Melissa Henry1,2,3,4,5,6,7, Saul Frenkiel3,5, Gabrielle Chartier5, Christina MacDonald5, Richard J Payne1,3,5,8, Martin J Black3,4,5, Alex M Mlynarek3,5,8, Anthony Zeitouni3,8, Karen Kost3,8, Carmen Loiselle1,4,9, Antoinette Ehrler6, Zeev Rosberger1,2,4,6,7, Michael Tamilia10,11, Yu Xin Chang12, Cecilia de la Mora4, Camille Arbaud4, Michael P Hier1,3,4,5. 1. Department of Oncology, McGill University, Montreal, Quebec, Canada. 2. Department of Psychology, McGill University, Montreal, Quebec, Canada. 3. Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada. 4. Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada. 5. Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada. 6. Department of Oncology and Segal Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada. 7. Department of Psychology, Jewish General Hospital, Montreal, Quebec, Canada. 8. Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada. 9. McGill Ingram School of Nursing, McGill University, Montreal, Quebec, Canada. 10. Department of Medicine, Division of Endocrinology and Metabolism, McGill University, Montreal, Quebec, Canada. 11. Department of Endocrinology, Jewish General Hospital, Montreal, Quebec, Canada. 12. Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Abstract
BACKGROUND: Thyroid cancer (ThyCa) is generally associated with a favorable prognosis and excellent surgical outcomes. Consequently, its treatment is medically focused and current guidelines recommend interdisciplinary care including access to a nurse for complex cases alone. To date, no studies have evaluated the need for and impact of an Interdisciplinary Team-based Care Approach (ITCA-ThyCa) for general thyroid cancer patients, including a dedicated nurse as part of a larger interdisciplinary team, as well as patient-reported outcomes, as is recommended worldwide in cancer care. Our aim was to evaluate such a program. METHODS: The ITCA-ThyCa was evaluated within a quasi-experimental design using the Centers for Disease Control Framework for Program Evaluation, including process and outcome measures. Patients eligible were adults with a biopsy indicating confirmed or highly suspicious ThyCa (TNM-Classification + Bethesda score of V/VI). The intervention group (IG) received ITCA-ThyCa and the comparison group (CG), usual care alone. RESULTS: In our sample comprised of 200 participants (122 IG; 78 CG), ITCA-ThyCa patients appeared to show significantly better outcomes than CG patients, namely, higher levels of overall well-being (P = .001) and fewer physical (P = .003) and practical (P = .003) issues and concerns. More satisfied with their overall care (P = .028), including care coordination (P = .049), they reported their health care provider as more approachable (P = .007), respectful (P = .005), and trustworthy (P = .077; trend) and were more likely to recommend their hospital (P = .02). Ninety-eight percent of IG patients recommended ITCA-ThyCa. CONCLUSION: Data from our program illustrates that hospital resources should not be allocated based on medical trajectory alone and challenges the idea that ThyCa is "straightforward." ThyCa patients seem to experience symptom distress at a level comparable to-or exceeding-that of general oncological patients despite their promising medical outcomes, indicating that better integrated care and support are in order.
BACKGROUND:Thyroid cancer (ThyCa) is generally associated with a favorable prognosis and excellent surgical outcomes. Consequently, its treatment is medically focused and current guidelines recommend interdisciplinary care including access to a nurse for complex cases alone. To date, no studies have evaluated the need for and impact of an Interdisciplinary Team-based Care Approach (ITCA-ThyCa) for general thyroid cancerpatients, including a dedicated nurse as part of a larger interdisciplinary team, as well as patient-reported outcomes, as is recommended worldwide in cancer care. Our aim was to evaluate such a program. METHODS: The ITCA-ThyCa was evaluated within a quasi-experimental design using the Centers for Disease Control Framework for Program Evaluation, including process and outcome measures. Patients eligible were adults with a biopsy indicating confirmed or highly suspicious ThyCa (TNM-Classification + Bethesda score of V/VI). The intervention group (IG) received ITCA-ThyCa and the comparison group (CG), usual care alone. RESULTS: In our sample comprised of 200 participants (122 IG; 78 CG), ITCA-ThyCa patients appeared to show significantly better outcomes than CG patients, namely, higher levels of overall well-being (P = .001) and fewer physical (P = .003) and practical (P = .003) issues and concerns. More satisfied with their overall care (P = .028), including care coordination (P = .049), they reported their health care provider as more approachable (P = .007), respectful (P = .005), and trustworthy (P = .077; trend) and were more likely to recommend their hospital (P = .02). Ninety-eight percent of IG patients recommended ITCA-ThyCa. CONCLUSION: Data from our program illustrates that hospital resources should not be allocated based on medical trajectory alone and challenges the idea that ThyCa is "straightforward." ThyCa patients seem to experience symptom distress at a level comparable to-or exceeding-that of general oncological patients despite their promising medical outcomes, indicating that better integrated care and support are in order.
Authors: Max A Schumm; Dalena T Nguyen; Jiyoon Kim; Chi-Hong Tseng; Amy Y Chow; Na Shen; Masha J Livhits Journal: Ann Surg Oncol Date: 2021-07-22 Impact factor: 5.344