Since the Institute of Medicine (IOM) released the seminal report, From Cancer Patient to Cancer Survivor: Lost in Transition 13 years ago, there has been substantial progress in understanding the health issues affecting cancer survivors, yet little has changed regarding survivorship care delivery. There remains a disconnect between primary care providers and oncology care teams that has led to persistent problems implementing risk-stratified survivorship care for cancer survivors. With advances in cancer therapy and improved survival rates, the risk of death from cardiovascular disease (CVD) now exceeds that of the cancer for many survivors. While cancer therapy may contribute to this risk, it is generally a compilation of non-modifiable factors (i.e., genetics, aging), as well as modifiable lifestyle behaviors (i.e., diet, exercise) that lead to both the cancer and to cardiovascular disease (CVD). With the lack of primary care provider (PCP) integration in the cancer care team and time constraints and difficulty keeping up with rapidly evolving non-cancer therapeutics for medical oncologists, there is an inferred lower priority for comorbidity management. We will determine the effectiveness of the multi-level iGuide intervention and the up-titrated iGuide2 intervention compared with usual care on the primary outcomes. The theory-driven, self-guided iGuide intervention consists of patient-level components (video vignettes, patient-facing webinars) and PCP-level components (electronic health record [EHR] automated cancer specialist-PCP letter, tele-education series, and automated reminders). The up-titrated iGuide2 intervention consists of tailored patient-level video vignettes and targeted EHR specialist-PCP communication. The primary outcomes of the ONE TEAM SMART-design study are (1) Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of the three CVD comorbidities (hypertension, type 2 diabetes mellitus, hypercholesterolemia) based upon laboratory and clinical measurement; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care). Secondary aims include exploring moderating and mediating factors in each level of the intervention, support of patient-centered outcomes, health care use, measures of provider activation, and costs of care resulting from the multi-level intervention. The overarching goal of this proposed project is to optimize the management and outcomes of individuals with cancer, both during and after treatment, and to develop a ?low-touch? multi-level intervention that can be generalized, adapted and scaled in other health care systems. The proposed ONE TEAM study brings together a multi-disciplinary research team with the necessary expertise and experience in survivorship research, population and behavioral science, primary care, oncology, and biostatistics. Results from this intervention will have important implications in the advancement of healthcare delivery for cancer survivors.

Public Health Relevance

Despite advances in understanding and preventing health care problems faced by cancer survivors, little has changed in the delivery of survivorship care. With the lack of a planned and formal transition of the cancer survivor from the cancer care to the primary care team, non-cancer-related comorbidities are poorly managed. The proposed study aims to use a multi-level intervention including patient and PCP strategies to optimize the management of CVD comorbidities during and after cancer therapy.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Special Emphasis Panel (ZCA1)
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Mollica, Michelle A
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Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
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