Stand by Me: Implementing Innovative Programs and Practices That Support Cancer Patients and Survivors

Addressing Barriers to Care: Process and Summative Evaluation of the Competency-Based Oncology Patient Navigator Training

Authors:

Kanako Kashima (Presenter)
The George Washington University (GW) Cancer Center

Mandi Pratt-Chapman, The George Washington University (GW) Cancer Center
Allison Harvey, The George Washington University (GW) Cancer Center
Rhea Suarez, The George Washington University (GW) Cancer Center
Aubrey Villalobos, The George Washington University (GW) Cancer Center

Public Health Statement: Training and guidance for patient navigators who do not a hold clinical license (e.g., nursing or social work) is needed to mitigate provider shortages.

Purpose: To evaluate the effectiveness of the no-cost, self-paced, online Oncology Patient Navigator Training: The Fundamentals, designed to train patient navigators on addressing barriers to care.

Methods/Approach: The George Washington University Cancer Center analyzed pre- and post- assessment data from 384 learners who completed the training from 2015 to 2016. Most questions were asked on a 5-point Likert scale (Strongly Disagree to Strongly Agree). STATA^®/IC 14.2 was used to assess changes in confidence across learning objectives (paired t-test) and compare differences in means between patient navigators and licensed health professionals (independent samples t-test).

Results: Learners were from 40 states, the District of Columbia, two U.S. territories/Pacific Island Jurisdictions and four tribes. Learners reported statistically significant (p<0.001) changes in confidence across all objectives, increasing from an average mean of 3.58 to 4.26. When stratified by non-clinical versus clinical (n=229), non-clinical professionals had significantly higher gains (p=0.02) with a mean change score of 0.694 compared to clinical professionals (0.566).

Conclusions/Implications: The training effectively increased all learners’ confidence on core competencies. The training was designed for non-clinical professionals so the benefits were more pronounced among the intended audience. The training has potential to make an even larger impact with further promotion and uptake.

Active Living After Breast Cancer: Combining Physical Activity and Survivorship Navigation to Improve the Health and Quality of Life of Cancer Survivors

Authors:

Karen Basen-Engquist (Presenter)
The University of Texas MD Anderson Cancer Center

Maria Lizette Rangel, The University of Texas MD Anderson Cancer Center
Leticia Gatus, The University of Texas MD Anderson Cancer Center
Ashley Alexander, Kelsey Research Foundation
Lorna McNeill, The University of Texas MD Anderson Cancer Center
Eileen Shinn, The University of Texas MD Anderson Cancer Center

Public Health Statement: Physical activity is associated with improved quality of life and increased disease-free survivor in breast cancer survivors. Active Living after Breast Cancer (ALABC) is a program funded by the Cancer Prevention and Research Institute of Texas to improve breast cancer survivors’ quality of life through increasing physical activity and providing survivorship information. The evidence-based program was developed and tested at MD Anderson, and adapted for delivery in the Houston community.

Purpose: This presentation will provide an overview of the ALABC program, integration into the community, as well as participant characteristics and changes in physical activity, physical functioning, and quality of life.

Methods/Approach: Participants for ALABC are recruited from the Houston community, including a local multi-specialty care provider, the public hospitals, and area support groups. The program is delivered in 12 group sessions. Each session covers behavioral skills for increasing physical activity (40–50 minutes), 10 minutes of physical activity, and 30 minutes on a survivorship topic. The program emphasizes increasing physical activity through incorporating short bouts of activity throughout the day. At the first and last sessions, participants complete questionnaires (IPAQ, PROMIS Global health short form), performance tasks (6-minute walk, 30-second sit-stand), and anthropometric assessments.

Results: The first group began November, 2014. Since then we have conducted 20 groups (5 in Spanish). We have screened a total of 439 survivors; 194 have started the program. Fifteen are currently in a class and 119 have completed the program (67% completion rate). Mean age of participants is 59.6 years (SD=10.5, range 26–84). Participants are 36% African-American, 53% white, 4% Asian, 7% other; 24% are Hispanic. Participants report increases in their weekly minutes of walking

Conclusions/Implications: Data from the ALABC program evaluation indicate that it is effective at increasing physical activity and improving quality of life. Furthermore, it is feasible to deliver to a diverse survivor population, including Spanish-speaking survivors.

First Steps: Clinical Integration of the LIVESTRONG at the YMCA Program

Authors:

Heather Hodge (Presenter)
YMCA of the USA

Matt Longjohn, YMCA of the USA
Katherine Hohman, YMCA of the USA

Public Health Statement: There are approximately 15.5 million cancer survivors in the US, and this number is growing.[1] LIVESTRONG® at the YMCA is an evidence-based program which has been shown to help cancer survivors meet or exceed the recommended amount of physical activity, improve overall Quality-of-Life (QOL), and decrease cancer-related fatigue.[2] The program has served over 45,000 cancer survivors at 585 sites in 40 states, but is not generally integrated into clinical care.

[1] Irwin M, Cartmel B, Harrigan M, et al. Impact of the LIVESTRONG at the YMCA Program on physical activity, fitness, and quality of life in cancer survivors. J Clin Oncol. 2015;33(15 suppl. 1).
[2] Bluethmann SM, Mariotto AB, Rowland, JH. Anticipating the ‘Silver Tsunami’: Prevalence Trajectories and Comorbidity Burden among Older Cancer Survivors in the United States. Cancer Epidemiol Biomarkers Prev. 2016;25:1029–1036.

Purpose: By leveraging an EMR, Y-USA aims to intentionally facilitate connections and relationships between health care providers and Ys delivering evidence-based programs.

Methods/Approach: Ten Ys piloted the registering, scheduling, and entering data of LIVESTRONG at the YMCA participants in the EMR to identify areas for improvement prior to full-scale rollout. Quality assurance tests were run on data extracts to identify inconsistencies.

Results: In 5 months, 224 participants were registered in the EMR, and over 2,300 visits were recorded. Attendance and outcome data were analyzed for completeness and accuracy. The pilot illuminated areas for improvement, including: updating EMR data fields, and enhancing EMR end-user and standard program trainings to clarify and standardize assessment processes.

Conclusions/Implications: Community integrated health for cancer survivors requires organizations like YMCAs to build capacity for clinical integration.

Impact of the LIVESTRONG at the YMCA Program on Physical Activity, Fitness, and Quality of Life in Cancer Survivors

Authors:

Jennifer Ligibel (Presenter)
Dana-Farber Cancer Institute

Melinda Irwin, Yale School of Public Health

Public Health Statement: Physical activity (PA) has been linked to cancer risk and outcomes, yet many survivors are inactive.

Purpose: We evaluated the impact of the LIVESTRONG at the YMCA program, an exercise program available for cancer survivors at YMCA’s across the USA, on PA, fitness, and quality of life (QOL).

Methods/Approach: Participants were recruited through Yale Cancer Center and Dana-Farber Cancer Institute. Key eligibility criteria included having a cancer diagnosis and being able to walk. Participants were randomized to immediate participation in a 12-week LIVESTRONG at the YMCA program in CT or MA, or to a wait-list control group. Study measures were collected at baseline and 12 weeks, and evaluated using generalized linear models.

Results: 186 participants were randomized (95 to the exercise group and 91 to the control group). The majority of patients were diagnosed with stage I to II cancer and 53% had breast cancer. Participants randomized to the exercise program experienced increases in PA (71% exercising at_150 minutes/week vs 26% of controls).

Conclusions/Implications: The LIVESTRONG at the YMCA exercise program has the potential to impact thousands of survivors across the YMCA network and could lead to improvements in disease and psychosocial outcomes in the growing population of cancer survivors.