Impact of a Multidisciplinary Supportive Care Model Using Distress Screening at an Asian Ambulatory Cancer Center: A Cluster Randomized Controlled Trial.

IF 4.7 3区 医学 Q1 ONCOLOGY JCO oncology practice Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI:10.1200/OP.23.00505
Yu Ke, Patricia Soek Hui Neo, Grace Meijuan Yang, Shirlyn Hui-Shan Neo, Yung Ying Tan, Yee Pin Tan, Mothi Babu Ramalingam, Kiley Wei-Jen Loh, Daniel Song Chiek Quah, Lita Chew, Phebe En Hui Si, Raymond Javan Chan, William Ying Khee Hwang, Alexandre Chan
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Abstract

Purpose: The Accessible Cancer Care to Enable Support for Cancer Survivors (ACCESS) program adopts a multidisciplinary supportive care model with routine distress screening to triage newly diagnosed cancer survivors for additional support on the basis of distress levels. This study aimed to evaluate the clinical impact of ACCESS over 1 year.

Methods: We performed cluster random assignment at the oncologist level in a 1:1 ratio to receive ACCESS or usual care. Participants 21 years and older, newly diagnosed with breast or gynecologic cancer, and receiving care at National Cancer Centre Singapore were included. Outcomes assessed every 3 months for 1 year included quality of life (QoL) (primary), functioning, physical and psychological symptom burden, and activity levels. Data were analyzed using mixed-effects models.

Results: Participants from 16 clusters (control = 90, intervention = 83) were analyzed. The ACCESS program did not significantly improve QoL (primary outcome). However, compared with usual care recipients, ACCESS recipients reported higher physical functioning (P = .017), role functioning (P = .001), and activity levels (P < .001) at 9 months and lower psychological distress (P = .025) at 12 months. ACCESS recipients screened with high distress had poorer QoL, lower role and social functioning, and higher physical symptom distress at 3 months but had comparable scores with ACCESS recipients without high distress after 12 months.

Conclusion: Compared with usual care, participation in the ACCESS program did not yield QoL improvement but showed earlier functioning recovery related to activities of daily living and reduced psychological distress. Routine distress screening is a promising mechanism to identify survivors with poorer health for more intensive supportive care.

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亚裔门诊癌症中心使用压力筛查的多学科支持性护理模式的影响:集群随机对照试验。
目的:"为癌症幸存者提供支持的无障碍癌症护理(ACCESS)"项目采用了一种多学科支持性护理模式,通过常规痛苦筛查,根据痛苦程度对新诊断的癌症幸存者进行分流,为其提供额外支持。本研究旨在评估 ACCESS 一年来的临床效果:我们按 1:1 的比例在肿瘤学家层面进行了分组随机分配,让患者接受 ACCESS 或常规护理。参与者年龄在 21 岁及以上,新诊断出患有乳腺癌或妇科癌症,并在新加坡国立癌症中心接受治疗。在为期 1 年的时间里,每 3 个月进行一次结果评估,包括生活质量(QoL)(主要)、功能、身体和心理症状负担以及活动水平。数据采用混合效应模型进行分析:对来自 16 个群组(对照组 = 90 人,干预组 = 83 人)的参与者进行了分析。ACCESS 计划并未明显改善 QoL(主要结果)。不过,与常规护理受助者相比,ACCESS 受助者在 9 个月时的身体机能(P = .017)、角色机能(P = .001)和活动水平(P < .001)均有所提高,在 12 个月时的心理压力(P = .025)也有所降低。被筛查出有严重心理困扰的 ACCESS 受助者在 3 个月时的 QoL 较差,角色和社会功能较低,身体症状困扰较高,但在 12 个月后,其得分与没有严重心理困扰的 ACCESS 受助者相当:结论:与常规护理相比,参与 ACCESS 计划并不能改善 QoL,但却能更早地恢复与日常生活相关的功能,并减少心理困扰。常规的心理困扰筛查是一种很有前景的机制,可以识别出健康状况较差的幸存者,为其提供更深入的支持性护理。
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CiteScore
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7.50%
发文量
518
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