system organization, resources, research, networking). The priorities to be implemented can be summarized in the MATERA acronym: Multidisciplinarity; Access to cancer care; Telemedicine and Territoriality; Equity, ethics, education; Research and resources; Alliance between stakeholders and patients.

In this commentary, we discuss opportunities to optimize cancer care delivery in the next decade building from evidence and advancements in the conceptualization and implementation of multi-level translational behavioral interventions. We summarize critical issues and discoveries describing new directions for translational behavioral research in the coming decade based on the promise of the accelerated application of this evidence within learning health systems. To illustrate these advances, we discuss cancer prevention, risk reduction (particularly precision prevention and early detection), and cancer treatment and survivorship (particularly risk- and need-stratified comprehensive care) and propose opportunities to equitably improve outcomes while addressing clinician shortages and cross-system coordination. We also discuss the impacts of COVID-19 and potential advances of scientific knowledge in the context of existing evidence, the need for adaptation, and potential areas of innovation to meet the needs of converging crises (e.g., fragmented care, workforce shortages, ongoing pandemic) in cancer health care delivery. Finally, we discuss new areas for exploration by applying key lessons gleaned from implementation efforts guided by advances in behavioral health.

Objective: Early access to work-related psychosocial cancer care can contribute to return to work of cancer survivors. We aimed to explore: (a) the extent to which hospital healthcare professionals conduct conversations about work-related issues with cancer survivors, (b) whether cancer survivors experience these conversations as helpful, and (c) the possible financial implications for cancer survivors of (not) discussing their work early on. Methods: The Dutch Federation of Cancer Patient Organizations developed and conducted a cross-sectional online survey, consisting of 27 items, among cancer survivors in the Netherlands. Results: In total, 3500 survivors participated in this study (71% female; mean age (SD) 56 (11) years). Thirty-two percent reported to have had a conversation about work-related issues with a healthcare professional in the hospital. Fifty-four percent indicated that this conversation had been helpful to them. Conversations about work-related issues took place more frequently with male cancer survivors, those aged 55 years or below, those diagnosed with gynecological, prostate, breast, and hematological or lymphatic cancer, those diagnosed ≤2 years ago, or those who received their last treatment ≤2 years ago. There was no statistically significant association between the occurrence of conversations about work-related issues and experiencing the financial consequences of cancer and/or its treatment as burdensome. Conclusions: Although conversations about work-related issues are generally experienced as helpful by cancer survivors, early access to work-related psychosocial cancer care in the hospital setting is not yet systematically offered.

The cancer burden is expected to reach 20 million new cases annually in low and middle-income countries (LMICs) by 2025. Few estimates suggest that thyroid cancer could become the third most common cancer diagnosed in women by 2019. Health care services need to gear up to provide close clinical follow-up care for patients especially in LMICs where there is already a shortage of healthcare personnel. We conducted this study to assess the effect of remote monitoring using tele-follow up on compliance, satisfaction and economic benefit. Participants were recruited to traditional hospital follow-up (consultation, clinical examination, and investigations as per hospital policy) or tele-follow up based on social media. Outcomes included information needs, participants’ compliance, and satisfaction, post-op complications, clinical investigations ordered. A total of 64 patients with thyroid cancer were recruited- 24 in hospital follow up group and 40 in the remote monitoring group. There were no significant differences between groups regarding satisfaction with information received. Responses were significantly more positive in the social media group, with a higher percentage reporting “very satisfied”. Wound evaluation through tele-follow up was on par with OPD follow up. If all of these 40 patients would have come to our OPD follow-up, they would have travelled on an average of 930 kms per patient. This study shows that social media is a practical tool in follow-up of cancer patients in LMICs where traditional telemedicine tools are restricted and conventional follow-up is economically challenging to patients. It also ensures compliance which is a major issue with conventional follow-up due to poor infrastructure.

Background With the current proliferation of clinical information technologies internationally, patient portals are increasingly being adopted in health care. Research, conducted mostly in the United States, shows that oncology patients have a keen interest in portals to gain access to and track comprehensive personal health information. In Canada, patient portals are relatively new and research into their use and effects is currently emerging. There is a need to understand oncology patients’ experiences of using eHealth tools and to ground these experiences in local sociopolitical contexts of technology implementation, while seeking to devise strategies to enhance portal benefits. Objective The purpose of this study was to explore the experiences of oncology patients and their family caregivers when using electronic patient portals to support their health care needs. We focused on how Alberta’s unique, 2-portal context shapes experiences of early portal adopters and nonadopters, in anticipation of a province-wide rollout of a clinical information system in oncology facilities. Methods This qualitative descriptive study employed individual semistructured interviews and demographic surveys with 11 participants. Interviews were audio-recorded and transcribed verbatim. Data were analyzed thematically. The study was approved by the University of Alberta Human Research Ethics Board. Results Participants currently living with nonactive cancer discussed an online patient portal as one among many tools (including the internet, phone, videoconferencing, print-out reports) available to make sense of their diagnosis and treatment, maintain connections with health care providers, and engage with information. In the Fall of 2020, most participants had access to 1 of 2 of Alberta’s patient portals and identified ways in which this portal was supportive (or not) of their ongoing health care needs. Four major themes, reflecting the participants’ broader concerns within which the portal use was occurring, were generated from the data: (1) experiencing doubt and the desire for transparency; (2) seeking to become an informed and active member of the health care team; (3) encountering complexity; and (4) emphasizing the importance of the patient–provider relationship. Conclusions Although people diagnosed with cancer and their family caregivers considered an online patient portal as beneficial, they identified several areas that limit how portals support their oncology care. Providers of health care portals are invited to recognize these limitations and work toward addressing them.

Background Patient-clinician communication is thought to be central to care outcomes, but when and how communication affects patient outcomes is not well understood. Objective We propose a conceptual model and classification framework upon which the empirical evidence base for the impact of patient-clinician communication can be summarized and further built. Design We use the proposed model and framework to summarize findings from two recent systematic reviews, one evaluating the use of shared decision making (SDM) on cancer care outcomes and the other evaluating the role of physician recommendation in cancer screening use. Key results Using this approach, we identified clusters of studies with positive findings, including those relying on the measurement of SDM from the patients’ perspective and affective-cognitive outcomes, particularly in the context of surgical treatment decision making. We also identify important gaps in the literature, including the role of SDM in post-surgical treatment and end-of-life care decisions, and those specifying particular physician communication strategies when recommending cancer screening. Conclusions Transparent linkages between key conceptual domains and the influence of methodological approaches on observed patient outcomes are needed to advance our understanding of how and when patient-clinician communication influences patient outcomes. The proposed conceptual model and classification framework can be used to facilitate the translation of empirical evidence into practice and to identify critical gaps in knowledge regarding how and when patient-clinician communication impacts care outcomes in the context of cancer and health care more broadly.

BackgroundHealth care systems are gradually moving toward new models of care based on integrated care processes shared by different care givers and on an empowered role of the patient. Mobile technologies are assuming an emerging role in this scenario. This is particularly true in care processes where the patient has a particularly enhanced role, as is the case of cancer supportive care. ObjectiveThis paper aims to review existing studies on the actual role and use of mobile technology during the different stages of care processes, with particular reference to cancer supportive care. MethodsWe carried out a review of literature with the aim of identifying studies related to the use of mHealth in cancer care and cancer supportive care. The final sample size consists of 106 records. ResultsThere is scant literature concerning the use of mHealth in cancer supportive care. Looking more generally at cancer care, we found that mHealth is mainly used for self-management activities carried out by patients. The main tools used are mobile devices like mobile phones and tablets, but remote monitoring devices also play an important role. Text messaging technologies (short message service, SMS) have a minor role, with the exception of middle income countries where text messaging plays a major role. Telehealth technologies are still rarely used in cancer care processes. If we look at the different stages of health care processes, we can see that mHealth is mainly used during the treatment of patients, especially for self-management activities. It is also used for prevention and diagnosis, although to a lesser extent, whereas it appears rarely used for decision-making and follow-up activities. ConclusionsSince mHealth seems to be employed only for limited uses and during limited phases of the care process, it is unlikely that it can really contribute to the creation of new care models. This under-utilization may depend on many issues, including the need for it to be embedded into broader information systems. If the purpose of introducing mHealth is to promote the adoption of integrated care models, using mHealth should not be limited to some activities or to some phases of the health care process. Instead, there should be a higher degree of pervasiveness at all stages and in all health care delivery activities.

Introduction Cancer is a deadly disease that, due to increasing risk factors, has been affecting increasingly more of the population. Due to this growth, there has been an increased demand for health system resources so that the individual affected can get the best possible outcome from their treatment as possible. The two parts of my thesis work together to understand the resources that must be accessible to cancer patients to have the best treatment outcomes possible. My Technical Project works to understand how access to infusion centers can be improved to increase throughput numbers, as infusions are very commonly used treatments for cancer. My STS Research Paper however, works to tackle cancer from a health literacy (HL) angle. It investigates how resources can be improved to reach and affect populations that may have different access to or comprehension of their cancer treatment more effectively. Project Summaries Through a systems-based approach, the technical portion of my thesis was completed as a capstone project that focused on improving an outpatient infusion center. We first conducted observations, interviews and created a process map to understand the current state of a Central Virginian infusion center and through this discovered a significant potential for increased efficiency. Themes including buffer time scheduling, idle time issues, pharmacy efficiency, and data quality were identified as well as improvement areas like unscheduled time, waiting time, and idle time. After investigating these areas as well as a plethora of timestamp data from the electronic health system, several strategies were identified to increase workflow efficiency. Linear regression helped us model and predict utilization hours, idle chair time, and if appointments go significantly over than expected. Through this, increased idle chair time was found to negatively affect utilization hours and previous literature identified drug pre-preparation to reduce these times. A pilot study was developed by our team and identified several drug candidates based on various variables. Overall, a holistic framework for understanding throughput issues and suggesting potential improvements was produced by this iterative technical work in close engagement with our stakeholders. Through my STS research, I came to the conclusion that because cancer health literacy directly impacts a patient’s outcome and it varies by social group, HL must be improved from an organizational approach. This means promotion and good cancer HL practices starts with the healthcare system as they are the best equipped to feasibly and equitably position the individual to receive the proper resources. The first step to systematically improve cancer HL is to assess the patient’s HL levels so that interactions and resources can be more tailored to the patient’s needs. Proper materials can then be disseminated to mitigate the issues of poor cancer HL as well as the disparities that exist within it. This research was completed mainly through literature review and the integration of the Social Construction of Technology (SCOT) framework. Conclusion By completing both my Capstone Project and my Research Paper, I was able to understand the various responsibilities of the cancer health system more clearly and how they directly and indirectly affect a cancer patient’s treatment. I am now able to draw insights into how the system must supplement their services for equitable access and care. A multidimensional approach is necessary for this as patients should be able to receive infusions when they need them, no matter the overall circumstances and patients should be positioned by this same health system to fully understand their treatments and decisions, no matter their social group. The two projects work together to help understand the holistic cancer care system and how they are in control of what resources the cancer patients are getting and how. Acknowledgments I would like to acknowledge my Capstone team: Devon Zavacky and Hayden Ratliff, as well as my Technical/Capstone advisor Dr. Rupa Valdez, and my STS advisor Richard Jacques. I would also like to acknowledge Daniel Kilgore, Gregory Pagonakis, Joey Valdez, Yara Mahmoud, Karen Measells, and Jamie Ford-Lane for their time and support throughout our entire Capstone project.

Efficiency in healthcare is crucial since available resources are scarce, and the cost of inefficient allocation is measured in prior outcomes. This is particularly relevant for cancer. The aim of this paper is to gain a comprehensive overview of the areas and dimensions to improve efficiency, and establish the indicators, different methods, perspectives, and areas of evaluation, to provide recommendations for how to improve efficiency and measure gains in cancer care. Methods: We conducted a two-phase design. First, a comprehensive scoping literature review was conducted, searching four databases. Studies published between 2000 and 2021 were included if they described experiences and cases of efficiency in cancer care or methods to evaluate efficiency. The results of the literature review were then discussed during two rounds of online consultation with a panel of 15 external experts invited to provide insight and comments to deliberate policy recommendations. Results: 46 papers met the inclusion criteria. Based on the papers retrieved we identified six areas for achieving efficiency gains throughout the entire care pathway and, for each area of efficiency, we categorized the methods and outcomes used to measure efficiency gain. Conclusion: This is the first attempt to systemize a scattered body of literature on how to improve efficiency in cancer care and identify key areas of improvement. Policy summary: There are many opportunities to improve efficiency in cancer care. We defined seven policy recommendations on how to improve efficiency in cancer care throughout the care pathway and how to improve the measurement of efficiency gains.

Yang Zhang,1 Fang Yao,1 Xiaohong Kuang,1 Lijuan Li,1 Lihua Huang,1 Qi Zhou,1 Jiazhu Peng,1 Qingyu Chang2 1Department of Nursing, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215600, People’s Republic of China; 2Department of Surgery, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215600, People’s Republic of ChinaCorrespondence: Xiaohong Kuang Email zjgszyyykxh@aliyun.comPurpose: To evaluate the quality of systematic reviews/meta-analyses (SR/MAs) on alternative exercise traditions in cancer care.Methods: PubMed, Cochrane Library, Web of Science, Ovid, EBSCOhost, WanFang Database, China National Knowledge Infrastructure, and VIP Database were searched from their inception to June 30, 2020. The search used a combination of subject words and free words. The search terms included “Tai Chi,” “Qigong,” “Baduanjin,” “Yoga,” “Pilates,” “Cancer,” “Meta-analysis,” and “Systematic review.” Two researchers independently performed literature screening and data extraction and used AMSTAR scale and PRISMA statement to evaluate the methodology and the quality of the evidence.Results: A total of 26 SR/MAs were included. The AMSTAR scale score was 5– 10 points, with an average of 7.46± 1.33 points. Overall, the methodological quality was considered to be moderate. The PRISMA list score was 13– 24 points, with an average of 19.19± 2.86 points. Among the papers evaluated, eight reports were relatively complete. A total of 15 papers indicated certain defects. A total of three papers showed relatively serious information defects.Conclusion: Relative to the control group, alternative exercise traditions may be effective in improving the quality of life, anxiety, depression, distress, and fatigue of cancer patients. However, they may not necessarily improve patients’ sleep outcome, body mass index, and pain. During convalescence, cancer patients can be encouraged to start engaging in physical exercise, and professionals can develop appropriate exercise alternatives to ensure the expected effect of exercise while ensuring the safety of patients. The methodological quality of the systematic evaluations of the intervention effects of alternative exercise traditions on cancer patients is not satisfactory. Hence, focus should be directed to the improvement of the preliminary design scheme, publication status, literature retrieval, conflict of interest, and other aspects.Keywgords: alternative exercise traditions, cancer care, COVID-19, overview

Purpose To evaluate the quality of systematic reviews/meta-analyses (SR/MAs) on alternative exercise traditions in cancer care. Methods PubMed, Cochrane Library, Web of Science, Ovid, EBSCOhost, WanFang Database, China National Knowledge Infrastructure, and VIP Database were searched from their inception to June 30, 2020. The search used a combination of subject words and free words. The search terms included “Tai Chi,” “Qigong,” “Baduanjin,” “Yoga,” “Pilates,” “Cancer,” “Meta-analysis,” and “Systematic review.” Two researchers independently performed literature screening and data extraction and used AMSTAR scale and PRISMA statement to evaluate the methodology and the quality of the evidence. Results A total of 26 SR/MAs were included. The AMSTAR scale score was 5–10 points, with an average of 7.46±1.33 points. Overall, the methodological quality was considered to be moderate. The PRISMA list score was 13–24 points, with an average of 19.19±2.86 points. Among the papers evaluated, eight reports were relatively complete. A total of 15 papers indicated certain defects. A total of three papers showed relatively serious information defects. Conclusion Relative to the control group, alternative exercise traditions may be effective in improving the quality of life, anxiety, depression, distress, and fatigue of cancer patients. However, they may not necessarily improve patients’ sleep outcome, body mass index, and pain. During convalescence, cancer patients can be encouraged to start engaging in physical exercise, and professionals can develop appropriate exercise alternatives to ensure the expected effect of exercise while ensuring the safety of patients. The methodological quality of the systematic evaluations of the intervention effects of alternative exercise traditions on cancer patients is not satisfactory. Hence, focus should be directed to the improvement of the preliminary design scheme, publication status, literature retrieval, conflict of interest, and other aspects.

Efficiency in healthcare is crucial since available resources are scarce, and the cost of inefficient allocation is measured in prior outcomes. This is particularly relevant for cancer. The aim of this paper is to gain a comprehensive overview of the areas and dimensions to improve efficiency, and establish the indicators, different methods, perspectives, and areas of evaluation, to provide recommendations for how to improve efficiency and measure gains in cancer care. Methods: We conducted a two-phase design. First, a comprehensive scoping literature review was conducted, searching four databases. Studies published between 2000 and 2021 were included if they described experiences and cases of efficiency in cancer care or methods to evaluate efficiency. The results of the literature review were then discussed during two rounds of online consultation with a panel of 15 external experts invited to provide insight and comments to deliberate policy recommendations. Results: 46 papers met the inclusion criteria. Based on the papers retrieved we identified six areas for achieving efficiency gains throughout the entire care pathway and, for each area of efficiency, we categorized the methods and outcomes used to measure efficiency gain. Conclusion: This is the first attempt to systemize a scattered body of literature on how to improve efficiency in cancer care and identify key areas of improvement. Policy summary: There are many opportunities to improve efficiency in cancer care. We defined seven policy recommendations on how to improve efficiency in cancer care throughout the care pathway and how to improve the measurement of efficiency gains.

The spread of instant messenger systems provides an excellent opportunity and a helpful tool to healthcare professionals. WhatsApp instant messenger use is widely prevalent among health professionals, cancer patients, caregivers and the general population. It is a quick and easy communication tool that may also be used on personal computers and business purposes. WhatsApp instant messenger and other similar tools may be a very useful complement for e-medicine. Instant messaging systems may be helpful, especially in rural areas, in medium- or low-income countries, or to avoid unnecessary travels, improve knowledge and awareness of cancer, monitor home care and support the delivery of home care. The unregulated use of WhatsApp instant messenger requires sound and shared guidelines to assure impeccable professional service. Although a significant number of papers have investigated the roles of social networks in connecting patients to health professionals, there is still a lack of information and scientific data about their uses, benefits and limitations in connecting health providers only for professional communication. The role of instant messenger systems in cancer practice and research needs to be clarified. In this paper, we report a focus on available data, pros and contras of the unregulated use of WhatsApp instant messaging, in the context of e-medicine, as an interprofessional and doctor/patient communication tool in oncology.

Objective: Shared decision making (SDM) and use of patient decision aids (PtDAs) are key components in patient-centered care in relapsed ovarian cancer. This paper describes the development and implementation process of PtDAs into a clinical routine in three departments. Methods: Two PtDAs were developed in collaboration between patients and clinicians. Acceptability and usability of the PtDAs were tested on clinicians and patients using items from the internationally validated questionnaire “Preparation for Decision Making Scale”. Results: Ten patients and 15 clinicians participated in the study. Most patients indicated that PtDAs would be helpful as preparation for the decision-making process with the clinicians. Ten (75%) of the clinicians responded that the PtDAs helped the patients to understand the benefits and disadvantages of each treatment option. Generally, the clinicians indicated that they would use SDM if they had a PtDA tailored to the clinical situation. Conclusions: Two PtDAs were systematically developed, tested, and implemented thereby supporting an SDM intervention. The PtDAs are still in use at the participating departments. Innovation: This study was successful in reusing a generic template for a patient decision aid (PtDA) developed at one institution and implemented in two other institutions. This was guided by a well-described systematic development process for PtDAs.

In this paper, we use a design science approach to develop a mobile app for lung cancer patients that facilitates their interactions with their clinicians, manages and reports on their health status, and provides them access to medical information/education. This paper contributes to the information systems literature by demonstrating the value of design science research to co-create solutions that advance health care outcomes through technological innovations. The design process engaged a diverse cast of experts and methods, such as a survey of oncologists and cancer patients, a workshop, roundtables and interviews with leading patient and clinician association representatives and focus groups, including two panels each of clinicians and cancer patients. Our approach also develops actionable knowledge that is grounded in evidence from the field, including design guidelines that recapitulate what we learned from the design-testing-redesign cycles of our artefact.

In this paper, we use a design science approach to develop a mobile app for lung cancer patients that facilitates their interactions with their clinicians, manages and reports on their health status, and provides them access to medical information/education. This paper contributes to the information systems literature by demonstrating the value of design science research to co-create solutions that advance health care outcomes through technological innovations. The design process engaged a diverse cast of experts and methods, such as a survey of oncologists and cancer patients, a workshop, roundtables and interviews with leading patient and clinician association representatives and focus groups, including two panels each of clinicians and cancer patients. Our approach also develops actionable knowledge that is grounded in evidence from the field, including design guidelines that recapitulate what we learned from the design-testing-redesign cycles of our artefact.

Introduction: Ageism towards older adults with cancer may impact treatment decisions, healthcare interactions, and shape health/psychosocial outcomes. The purpose of this review is twofold: (1) To synthesize the literature on ageism towards older adults with cancer in oncology and (2) To identify interventions that address ageism in the healthcare context applicable to oncology.Materials and methods: We conducted a scoping review following Arksey and O'Malley and Levac methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted an exhaustive multi-database search, screening 30,926 titles/abstracts. Following data abstraction, we conducted tabular, narrative, and textual synthesis.Results: We extracted data on 133 papers. Most (n = 44) were expert opinions, reviews, and letters to editors highlighting the negative impacts of ageism, expressing the need for approaches addressing heterogeneity of older adults, and calling for increased clinical trial inclusion for older adults. Qualitative studies (n = 3) described healthcare professionals' perceived influence of age on treatment recommendations, whereas quantitative studies (n = 32) were inconclusive as to whether age-related bias impacted treatment recommendations/outcomes or survival. Intervention studies (n = 54) targeted ageism in pre/post-licensure healthcare professionals and reported participants' improvement in knowledge and/or attitudes towards older adults. No interventions were found that had been implemented in oncology.Discussion: Concerns relating to ageism in cancer care are consistently described in the literature. Interventions exist to address ageism; however, none have been developed or tested in oncology settings. Addressing ageism in oncology will require integration of geriatric knowledge/interventions to address conscious and unconscious ageist attitudes impacting care and outcomes. Interventions hold promise if tailored for cancer care settings.

This paper reviews perspectives of the significance of the National Cancer Act of 1971, made personal through two lengthy oncology nursing careers, one alongside the experience of a now long-term cancer survivor. Our careers have come to be de ned by a variety of oncology nursing roles, leadership in the Oncology Nursing Society, and interests in nursing history, particularly as it relates to nurses whose career paths largely focus on individuals affected by cancer, encompassing acute and chronic cancer care, cancer research, oncology nursing research, and the evolution of understanding the needs of cancer survivors.

Introduction To improve quality across levels of care, we developed a standardized care pathway (SCP) integrating palliative and oncology services for hospitalized and home-dwelling palliative cancer patients in a rural region. Methods A multifaceted implementation strategy was directed towards a combination of target groups. The implementation was conducted on a system level, and implementation-related activities were registered prospectively. Adult patients with advanced cancer treated with non-curative intent were included and interviewed. Healthcare leaders (HCLs) and healthcare professionals (HCPs) involved in the development of the SCP or exposed to the implementation strategy were interviewed. In addition, HCLs and HCPs exposed to the implementation strategy answered standardized questionnaires. Hospital admissions were registered prospectively. Results To assess the use of the SCP, 129 cancer patients were included. Fifteen patients were interviewed about their experiences with the patient-held record (PHR). Sixty interviews were performed among 1320 HCPs exposed to the implementation strategy. Two hundred and eighty-seven HCPs reported on their training in and use of the SCP. Despite organizational cultural differences, developing an SCP integrating palliative and oncology services across levels of care was feasible. Both HCLs and HCPs reported improved quality of care in the wake of the implementation process. Two and a half years after the implementation was launched, 28% of the HCPs used the SCP and 41% had received training in its use. Patients reported limited use and benefit of the PHR. Conclusion An SCP may be a usable tool for integrating palliative and oncology services across care levels in a rural region. An extensive implementation process resulted in improvements of process outcomes, yet still limited use of the SCP in clinical practice. HCLs and HCPs reported improved quality of cancer care following the implementation process. Future research should address mandatory elements for usefulness and successful implementation of SCPs for palliative cancer patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-021-00176-y., Plain language summary When a patient has incurable cancer, it is beneficial to introduce palliative care early in the disease trajectory along with anti-cancer treatment. A standardized care pathway is a method to improve quality and reduce variation in healthcare. It can promote integrated healthcare services in palliative care, e.g. by specifying action points when the patient’s situation is changing. In this study, a standardized care pathway for cancer patients with palliative care needs was developed in a rural region of Norway. The pathway focused on patients’ needs and symptoms and on smooth transition between levels of care. An educational program and an information strategy were developed to ensure implementation. To evaluate the implementation, all activity regarding the implementation process was registered. Cancer patients and healthcare professionals were interviewed and answered questionnaires. One thousand three hundred and twenty healthcare professionals were exposed to the implementation strategy. One hundred and twenty-nine cancer patients were followed up according to the standardized care pathway. Despite different perspectives of care, it was feasible to develop a standardized care pathway for palliative cancer patients across care settings. A paper-based patient-held record was only found to be useful by a limited number of patients. An extensive implementation process was completed and resulted in improvements regarding healthcare professionals’ experience with the quality of cancer care in the region, but limited use of the care pathway in clinical practice. Further research should identify the most important elements for usefulness and successful implementation of the care pathway. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-021-00176-y.

This brief report aimed to describe a narrative review about the application of machine learning (ML) methods and Blockchain technology (BCT) in the healthcare field, and to illustrate the integration of these two technologies in cancer survivorship care. A total of six eligible papers were included in the narrative review. ML and BCT are two data-driven technologies, and there is rapidly growing interest in integrating them for clinical data management and analysis in healthcare. The findings of this report indicate that both technologies can integrate feasibly and effectively. In conclusion, this brief report provided the state-of-art evidence about the integration of the most promising technologies of ML and BCT in health field, and gave an example of how to apply these two most disruptive technologies in cancer survivorship care.

Carcinosarcoma, leiomyosarcoma, melanoma and carcinoid as primary tumors in the ovary are extremely rare. In this paper, the authors reviewed the literature from 2010 to 2021, based on specific criteria, to analyze the treatment of these rare ovarian neoplasms. We also aimed to verify whether modern therapies have been found in recent years. For this article, 80 papers were finally selected. The vast majority of the articles were clinical case reports. Despite single mentions of new potential pharmacological treatments, surgery (radical or fertility-sparing) is definitely the mainstay of treatment. There are currently no treatment guidelines for these tumors. A review of the literature has revealed the use of various adjuvant treatments. We, therefore, believe that a more detailed understanding of the biology of these tumors is necessary in order to find new target points for treatment. We would like to emphasize the importance of creating an international database of rare ovarian tumors which would make it possible to gather data from various oncological centers and enable further research into these neoplasms.

Agradecimentos: Authors would like to acknowledge the contribution of Maria Do Carmo Esteves da Costa, Fernanda Paula Sousa, Claudia Furia Cesar, Cristiane Castro, Fernanda Paula Sousa, Larissa Verissimo, Otavio Ferraz, Pedro Pairazaman, Saskia Nahrgan and Ezau Pontes. Mario Henrique Neiva Saraiva and Ashleigh Dunworth provided excellent research assistance. Authors are grateful for significant technical input and logistical support for the fieldwork in Bahia from all the involved municipalities (Salvador, Saubara, Vera Cruz, Camaçari, Ipojuca, Dias d’Ávila, Santo Antônio de Jesus, Amargosa, Itatim, Cruz das Almas, Governador Mangabeira e Maragogipe), as well as from the many health professionals and health system managers that participated in the process. Lastly, we would like to thank two anonymous reviewers for valuable suggestions and comments Abstract: Health is recognized as a fundamental right in Brazil’s constitution. In the absence of a clearly defined benefit packages of healthcare services that are financed under the Unified Health System (Sistema Único de Saúde, SUS), courts have become important in adjudicating coverage decisions. Empirical assessments of equity and the right to health tend to focus on simple measures of access. However, these empirical perspectives belie the significant inequalities and rights violations that arise in the case of more complex health needs such as cancer. To shed light on these issues, this paper focuses on the care pathways for breast and cervical cancer and explores access and quality issues that arise at different points along the care pathway with implications for the realization of the right to health in Brazil. A mixed method approach is used. The analysis is primarily based on a quantitative analysis of national representative administrative data principally from the cervical and breast cancer information systems and the hospital cancer registry. To gain more insights into the organization of cancer care, qualitative data was collected from the state of Bahia, through document analysis, direct observation, roundtable discussions with health workers (HWs), and structured interviews with health care administrators. The paper reveals that the volume of completed screening exams is well below the estimated need, and a tendency toward lower breast cancer screening rates in poorer states and for women in the lowest income brackets. Only 26% of breast cancer cases and 29% of cervical cancer cases are diagnosed at an early stage (stage 0 or I), thereby reducing the survival prospects of patients. Waiting times between confirmed diagnosis and treatment are long, despite new legislation that guarantees a maximum of 60?days. The waiting times are significantly longer for patients that follow the recommended patient pathways, and who are diagnosed outside the hospital. The study reveals that there are large variations between states and patients, where the poorest states and patients fare worse on key indicators. More broadly, the paper shows the importance of collecting data both on patient characteristics and health system performance and carry out detailed health system analysis for exposing, empirically, rights violations and for identifying how they can be addressed Aberto

From 1999 to 2011, It is estimated that more than 1,000,000 cancer survivors in Korea and it was found that 1 per 45 persons in the total population was receiving cancer treatment or was surviving after cancer treatment (Jung et al 2014). As the number and survival period of cancer survivors increase, their late complications, Both of management of cancer as chronic diseases and prevention of secondary cancer have emerged as new health isssues, requiring the interest of medical professionals and development of medical policies. In this paper, the health issues from cancer survivors are reviewed, and clinical and policy measures are sought regarding the medical environment in Korea.

Resumen: El presente artículo de reflexión revisa aspectos bioéticos en estudios científicos de plantas utilizadas en medicina tradicional para el tratamiento del cáncer en México. El conocimiento de las plantas medicinales documentadas en la medicina tradicional se relaciona con enfermedades como el cáncer. Esta enfermedad presenta altas tasas de mortalidad en el mundo, lo que incrementa la necesidad de nuevos fármacos para la quimioterapia. Aquí las plantas medicinales juegan un papel importante. Así, al ejecutar un estudio de plantas medicinales se deben considerar aspectos bioéticos fundamentales para la medicina tradicional como el muestreo, el estudio fitoquímico y biológico en líneas celulares de cáncer, basándose en la normatividad vigente, en estándares internacionales del Instituto Nacional del Cáncer y, principalmente, en los cuatro principios básicos de la bioética. Concluimos que es tarea de la comunidad científica avalar o desmentir el uso tradicional de las plantas medicinales para el tratamiento de enfermedades. El estudio de especies vegetales debe cumplir criterios donde la teoría, la investigación y la práctica ofrezcan soluciones a largo plazo y la protección ética de estas, del conocimiento tradicional y de los pacientes que recurren a esta alternativa. Abstract: The present reflection paper reviews bioethical aspects in scientific studies of plants used in traditional medicine for the treatment of cancer in Mexico. The knowledge of medicinal plants documented in traditional medicine is related to diseases such as cancer. This disease has high mortality rates worldwide, increasing the need for new chemotherapy drugs. Here medicinal plants play an important role. Thus, when executing a study of medicinal plants, fundamental bioethical aspects for traditional medicine such as sampling, phytochemical and biological study in cancer cell lines, based on current regulations, international standards of the National Cancer Institute and, mainly, the four basic principles of bioethics, should be considered. We conclude that it is the task of the scientific community to endorse or deny the traditional use of medicinal plants for the treatment of diseases. The study of plant species must meet criteria where theory, research and practice offer long-term solutions and the ethical protection of plant species, traditional knowledge and patients who resort to this alternative. Resumo: Neste artigo de reflexão, são revisados aspectos bioéticos em estudos científicos de plantas utilizadas na medicina tradicional para tratar o câncer no México. O conhecimento das plantas medicinais documentadas na medicina tradicional está relacionado com doenças como o câncer. Essa doença apresenta altas taxas de mortalidade em todo o mundo, o que aumenta a necessidade de novos fármacos para a quimioterapia. Aqui, as plantas medicinais desempenham um papel importante. Assim, ao realizar um estudo de plantas medicinais, devem ser considerados aspectos bioéticos fundamentais para a medicina tradicional como a amostra, o estudo fitoquímico e biológico em linhas celulares de câncer, com base na normatividade vigente, em parâmetros internacionais do Instituto Nacional do Câncer e, principalmente, nos quatro princípios básicos da bioética. Concluímos que é tarefa da comunidade científica confirmar ou desmentir o uso tradicional das plantas medicinais para o tratamento de doenças. O estudo de espécies vegetais deve cumprir com critérios em que a teoria, a pesquisa e a prática ofereçam soluções em longo prazo e com a proteção ética destas, do conhecimento tradicional e dos pacientes que recorrem a essa alternativa.

Highlights of the paper • This paper highlights the use of telemedicine based interventions which have emerged as reasonable practical solutions to these impediments in the delivery of care to cancer patients. • This paper highlights the benefits for both patients and doctors in term to provide quality care without shifting to physical location. • Telemedicine has also been utilized to manage difficult cases remotely and even chemotherapy in different states was administered under guidance and monitoring was advised by Tele-hand-holding. • Care teams and health systems across the world need to focus on innovating and developing newer technologies to incorporate virtual care into the practice of oncology and this paper highlights this issue. • Telemedicine is here to stay and revolutionize cancer care in the times to come and most futuristic modality to optimise cancer care in pandemic and beyond., In the current era of COVID-19 pandemic where at least some degree of social distancing is the norm and hospitals have emerged as hotspots for acquiring the infection, it has become important for oncologists to devise methods of providing care to cancer patients while minimizing patients’ exposure to healthcare settings. In light of the on-going pandemic, it has been recommended that in-patient visits for cancer patients should be substituted by virtual visits and patients should be advised to proceed directly for infusion treatment. Telemedicine and tele-health based interventions have emerged as reasonably practical solutions to these impediments in the delivery of care to cancer patients. Technological advancements have resolved the issue of connectivity for telemedicine even to the remotest places. Teleconsultation is becoming an acceptable alternative for patients and health care providers in this era of information technology. Albeit the challenges that we are facing are diverse and therefore cannot have a singular full proof answer, telemedicine and tele-health based interventions seem to offer promise in effectively complementing our efforts in that direction. Telemedicine is beneficial for both patients and doctors in term to provide quality care without shifting to physical location.

Physical function (PF) in older patients with cancer may decline during and after oncologic therapy. This study aimed to develop and pilot test an individually tailored unsupervised physical activity (PA) program and dietary recommendations to promote PF in older patients with cancer. Following development and pretest, the intervention was pilot tested to explore feasibility, acceptance, adherence and potential benefit. Patients ≥60 years, with heterogeneous cancer diagnoses, starting outpatient radiotherapy were randomized in two study arms: paper-based vs. video-based instructions. Based on assessments of PF, PA, nutrition, cognition, mental health, social support, HRQOL and personal goals, participants received individual recommendations for PA and nutrition. After 12 weeks of intervention (T1), reassessments were performed. The postal 4-week follow-up questionnaire included PA, nutrition and HRQOL. Participants (n = 24, 14 female, mean age 70 ± 7 years) showed comparable characteristics in both study arms. The majority rated the program as helpful. Facilitators and barriers to PA adherence were collected. Both modes of instructions were appreciated equally. PF (EORTC QLQ-C30) declined slightly (not clinically relevant >10 pts.) at group level T0: 76 ± 16, T1: 68 ± 21, T2: 69 ± 24. The intervention was feasible, well accepted, showing potential benefit for the maintenance of PF during outpatient radiotherapy, and should be further tested in a larger sample.

Introduction: Ageism towards older adults with cancer may impact treatment decisions, healthcare interactions, and shape health/psychosocial outcomes. The purpose of this review is twofold: (1) To synthesize the literature on ageism towards older adults with cancer in oncology and (2) To identify interventions that address ageism in the healthcare context applicable to oncology. Materials and methods: We conducted a scoping review following Arksey and O'Malley and Levac methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted an exhaustive multi-database search, screening 30,926 titles/abstracts. Following data abstraction, we conducted tabular, narrative, and textual synthesis. Results: We extracted data on 133 papers. Most (n = 44) were expert opinions, reviews, and letters to editors highlighting the negative impacts of ageism, expressing the need for approaches addressing heterogeneity of older adults, and calling for increased clinical trial inclusion for older adults. Qualitative studies (n = 3) described healthcare professionals' perceived influence of age on treatment recommendations, whereas quantitative studies (n = 32) were inconclusive as to whether age-related bias impacted treatment recommendations/outcomes or survival. Intervention studies (n = 54) targeted ageism in pre/post-licensure healthcare professionals and reported participants' improvement in knowledge and/or attitudes towards older adults. No interventions were found that had been implemented in oncology. Discussion: Concerns relating to ageism in cancer care are consistently described in the literature. Interventions exist to address ageism; however, none have been developed or tested in oncology settings. Addressing ageism in oncology will require integration of geriatric knowledge/interventions to address conscious and unconscious ageist attitudes impacting care and outcomes. Interventions hold promise if tailored for cancer care settings.

Background Health is recognized as a fundamental right in Brazil’s constitution. In the absence of a clearly defined benefit packages of healthcare services that are financed under the Unified Health System (Sistema Único de Saúde, SUS), courts have become important in adjudicating coverage decisions. Empirical assessments of equity and the right to health tend to focus on simple measures of access. However, these empirical perspectives belie the significant inequalities and rights violations that arise in the case of more complex health needs such as cancer. To shed light on these issues, this paper focuses on the care pathways for breast and cervical cancer and explores access and quality issues that arise at different points along the care pathway with implications for the realization of the right to health in Brazil. Method A mixed method approach is used. The analysis is primarily based on a quantitative analysis of national representative administrative data principally from the cervical and breast cancer information systems and the hospital cancer registry. To gain more insights into the organization of cancer care, qualitative data was collected from the state of Bahia, through document analysis, direct observation, roundtable discussions with health workers (HWs), and structured interviews with health care administrators. Results The paper reveals that the volume of completed screening exams is well below the estimated need, and a tendency toward lower breast cancer screening rates in poorer states and for women in the lowest income brackets. Only 26% of breast cancer cases and 29% of cervical cancer cases are diagnosed at an early stage (stage 0 or I), thereby reducing the survival prospects of patients. Waiting times between confirmed diagnosis and treatment are long, despite new legislation that guarantees a maximum of 60 days. The waiting times are significantly longer for patients that follow the recommended patient pathways, and who are diagnosed outside the hospital. Conclusion The study reveals that there are large variations between states and patients, where the poorest states and patients fare worse on key indicators. More broadly, the paper shows the importance of collecting data both on patient characteristics and health system performance and carry out detailed health system analysis for exposing, empirically, rights violations and for identifying how they can be addressed. Electronic supplementary material The online version of this article (10.1186/s12939-019-0938-x) contains supplementary material, which is available to authorized users.

Patient distress is frequently missed in everyday cancer care, yet can be associated with decreased quality of life and satisfaction with care, as well as increased risk for comorbidity and morbidity. Considered as an aspect of a patient-centred approach, screening for distress is now an international standard of practice and constitutes an accreditation criterion for cancer centers in the USA and Canada. Inspired by existing health partnership models, the Centre Hospitalier de l’Université de Montréal’s (CHUM) Integrative Cancer Care Center recruited patients to act as partners during the creation and implementation of its screening for distress program. Patient partner roles in the program included becoming a member of a specialized psychosocial oncology team, contributing to a healthcare professional training program and helping to select tools to detect distress. This paper describes why and how the CHUM cancer care centre developed an innovative screening for distress program, using a patient partnership approach, to better meet the needs of patients with cancer.

Введение (актуальность). Рак молочной железы  наиболее распространенный вид злокачественных опухолей у женщин. Каждый год регистрируется более 2 миллионов новых случаев РМЖ. Это злокачественное новообразование является одной из основных причин женской онкологической смертности в мире. Цель исследования. Обобщение методических подходов к автоматизации оценок качества лечения РМЖ. Результаты. Общеевропейская методология контроля качества лечения РМЖ реализуется на добровольной основе. Аудиторы проверяют соответствие деятельности медицинской организации предустановленным требованиям как удаленно, так и непосредственно во время визитов в организации по лечению РМЖ. Учреждения, вовлеченные в организацию и оказание онкологической помощи при РМЖ могут самостоятельно рассчитывать показатели качества путем анализа внутренних сведений без передачи их за пределы организации, оказывающей помощь при РМЖ. Для этого был разработан европейский Калькулятора показателей качества, представляющий собой ИТ-инструмент с возможностью инсталляции его на компьютеры в организациях по диагностике и лечению РМЖ. В данной научной статье обобщены характеристики европейского калькулятора показателей качества лечения РМЖ. Обсуждение и выводы. В Евросоюзе разработан новейший легко адаптируемый на практике автоматизированный калькулятор измерения качества, позволяющий формировать отчетность о предоставляемой онкологической помощи при РМЖ. Автоматизация оценок качества благоприятствует реализации принципов прозрачности и объективности в осуществлении контроля медицинской деятельности, а также является одним из условий создания комплексной интегративной системы непрерывного цифрового мониторинга и анализа качества онкологической помощи в реальном времени., Introduction (relevance). Breast cancer is the most common type of malignancy in women. More than 2 million new cases of breast cancer are reported each year. This malignancy is one of the leading causes of cancer mortality in women worldwide. Objective of the study. To summarize methodological approaches to the automation of breast cancer treatment quality assessment. Results. A pan-European methodology for monitoring the quality of breast cancer treatment is being implemented on a voluntary basis. Auditors verify a healthcare organisation's compliance with pre-specified requirements both remotely and by visiting breast cancer treatment facilities. Institutions involved in the organisation and delivery of cancer care for breast cancer can calculate quality indicators on their own by analysing internal data without transferring them outside the cancer care organisation. For this purpose, the European Quality Indicator Calculator has been developed as an IT tool that can be installed on computers in cancer organisations. This research paper summarises the characteristics of the European Quality Indicator Calculator for Cancer Treatment. Discussion and conclusions. The European Union has developed a novel, easily adaptable, automated quality measurement calculator for reporting of cancer care provided for breast cancer. The automation of quality assessments favours the principles of transparency and objectivity in the control of medical activities and is one of the conditions for establishing a comprehensive integrative system for continuous digital monitoring and analysis of the quality of cancer care in real time.

Background: According to the literature an increasing number of cancer patients demand for complementary therapies during their disease. Research has demonstrated that some of these therapies are effective and safe as adjunctive treatments in specific symptoms of these patients. Methods: The aims of the paper are to review the main and recent papers of international literature on the effectiveness of complementary medicine (CM) therapies on side effects of anti-cancer protocols and improvement in the quality of life of oncological patients, and to describe the integration of evidence-based acupuncture, herbal medicine and homeopathy treatments in Public Cancer Network of the region of Tuscany. Results: After the review of literature and the approval of a Regional Resolution, some CM will be introduced in Cancer Departments in Tuscany to additionally treat cancer-related symptoms and side effects of conventional cancer therapy: acupuncture for nausea and post-chemotherapy and post-surgery vomiting, pain, hot flashes of iatrogenic menopause, xerostomia; homeopathy for hot flashes of iatrogenic menopause and the side effects of radiotherapy; herbal medicine for cancer-related fatigue, nausea and vomiting, pain, mucositis, anxiety, and depression. Conclusions: The integration of evidence-based complementary treatments allows for an effective response to the demand coming from cancer patients and combines safety and equity of access in public health systems.

The present reflection paper reviews bioethical aspects in scientific studies of plants used in traditional medicine for the treatment of cancer in Mexico. The knowledge of medicinal plants documented in traditional medicine is related to diseases such as cancer. This disease has high mortality rates worldwide, increasing the need for new chemotherapy drugs. Here medicinal plants play an important role. Thus, when executing a study of medicinal plants, fundamental bioethical aspects for traditional medicine such as sampling, phytochemical and biological study in cancer cell lines, based on current regulations, international standards of the National Cancer Institute and, mainly, the four basic principles of bioethics, should be considered. We conclude that it is the task of the scientific community to endorse or deny the traditional use of medicinal plants for the treatment of diseases. The study of plant species must meet criteria where theory, research and practice offer long-term solutions and the ethical protection of plant species, traditional knowledge and patients who resort to this alternative. El presente artículo de reflexión revisa aspectos bioéticos en estudios científicos de plantas utilizadas en medicina tradicional para el tratamiento del cáncer en México. El conocimiento de las plantas medicinales documentadas en la medicina tradicional se relaciona con enfermedades como el cáncer. Esta enfermedad presenta altas tasas de mortalidad en el mundo, lo que incrementa la necesidad de nuevos fármacos para la quimioterapia. Aquí las plantas medicinales juegan un papel importante. Así, al ejecutar un estudio de plantas medicinales se deben considerar aspectos bioéticos fundamentales para la medicina tradicional como el muestreo, el estudio fitoquímico y biológico en líneas celulares de cáncer, basándose en la normatividad vigente, en estándares internacionales del Instituto Nacional del Cáncer y, principalmente, en los cuatro principios básicos de la bioética. Concluimos que es tarea de la comunidad científica avalar o desmentir el uso tradicional de las plantas medicinales para el tratamiento de enfermedades. El estudio de especies vegetales debe cumplir criterios donde la teoría, la investigación y la práctica ofrezcan soluciones a largo plazo y la protección ética de estas, del conocimiento tradicional y de los pacientes que recurren a esta alternativa. Neste artigo de reflexão, são revisados aspectos bioéticos em estudos científicos de plantas utilizadas na medicina tradicional para tratar o câncer no México. O conhecimento das plantas medicinais documentadas na medicina tradicional está relacionado com doenças como o câncer. Essa doença apresenta altas taxas de mortalidade em todo o mundo, o que aumenta a necessidade de novos fármacos para a quimioterapia. Aqui, as plantas medicinais desempenham um papel importante. Assim, ao realizar um estudo de plantas medicinais, devem ser considerados aspectos bioéticos fundamentais para a medicina tradicional como a amostra, o estudo fitoquímico e biológico em linhas celulares de câncer, com base na normatividade vigente, em parâmetros internacionais do Instituto Nacional do Câncer e, principalmente, nos quatro princípios básicos da bioética. Concluímos que é tarefa da comunidade científica confirmar ou desmentir o uso tradicional das plantas medicinais para o tratamento de doenças. O estudo de espécies vegetais deve cumprir com critérios em que a teoria, a pesquisa e a prática ofereçam soluções em longo prazo e com a proteção ética destas, do conhecimento tradicional e dos pacientes que recorrem a essa alternativa.

Background: Healthcare services have responded to the challenges of service delivery during COVID-19 with telehealth and hybrid models of care. However, there is limited understanding of the experiences of care among people affected by cancer and how their experiences may change and evolve against the shifting landscape of COVID-19 incidence, mortality, vaccination and refinements in service delivery. Objectives: This study explores the experiences of cancer care among people affected by cancer in Ireland during the COVID-19 pandemic. This paper presents the results of the initial cross-sectional semi-structured interviews and the longitudinal qualitative research design which will be employed in this study. Design: A longitudinal descriptive qualitative study. Setting: Ireland. Participants: People living with and after cancer or caring for someone with cancer during the COVID-19 pandemic. Methods: Participants were recruited to the study via social media advertisements and consented to participate in up to three semi-structured interviews between January and July 2021. Initial semi-structured interviews were conducted with 16 participants in January 2021. Participants completed measures of resilience (2-item Connor-Davidson Resilience Scale) and distress (The National Comprehensive Cancer Network Distress Thermometer). Interviews were recorded, transcribed and analyzed thematically. Results: Participants reported low levels of distress and moderate to high levels of resilience on average. Three themes were generated from analysis of the first phase of cross-sectional interviews. Participants described a counterbalance of being cautious of infection and keeping safe through prevention and shielding strategies. Although hospitals felt safe and were working efficiently, some participants felt COVID-19 had compromised person-centredness and empathy in care. While participants valued the restrictions being taken to minimize infection risk, substitution of face-to-face appointments with telehealth services and attending essential face-to-face appointments alone restricted participants' access to professional and social support. Despite this, many participants felt public health measures to reduce transmission of COVID-19 had created a sense of not missing out, feeling safe and reduced difficult social interactions requiring explanation of their diagnosis. Conclusions: There is an opportunity to learn from the experiences of healthcare delivery from the perspectives of people affected by cancer during the COVID-19 pandemic. The results highlight the complexities and dualities of living with, after or caring for someone with cancer during the COVID-19 pandemic. Opportunities for longitudinal qualitative research to explore the evolving experiences, concerns and persistent and emerging unmet information and clinical needs within the rapidly changing socio-political, socio-cultural and healthcare contexts of the COVID-19 pandemic are highlighted.

Objective – This paper seeks to investigate the extent to which architects and clients involved in the design of cancer care facilities integrate the perspectives of users generally, and people affected by cancer specifically, in the design process. Background – Increasingly hospital users contribute to design briefs and participate as stakeholders in design processes. If the best available research and experience is to inform the design of cancer care facilities and ensure quality improvement in care, it is essential that user perspectives are engaged. Cancer patients are interesting to consult as they are exposed to different aspects of healthcare environments in a wide variety of situations. However, the literature suggests that users are inadequately addressed in design briefs for healthcare environments. Research question – What supports and challenges can be identified regarding the integration of user perspectives in the design of cancer care facilities? Methods – A multiple case study enquiry analysed two cases. The cases are information-rich and unique examples of completed building projects that encompass cancer care facilities. They enable an in-depth study of the design process as the phenomenon of interest. One case is a new general hospital in which cancer care is integrated. The other case concerns a renovation of an oncology consultation in a university hospital. Interviews were conducted with the project’s ‘client’ and ‘architect’ and project documents were analysed. Results – The integration of user perspectives is supported by individual staff members, and by the use of mock-ups and 3D images. A major challenge is that patients are only consulted with indirectly. Care professionals are a primary source of knowledge informing the design process with their own perspectives and that of patients. The more tangible a design becomes, the more feedback is elicited. A tension results between care professionals’ ideas to make the design (more) effective and the ambition of ‘building oriented’ stakeholders to finalise decisions. Also, matters of spatial organisation established early on make it difficult to respond to the evolving organisation of cancer care. Conclusion – For clients and architects to develop an affinity with the perspectives of people affected by cancer, it is necessary to reconsider how knowledge about users is acquired. Our findings suggest attention for patient perspectives may require focussing on spaces other than those utilised for the delivery of care. The approach taken provided insights into current practice and further suggests clients distinguish between staff participation for organisational reasons and spatial design activities. ispartof: pages:146-155 ispartof: ARCH19: BUILDING FOR BETTER HEALTH - Research & innovation in architecture & urban design for care & health pages:146-155 ispartof: ARCH19: BUILDING FOR BETTER HEALTH - Research & innovation in architecture & urban design for care & health location:Trondheim date:12 Jun - 13 Jun 2019 status: Published online

Cancer is a major public health problem worldwide. In the European Union (EU), Croatia (HR) and Hungary have the highest standardized cancer mortality rates (each min 330/100, 000 inhabitants, EU average 259.5/100, 000 inhabitants). The five-year survival rates for cancer patients in HR are also lower than the EU average. By analysing all segments of oncology care, we wanted to find out what could be the reason for this. Methods: This paper contains data from all oncology centres in HR (nine non-clinical and five clinical hospital centres), data from the Croatian Bureau of Statistics, the Croatian Institute of Public Health, Eurostat, and the Swedish Institute for Health Economics. Results: In HR, the health care of patients with malignant diseases is carried out in clinical hospital centres (CHC) and general hospitals (GH). 48% of the population live in counties that do not have clinical oncology centres. 30% of them have access to oncology treatment in their counties and 18% do not have oncology treatment in their counties. More people in HR than in any other EU Member State claim that their health needs are not met due to geographical distance (HR 0.6%, EU 0.1%). The presence of risk factors in HR is higher than the EU average, especially smoking and obesity and the response to screening programs for breast cancer, colorectal cancer, and cervical cancer is generally below the EU average. In HR in 2020 there are 130 oncologists (3.1 oncologists/100, 000 inhabitants), which is less than the EU average (Italy 7.1 ; Spain 3.9 ; United Kingdom 3.8 ; Germany 3.5). 106 oncologists (82%) work in clinical centres and 24 oncologists (18%) in non-clinical centres. 62 physicians specialize in oncology (77% for CHC and 23% for GH). The radiation equipment in HR is insufficient: there are 15 linear accelerators out of an optimal 24 (0.4/100, 000 inhabitants) and has a waiting time of w 2.5 months. In 2017, HR spent 6.8% of GDP on health care, less than the EU average (9.8%). Direct costs per capita for cancer treatment are significantly lower than other EU Member States (HR 100 €, EU average 195 €). Conclusions: If we want to improve the outcomes of cancer patients in HR, considerable efforts must be made to improve all segments of cancer care.

Objective The aim of this study was to describe patterns of health service utilisation among the Australian population with cancer compared with the general population. Methods Data for all respondents aged ≥25 years from two successive National Health Surveys conducted between 2011 and 2014 were analysed. Respondents with a history of cancer were identified as the cancer group, whereas all other respondents who did not report having had a cancer were included in the non-cancer control group. Comparisons were made between the two groups using logistic regression models. Results The population with cancer was more likely to report having consulted their general practitioner, specialist, chemist, dietician, naturopath, nurse, optometrist, dentist, audiologist and other health professionals than the non-cancer population. The cancer population was also more likely to be admitted to hospital and to have visited an out-patient clinic, emergency department and day clinic. The presence of comorbidity and a current cancer were associated with a greater likelihood of receiving health services among the population with cancer. Conclusion The population with cancer used health services significantly more than the non-cancer population. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation. What is known about the topic? Multimorbidity is highly prevalent among the cancer population due to risk factors shared between cancer and other chronic diseases, and the development of new conditions resulting from cancer treatment and cancer complications. However, the Australian healthcare system is not set up optimally to address issues related to multimorbidity. What does this paper add? This study is the first step in quantifying health services use by the population with cancer compared with the general population without cancer. Cancer survivors have an increased need for specific health services, particularly among those with multimorbidity. What are the implications for practitioners? The development of integrated care models to manage multiple chronic diseases aligned with the Australian National Strategic Framework for Chronic Conditions is warranted. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation.

Background: Advances in research and technology coupled with an increased cancer incidence and prevalence have resulted in significant expansion of cancer nurse role, in order to meet the growing demands and expectations of people affected by cancer (PABC). Cancer nurses are also tasked with delivering an increasing number of complex interventions as a result of ongoing clinical trials in cancer research. However much of this innovation is undocumented, and we have little insight about the nature of novel interventions currently being designed or delivered by cancer nurses. Objectives: To identify and synthesise the available evidence from clinical trials on interventions delivered or facilitated by cancer nurses. Data sources and review methods: A systematic review of randomised controlled trials (RCT), quasi-RCTs and controlled before and after studies (CBA) of cancer nursing interventions aimed at improving the experience and outcomes of PABC. Ten electronic databases (CENTRAL, MEDLINE, AMED, CINAHL, EMBASE, Epistemonikos, CDSR, DARE, HTA, WHO ICTRP) were searched between 01 January 2000 and 31 May 2016. No language restrictions were applied. Bibliographies of selected studies and relevant Cochrane reviews were also hand-searched. Interventions delivered by cancer nurses were classified according to the OMAHA System. Heat maps were used to highlight the volume of evidence available for different cancer groups, intervention types and stage of cancer care continuum. Results: The search identified 22,450 records; we screened 16,169 abstracts and considered 925 full papers, of which 214 studies (247,550 participants) were included in the evidence synthesis. The majority of studies were conducted in Europe (n = 79) and USA (n = 74). Interventions were delivered across the cancer continuum from prevention and risk reduction to survivorship, with the majority of interventions delivered during the treatment phase (n = 137). Most studies (131/214) had a teaching, guidance or counselling component. Cancer nurse interventions were targeted at primarily breast, prostate or multiple cancers. No studies were conducted in brain, sarcoma or other rare cancer types. The majority of the studies (n = 153) were nurse-led and delivered by specialist cancer nurses (n = 74) or advanced cancer nurses (n = 29), although the quality of reporting was poor. Conclusions: To the best of our knowledge, this is the first review to synthesise evidence from intervention studies across the entire cancer spectrum. As such, this work provides new insights into the nature of the contribution that cancer nurses have made to evidence-based innovations, as well as highlighting areas in which cancer nursing trials can be developed in the future. This project is jointly funded by the European Oncology Nursing Society (EONS) and the European Cancer Organisation (ECCO).

This research investigates reasons why male cancer patients may refrain from patronizing cancer resource centers. By drawing upon a wide range of research from the social sciences and visual design literatures, the authors put forth original propositions that suggest how cancer resource center managers can manipulate a center's servicescape, or built environment, as well as its service offerings, website design, and printed communications to attract more male cancer patients. Despite the inherent challenges of discussing gender in cancer care and limitations to its generalizability in all settings, this research reveals that differences exist regarding the way men and women respond to cancer resource center marketing initiatives. Given the profound benefits that cancer resource centers often assume in a cancer patient's life, including a decreased mortality rate, we encourage service marketing and public health researchers, as well as cancer resource center directors, to consider the propositions put forth in this paper.

This paper explicates how Orem's Self-care Deficit Theory of Nursing (Orem, 1995) was selected to guide a study to explore and measure cancer related fatigue (CRF), and determine the most effective self-care strategies used to combat CRF in a cohort of patients with a diagnosis of cancer (breast cancer, colorectal cancer, Hodgkin's and Non-Hodgkin's lymphoma). The secondary aim was to explore self-care agency and its relationship to CRF.

Cancer is the third highest cause of death in Kenya, preceded by infectious and cardiovascular diseases, and in most cases, diagnosed in later stages. Nurses are the primary caregivers, assessing and managing these patients in the clinic, in inpatient settings, and in rural and remote communities. While cancer rates remain high, the burden to the patient, the caregiver, and society as a whole continues to rise. Kenya's poverty complicates cancer even further. Many Kenyans are unaware of cancer's signs and symptoms, and limited diagnostic and treatment centers are available. Despite these barriers, there is still hope and help for those in Kenya, who suffer from cancer. The World Health Organization has stated that palliative care is a basic human right and nurses providing this care in Kenya are making efforts to support cancer patients' ongoing needs, in order to promote compassionate palliative care and prevent suffering. The purpose of this paper is to address the palliative care needs of patients with cancer in Kenya by providing education to nurses and influencing health-care policy and education at micro and macro levels. A case study weaved throughout will highlight these issues.

Changes in the nature and structure of healthcare pathways have implications for healthcare professionals' jurisdictional boundaries. The introduction of treatment focused BRCA1 and 2 genetic testing (TFGT) for newly diagnosed patients with breast cancer offers a contemporary example of pathway change brought about by technological advancements in gene testing and clinical evidence, and reflects the cultural shift towards genomics. Forming part of an ethnographically informed study of patient and practitioner experiences of TFGT at a UK teaching hospital, this paper focuses on the impact of a proposal to pilot a mainstreamed TFGT pathway on healthcare professionals' negotiations of professional jurisdiction. Based upon semi-structured interviews (n = 19) with breast surgeons, medical oncologists and members of the genetics team, alongside observations of breast multidisciplinary team meetings, during the time leading up to the implementation of the pilot, we describe how clinicians responded to the anticipated changes associated with mainstreaming. Interviews suggest that mainstreaming the breast cancer pathway, and the associated jurisdictional reconfigurations, had advocates as well as detractors. Medical oncologists championed the plans, viewing this adaptation in care provision and their professional role as a logical next step. Breast surgeons, however, regarded mainstreaming as an unfeasible expansion of their workload and questioned the relevance of TFGT to their clinical practice. The genetics team, who introduced the pilot, appeared cautiously optimistic about the potential changes. Drawing on sociological understandings of the negotiation of professional jurisdictions our work contributes a timely, micro-level examination of the responses among clinicians as they worked to renegotiate professional boundaries in response to the innovative application of treatment-focused BRCA testing in cancer care – a local and dynamic process which we refer to as an ‘oncogenetic taskscape in the making’.

Background Advances in research and technology coupled with an increased cancer incidence and prevalence have resulted in significant expansion of cancer nurse role, in order to meet the growing demands and expectations of people affected by cancer (PABC). Cancer nurses are also tasked with delivering an increasing number of complex interventions as a result of ongoing clinical trials in cancer research. However much of this innovation is undocumented, and we have little insight about the nature of novel interventions currently being designed or delivered by cancer nurses. Objectives To identify and synthesise the available evidence from clinical trials on interventions delivered or facilitated by cancer nurses. Data sources and review methods A systematic review of randomised controlled trials (RCT), quasi-RCTs and controlled before and after studies (CBA) of cancer nursing interventions aimed at improving the experience and outcomes of PABC. Ten electronic databases (CENTRAL, MEDLINE, AMED, CINAHL, EMBASE, Epistemonikos, CDSR, DARE, HTA, WHO ICTRP) were searched between 01 January 2000 and 31 May 2016. No language restrictions were applied. Bibliographies of selected studies and relevant Cochrane reviews were also hand-searched. Interventions delivered by cancer nurses were classified according to the OMAHA System. Heat maps were used to highlight the volume of evidence available for different cancer groups, intervention types and stage of cancer care continuum. Results The search identified 22,450 records; we screened 16,169 abstracts and considered 925 full papers, of which 214 studies (247,550 participants) were included in the evidence synthesis. The majority of studies were conducted in Europe (n = 79) and USA (n = 74). Interventions were delivered across the cancer continuum from prevention and risk reduction to survivorship, with the majority of interventions delivered during the treatment T phase (n = 137). Most studies (131/214) had a teaching, guidance or counselling component. Cancer nurse interventions were targeted at primarily breast, prostate or multiple cancers. No studies were conducted in brain, sarcoma or other rare cancer types. The majority of the studies (n = 153) were nurse-led and delivered by specialist cancer nurses (n = 74) or advanced cancer nurses (n = 29), although the quality of reporting was poor. Conclusions To the best of our knowledge, this is the first review to synthesise evidence from intervention studies across the entire cancer spectrum. As such, this work provides new insights into the nature of the contribution that cancer nurses have made to evidence-based innovations, as well as highlighting areas in which cancer nursing trials can be developed in the future.

Secure and scalable data sharing is essential for collaborative clinical decision making. Conventional clinical data efforts are often siloed, however, which creates barriers to efficient information exchange and impedes effective treatment decision made for patients. This paper provides four contributions to the study of applying blockchain technology to clinical data sharing in the context of technical requirements defined in the “Shared Nationwide Interoperability Roadmap” from the Office of the National Coordinator for Health Information Technology (ONC). First, we analyze the ONC requirements and their implications for blockchain-based systems. Second, we present FHIRChain, which is a blockchain-based architecture designed to meet ONC requirements by encapsulating the HL7 Fast Healthcare Interoperability Resources (FHIR) standard for shared clinical data. Third, we demonstrate a FHIRChain-based decentralized app using digital health identities to authenticate participants in a case study of collaborative decision making for remote cancer care. Fourth, we highlight key lessons learned from our case study. Keywords: Blockchain, Smart contracts, Decentralized app, Interoperability, Digital health identity, Clinical data sharing, Cancer care

Palliative care is an area in healthcare that is focused on alleviating and/or preventing the suffering experienced by patients across various conditions. In recent years, palliative care has grown tremendously as an integral part of healthcare institutions worldwide. However, not all countries have well-established palliative care services, or recognise the importance of palliative care. It is important for healthcare professionals to recognise the value of palliative care, and those who work in order to be able to provide such care to patients. However, there may be professional and cultural barriers that prevent practitioners in specific contexts to be able to do so. Specifically, this paper considered the context of the Kingdom of Saudi Arabia (KSA), which is known to be culturally different from the west where the concept of palliative care originated and where the recent progress in palliative care is most evident. In this paper, reviewing of articles regarding cancer care in Saudi Arabia, cancer pain in Saudi Arabia, overview of palliative care in Saudi Arabia and issues with palliative care in Saudi Arabia are analysed and discussed to proceed with the intended research study to solve the research questions.

Part 4: Health and Biosphere; International audience; The paper introduces processing, modelling, analysis and visualisation of data on cancer epidemiology and cancer care in compliance with a proven and validated methodology. We aim to provide online access to unique data on cancer care and cancer epidemiology, including an interactive visualisation of various analytical reports in order to provide relevant information to the general public as well as to experts, such as health care managers, environmental experts and risk assessors. The data viewer has been developed and implemented as a web-based application, making a very time-consuming process of data analysis fully automatic. The presented data contain dozens of validated epidemiological trends in the form of tables, graphs and maps.

Introduction: In Ireland, the risk of a women developing breast cancer is 1 in 9. For hormone responsive breast cancer, the risk of re-occurrence is reduced by anti-hormone therapy. However, the treatment induces menopausal symptoms that are often severe and adversely impact on quality of life and treatment adherence. This project adopts a guideline adaptation approach to develop clinical guidelines for the management of menopausal symptoms in breast cancer survivors in North East Ireland. Guideline adaptation involves identifying standards from existing clinical practice guidelines and contextualising them into an adapted guideline for local context. Guideline adaptation frameworks offer a systematic way of approaching adaptation to improve transparency, methodological rigor, and the quality of the adapted guideline (1). This paper provides a process evaluation on the value and utility of the guideline adaptation framework CAN-IMPLEMENT © (2, 3). Methods: This case study design utilised a collaborative participatory model within the CAN-IMPLEMENT © Framework.. Stakeholder engagement included patients, policymakers, researchers and healthcare professionals from medical oncology, cancer nursing, pharmacy and community. An evaluation was conducted with the Guideline Development Group. Data collection included documentary meeting notes, individual interviews and a validation evaluation forum. Findings: CAN-IMPLEMENT was evaluated as a rigorous, systematic method that provided novice guideline developers with methodological and practice assistance in both guideline adaptation and implementation planning. The AGREE II tool for appraisal and evaluation of existing international clinical guidelines was evaluated as a positive feature of the framework. The framework was limited in providing tools to support implementation planning. The facilitating strategies for multidisciplinary collaboration embedded within CAN-IMPLEMENT was considered a favourable feature of the framework as it facilitated strong stakeholder engagement to facilitate the complex multi-faceted process of guideline adaptation. Conclusions: CAN-IMPLEMENT provides transparency and methodological rigor for the development of a quality adapted guideline. The collaborative approach fosters engagement and empowerment of patients and healthcare communities to become equal partners in care. Discussions: A guideline adaptation framework is valuable, as it helps to ensure that the recommendations stay true to the evidence while taking local needs and implementation into account. Stakeholder engagement is a potent mechanism to develop capacity building among the local healthcare community. Lessons learned: Developing a guideline without adequate consideration of local context implementation hinders the uptake and adoption of existing high quality guidelines. CAN-IMPLEMENT is a valuable framework to address this challenge and has application potential across any healthcare environ. Limitations: This process evaluation was a single case study representing a cancer health service region in Ireland. The evaluation was based on self-reports rather than a formal framework evaluation tool. Suggestions for future research: This evaluation could be augmented by other evaluation studies of CAN-IMPLEMENT. References: 1- Wang Z, Norris SL, Bero L. The advantages and limitations of guideline adaptation frameworks. Implementation Science. 2018;13(1):72. 2- Harrison MB, Graham ID, van den Hoek J, Dogherty EJ, Carley ME, Angus V. Guideline adaptation and implementation planning: a prospective observational study. Implementation Science. 2013;8(1):49. 3- Cancer CPA. Canadian Partnership Against Cancer Toronto CAN-IMPLEMENT]. Available from: https://www.partnershipagainstcancer.ca/can-implement/

The aim of this research paper is to explore the dangers of involving children as family caregivers of palliative care and home-based-care to advanced HIV/AIDS patients, while its objective is to discuss the dangers or perfidiousness that minors especially the girl children face as they handle care giving of advanced HIV/AIDS patients. The article has relied on eclectic data sources. The research has foundminors disadvantaged by the following: being engulfed by fear and denied rights through care giving; being emotionally and physiologically overwhelmed; being oppressed and suppressed by caring duties; being at risk of contracting HIV/AIDS; and having their education compromised by care giving. The paper recommends: (1) strengthening and emphasizing on children's rights; (2) maintaining gender balance in care giving; (3) implementation and domestication of the United Nations conventions on the rights of children; (4) community awareness on equal gender co participation in care giving; (5) and fostering realization that relying on child care giving is a negative score in fulfilling global Millennium Development Goals.

Canada is facing cancer crisis. Cancer has become the leading cause of death in Canada. Despite recent advances in cancer management and research, growing disparities in cancer care have been noticed, especially in socio-economically disadvantaged groups and under-served communities. With the rising incidence of cancer and the increasing numbers of minorities and of social disparities in general, and without appropriate interventions, cancer care disparities will become only more pronounced. This paper highlights the concepts and definitions of equity in health and health care and examines several health determinants that increase the risk of cancer. It also reviews cancer care inequity in the high-risk groups. A conceptual framework is proposed and recommendations are made for the eradication of disparities within the health care system and beyond.

Background Communication between different health care providers (conventional and complementary) and cancer patients about their use of complementary therapies affects the health and safety of the patients. The aim of this study was to examine the qualitative research literature on the perception of and communication about the risk of complementary therapies between different health care providers and cancer patients. Methods Systematic searches in six medical databases covering literature from 2000 to 2015 were performed. The studies were accessed according to the level of evidence and summarized into different risk situations. Qualitative content analysis was used to analyze the text data, and the codes were defined before and during the data analysis. Results Twenty-nine papers were included in the primary analysis and five main themes were identified and discussed. The main risk situations identified were 1. Differences in treatment concepts and philosophical values among complementary and conventional health care providers. 2. Adverse effects from complementary products and herbs due to their contamination/toxicity and interactions with conventional cancer treatment. 3. Health care physicians and oncologists find it difficult to recommend many complementary modalities due to the lack of scientific evidence for their effect. 4. Lack of knowledge and information about complementary and conventional cancer treatments among different health care providers. Conclusion The risk of consuming herbs and products containing high level of toxins is a considerable threat to patient safety (direct risk). At the same time, the lack of scientific evidence of effect for many complementary therapies and differences in treatment philosophy among complementary and conventional health care providers potentially hinder effective communication about these threats with mutual patients (indirect risk). As such, indirect risk may pose an additional risk to patients who want to combine complementary therapies with conventional treatment in cancer care. Health care providers who care for cancer patients should be aware of these risks. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1326-3) contains supplementary material, which is available to authorized users.

The aim of this study was to summarize the existing qualitative literature in order to develop the evidence base for understanding and managing weight loss and anorexia, in order to make recommendations for clinical practice. A systematic search was performed to retrieve English language studies using electronic search and manual checks of selected reference lists. Keywords included qualitative, cancer cachexia, weight loss, anorexia, appetite, malnutrition, food, eating, and drinking. The selection and appraisal of papers were undertaken by two reviewers. Twenty-one qualitative articles were included in the review. There were three major findings emerging from the previous qualitative studies including ‘the multidimensionality of weight loss and anorexia experience’, ‘patients and caregivers' responses to coping with weight loss and anorexia’, and ‘clinical assessment and management of weight loss and anorexia’. The literature review revealed the multidimensional nature of cachexia and weight loss experience by patients and caregivers, which was not recognized and adequately managed by healthcare professionals. Future research in this area would be helpful in enabling a deeper understanding of the complexity of cachexia and weight loss experience in order to move forward to develop an optimal model of supportive care for patients and caregivers.