Our Publications

Alliance program sites are working with regional and community partners to develop and implement comprehensive patient-centered interventions and quality improvement programs in the United States. Following our stated goal of disseminating key findings and lessons learned to promote best practices in patient-centered cancer care, we have included here a collection of peer-reviewed publications and other dissemination opportunities.

If you would like to learn even more about our interventions, make sure to head over to the resources page, which contains links to our latest publications and a collection of our video explainers and webinar recordings.

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The Alliance National Program Office (NPO)

The University of Michigan School of Nursing serves as the National Program Office (NPO) for the Alliance. The NPO supports program efforts and encourages collaboration among program partners and community-based organizations to share best practices and lessons learned.

Strategies to improve the reach of interventions to address inequities in cancer care: Results from a six-site initiative

13th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, Barton D, Ghosh B, Hamann H, Percac-Lima S, Dobs A, Naughton M, Matthews R, Gabram-Mendola S, Simon M, Bueno Y, Moy B, Paskett E, Danner S, Chen B, Ploutz-Snyder R, Friese C, October 2020.

NPO Co-Director Debra L. Barton, RN, PhD, FAAN presented a poster examining the reach of Alliance interventions by comparing the demographics of the population potentially eligible for interventions with those of enrolled participants. The results show that sites are enrolling vulnerable and underserved patient population groups that largely reflect the demographic distribution of the total eligible population.

Registered conference attendees can review this content any time: https://www.pathlms.com/aacr/courses/22851

The Georgia Cancer Center for Excellence at Grady Health System

The GCCE at Grady Health System presented promising results from their interventions at several academic conferences. Included here is a brief overview of their presentations:

The Impact of a Registered Dietitian in an Urban Safety Net Oncology Clinic

Food and Nutrition Conference of the Academy of Nutrition and Dietetics, Forbus MP, Matthews R, Mishra P, Facdol J, Bascho-George V, Coples S, Garrett R, Wang Z, Gabram-Mendola S., October 2020.

A summary of their findings: In a safety net hospital, a registered dietitian intervention significantly changed patients’ viewpoints on the importance of adequate nutrition during cancer treatment. By having an RD/CSO as part of the cancer team, patients also showed a significant change in making conscious healthy choices at mealtimes.

Improving Timeliness of Care for Breast, GYN, and Aerodigestive Cancer Patients with Nurse Navigators in a Safety Net Hospital.

ASCO Quality Care Symposium, C. Rehr, T. Carter, E. Flenaugh MD, Wang Z, G. Ohaegbulam MD, R. Matthews MD, P. Mishra, J. Facdol, S. Coples RN, D. Thomas RN, R. Garrett RN, S. Gabram MD, October 9-10, 2020

A summary of their findings: After the addition of nurse navigators within the cancer program, data showed a decrease in time patients spent between diagnosis and treatment. The intervention focused on breast, GYN, and aerodigestive cancer patients. These measurable improvements over three cancer sites, largely attributed to nurse navigation, suggest that cancer outcomes for patients treated in the safety net hospital will improve over time.

The Johns Hopkins University School of Medicine

The Johns Hopkins Primary Care for Cancer Survivor Clinic: lessons learned in our first 4 years

Johns Hopkins Medicine established the Primary Care for Cancer Survivor (PCCS) Clinic in 2015 to address the unique needs of survivors of cancer. Between 2015 and 2019, the clinic saw over 230 patients; nearly half were breast cancer survivors. The team learned several valuable lessons along the way. The first one was the importance of building a strong network of referrals, greatly aided by consistent communication with cancer teams. The second was choosing to have survivorship care embedded in general medicine, where patients are viewed as whole individuals, and can receive help for all of their physical and emotional concerns. Lastly, the success of the clinic is attributed to getting crucial buy-in from oncologists and general medicine practitioners alike.

Learn more here: https://doi.org/10.1007/s11764-019-00816-3

Massachusetts General Hospital (MGH) Cancer Center

The MGH Cancer Center has reported extensively on the status of their interventions, participating in a number of academic and clinical conferences, at the local, national, and international levels. We are highlighting two important presentations:

The Merck Foundation Alliance to Advance Patient‐Centered Cancer Care: decreasing disparities in cancer care for underserved patients through collaborative care and community partnerships

The American Psychosocial Oncology Society (APOS) 15th Annual Conference, with Irwin, K., 22‐24 February 2018, Tucson, Arizona.

A summary of their findings: Investigators from 3 sites funded by the Merck Foundation outlined collaborative care models developed to provide better care to underserved cancer patients with mental illness, Latino patients, and patients from low‐income communities. Presenters shared strategies to promote comprehensive, high‐quality, and person‐centered cancer care for vulnerable patients including: (1) collaborative care to improve care integration, (2) a diverse care team to increase patient engagement, and (3) fostering sustainable community partnerships.

Patient navigation program for community health center patients with cancer

The Cancer and Primary Care Research International Network (Ca-PRI) Conference. In Walker, J. (Chair), Addressing cancer-related health inequities [Symposium] by Percac-Lima, S., Ivan, S., Shahid, N., Benjamin, C., Irwin, K., Moy, B., April 2019, Toronto, Canada.

A summary of their findings: The Massachusetts General Hospital Cancer Center’s intervention aims to improve care for newly diagnosed patients on multiple fronts: the TopCare registry can help detect patients in need of additional support, and Patient Navigators are empowered to step in and act as a conduit between primary care and oncology services. Patient Navigators can support patients in securing transportation to and from appointments, guide the patient through treatment decisions and subsequent treatment options, and can help manage financial concerns. Patient Navigators can also provide interpreter services and accompany patients to their medical appointments.

Northwestern University Feinberg School of Medicine

Systematic patient navigation strategies to scale breast cancer disparity reduction by improved cancer prevention and care delivery processes

Northwestern University Feinberg School of Medicine developed the 4R (the Right information and Right care for the Right patient at the Right time) model to provide patients with a clear project plan of their treatment, regardless of how many facilities may be involved in their care or their stage of treatment. Care sequence templates, like the 4R care model, can help a clinical care team to optimize a patient’s care. Data collected from one patient can in turn inform process improvement of patient care and expansion of navigation services at a health system level. A learning health care system approach that systematically integrates data patterns emerging from multiple patient navigation experiences may improve processes of care and reduce cancer disparities.

Learn more here: https://doi.org/10.1200/JOP.19.00314

The Ohio State University Comprehensive Cancer Center

Feasibility of text-based symptom monitoring of ovarian and endometrial patients during treatment.

Unreported symptoms during cancer treatment can lead to poorer patient care and quality of life. Newer technology enables effective means to track patients’ health in real time. This quality improvement program evaluated the feasibility of implementing systematic patient symptom monitoring during the first 12 months after a diagnosis of cancer. Patients are asked to respond to a questionnaire once a month, reporting on a variety of psychological and physical symptoms. Survey results are reviewed by specially-trained triage coordinators who, in turn, refer the patient to their physician or to specialized navigation services, if needed.

Learn more here: https://doi.org/10.1200/JCO.2019.37.15_suppl.e18299

The University of Arizona Cancer Center

Survivorship care plan outcomes for primary care physicians, cancer survivors, and systems: a scoping review

This paper reviews 25 studies that look at the involvement of primary care physicians (PCPs) in the use of survivorship care plans (SCPs). Survivorship care plans include important guidelines for monitoring and maintaining a person’s health, and are specially tailored to an individual’s health history, diagnosis of cancer, and subsequent treatment. This paper found that although 90% of PCPs believe that SCPs are useful in understanding components of care and follow-up, only 13% consistently received them.

Learn more here: https://doi.org/10.1007/s11764-017-0673-5

Oregon’s Familias en Acción replicates benefits for underserved cancer co-survivors through Un Abrazo Para la Familia

The paper assesses the effectiveness of reproducing the intervention Un Abrazo Para La Familia™, moving the program from Southern Arizona to Portland, Oregon. Abrazo is a brief (three one-hour sessions), low-cost intervention presented in the language of choice (Spanish or English) of participants. It focuses on understanding cancer as a life-threatening chronic illness by providing specific information on the disease, coping with the diagnosis, and connecting participants with other supportive programs in Arizona. Findings show that participants have an increased understanding of their or their loved one’s diagnosis, and an almost twofold self-efficacy increase. Self-efficacy measures how well an individual can execute a course of action required to deal with a given situation, in this case a diagnosis of cancer. Successfully replicating the intervention in a different environment is a crucial step in assessing its effectiveness.

Learn more here: https://doi.org/10.1002/pon.4841

The evolution of Un Abrazo Para La Familia™: implications for survivors of cancer

The team from the intervention Un Abrazo Para La Familia™ shared valuable lessons learned to improve promotora (community health worker) training and increase the project’s effectiveness and efficiency. A competency-based test was delivered in June 2018 to 10 promotoras who had completed the training to examine their ability to successfully deliver the Abrazo intervention. Results show that the trained promotoras demonstrated the necessary skills to lead and direct the Abrazo intervention.

Learn more here: https://doi.org/10.1007/s13187-020-01737-x

Testing active learning workshops for reducing implicit stereotyping of Hispanics by majority and minority group medical students

This paper analyzes the development of an intervention aimed at reducing the stereotyping of Hispanic patients as medically non-compliant. Controlling the expression of implicit bias in a clinical setting is a very complex balancing act. Physicians need to rely on categorizations based on age, gender, race, and ethnicity when formulating a diagnosis. However, once these biases are activated, physicians need to then “individuate” the patient, developing personalized treatment recommendations and engaging in patient-centered dialogue that will help the patient be fully involved in all treatment decisions.

Learn more here: https://doi.org/10.1007/s00520-020-05468-z

Patient-reported financial toxicity, quality of life, and health behaviors in insured US cancer survivors

The paper examines the concept of financial toxicity (FT) in insured cancer patients. The National Cancer Institute defines financial toxicity as any problem a cancer patient may experience as related to the cost of medical care. Findings show that 18% of patients surveyed reported significant financial burden, with greater FT significantly associated with some demographic characteristics, such as marital status, educational attainment, and employment status. Greater FT was a significant predictor of lower health-related quality of life.

Learn more here: https://doi.org/10.1007/s00520-020-05468-z