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Meyerhardt J.A.,Dana-Farber Cancer Institute | Mangu P.B.,American Society of Clinical Oncology | Flynn P.J.,Minnesota Oncology | Korde L.,University of Washington | And 7 more authors.
Journal of Clinical Oncology | Year: 2013

Purpose The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing recent clinical practice guidelines that have been developed by other professional organizations. Methods The Cancer Care Ontario (CCO) Guideline on Follow-up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer was reviewed by ASCO for methodologic rigor and considered for endorsement. Results The ASCO Panel concurred with the CCO recommendations and recommended endorsement, with the addition of several qualifying statements. Conclusion Surveillance should be guided by presumed risk of recurrence and functional status of the patient (important within the first 2 to 4 years). Medical history, physical examination, and carcinoembryonic antigen testing should be performed every 3 to 6 months for 5 years. Patients at higher risk of recurrence should be considered for testing in the more frequent end of the range. A computed tomography scan (abdominal and chest) is recommended annually for 3 years, in most cases. Positron emission tomography scans should not be used for surveillance outside of a clinical trial. A surveillance colonoscopy should be performed 1 year after the initial surgery and then every 5 years, dictated by the findings of the previous one. If a colonoscopy was not preformed before diagnosis, it should be done after completion of adjuvant therapy (before 1 year). Secondary prevention (maintaining a healthy body weight and active lifestyle) is recommended. If a patient is not a candidate for surgery or systemic therapy because of severe comorbid conditions, surveillance tests should not be performed. A treatment plan from the specialist should have clear directions on appropriate follow-up by a nonspecialist. © 2013 by American Society of Clinical Oncolog.

Kim C.,University of Minnesota | Economou S.,Plastic Surgery Consultants | Amatruda T.T.,Minnesota Oncology | Martin J.C.,Hospital Pathology Associates | Dudek A.Z.,University of Illinois at Chicago
Anticancer Research | Year: 2015

Background/Aim: Sentinel lymph node (SLN) biopsy provides useful prognostic information for patients with melanoma. The present study sought to determine the prognostic value of SLN tumor burden on overall survival (OS) and disease-free survival (DFS). We also assessed its association with non-sentinel lympth node (NSLN) involvement. Patients and Methods: We conducted a retrospective review of 138 patients with cutaneous melanoma, who were found to have positive SLNs from 2000 to 2011. SLN tumor burden was measured in the maximum diameter of the largest tumor focus. OS and DFS were assessed by the Kaplan-Meier method and Cox proportional hazard regression model. A logistic regression model was used to evaluate the association between SLN tumor burden and NSLN positivity.Results: On multivariable analysis, SLN tumor burden was significantly associated with OS (hazard ratio (HR)>1 vs. ≤1mm=5.15; 95% confidence interval (CI)=2.32-11.44; p<0.0001) and DFS rate (HR>1 vs. ≤1mm=3.02; 95% CI=1.37-6.67; p=0.0064). On univariate analysis, SLN tumor burden was significantly associated with NSLN positivity (OR>1 vs. ≤1mm=3.41; 95% CI=1.03-11.27; p=0.04).Conclusion: SLN tumor burden, by measuring the maximum diameter of the largest tumor focus, is significantly associated with OS, DFS and NSLN involvement.

O'Brien M.,Minnesota Oncology | Stricker C.T.,University of Pennsylvania
Clinical Journal of Oncology Nursing | Year: 2014

Nurses have an important role in the development, implementation, and evaluation of cancer survivorship programs. Growing numbers of cancer survivors challenge community oncology practices to incorporate survivorship care according to new standards and guidelines. In response, one community-based oncology clinic created an advanced practice nurse (APN)-led survivorship program using the concept of Seasons of Survival as a guide. Survivorship care, when based on a more expansive definition of survivorship as beginning at the time of diagnosis, encompasses holistic nursing and multidisciplinary care. The APN assesses each patient's concerns and quality of life using a validated measure to tailor survivorship and supportive care. This article reviews the foundation and structure of the program in detail, describes program implementation using case studies, and outlines the program evaluation process and results. © Oncology Nursing Society.

Stricker C.T.,University of Pennsylvania | O'Brien M.,Minnesota Oncology
Clinical Journal of Oncology Nursing | Year: 2014

The number of adult cancer survivors in the United States has exceeded 13 million and continues to rise, yet care for these survivors continues to be poorly coordinated and their needs remain inadequately addressed. As one solution to this growing problem, the Institute of Medicine in 2006 recommended the delivery of a survivorship care plan (SCP) to each patient completing active treatment. The American College of Surgeons Commission on Cancer subsequently published its Program Standard 3.3, requiring accredited programs to implement treatment summaries and SCPs by 2015, to help improve communication, quality, and coordination of care for cancer survivors. As practices and cancer centers around the country have undertaken SCP implementation efforts, myriad barriers to their preparation and delivery have emerged, with time and human resource burden top among these, in addition to a lack of proven outcomes. Fortunately, a growing number of publications document practical and feasible delivery models, and an increasingly robust body of research on stakeholder preferences is available to focus SCP implementation efforts. © Oncology Nursing Society.

Gesme B.D.H.,Minnesota Oncology | Wiseman M.,Wiseman Communications
Journal of Oncology Practice | Year: 2011

Pathway users say that pathways reduce errors, reduce costs, and increase efficiency. Hennessy notes that KCCC regularly monitors patient satisfaction and has also found that since implementing pathways, patient satisfaction has increased. "It's clear that you can have pathways and high patient satisfaction at the same time." Michigan's Neumann says the big issue for the future is who will drive the process of cancer care: the payer, the providers, or a commercial third party. He comments, "We realize there are savings to be made in managing chemotherapy better and in efficient management of disease, including such things as diagnostic approach, end-of-life care, and emergency department visits. Better management of all of these areas is in the sights of\ these pathway programs. We need to figure out how to do that in a way that aligns physician incentives with cost-efficient medicine. Copyright © 2011 by American Society of Clinical Oncology.

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