Integrating Traditional Chinese Medicine Into Cancer Survivorship Care Model Based On Chinese Cancer Survivors’ Needs And International Practice

BackgroundCancer survivors are cancer patients who have undergone active cancer treatments.Broad definition also includes patients under active cancer treatments,and in late stage of the disease.Cancer survivorship care aims to help cancer survivors get back to their normal life after cancer treatments.In many western countries,the field of cancer survivorship has developed from physical rehabilitation to comprehensive and multidisciplinary care after over fifty years’efforts.Although cancer survivors are expanding rapidly in China,cancer survivorship care is still an emerging field.Chinese cancer patients use Traditional Chinese Medicine(TCM)widely during or after cancer treatments.TCM theories and treatments emphasize patient-centered and comprehensive care,which share the similar goals with modern cancer survivorship care.It is also national health policy that TCM should be able to play a leading role in disease rehabilitation until 2030.Therefore,it is necessary to integrate TCM into cancer survivorship care system in China.However,four questions need to be addressed first:1.What are Chinese cancer survivors’ needs and attitudes towards cancer survivorship care;2.How multidisciplinary team,especially western medicine oncologists and nurses view on TCM’s role in survivorship care system in China;3.Could TCM provide better services to meet cancer survivors’ needs in future TCM survivorship model;4.What are the experiences of mature cancer survivorship care model from developed countries and how could we learn from them.ObjectivesAccording to the four questions raised above,the current study aimed to:1.Investigate Chinese cancer survivors’ needs and attitudes towards cancer survivorship care and impact factors of willingness to use TCM;2.Understand Chinese oncologists and nurses’ willingness to refer TCM to cancer survivors and impact factors;3.Explore Chinese cancer survivors’ expectations and barriers towards using TCM and impact factors for unmet needs during survivorship care;4.Learn experiences from developed countries on cancer survivorship care model;5.Establish the initial design and framework of integrative TCM cancer survivorship care model.The current study could help meet increasing needs of cancer survivors and address significant burden to their family and the whole community.MethodsThe current study includes literature review,cross-sectional study and qualitative study.Literature review part of the study reviewed the development and advances in cancer survivorship care field aboard and in China.This part also reviewed TCM’s theories bases and existed evidences on cancer survivorship care.The cross-sectional study part was conducted between September 2015 and February 2016 among over 1800 cancer survivors,Chinese oncologists and nurses.This part concludes three cross-sectional survey studies.The first survey enrolled cancer survivors from Beijing Anti-Cancer Association between September and October,2015 in Beijing,China.The second survey was conducted respectively among Chinese oncologists during 2015 annual conference of China Society of Clinical Oncology,as well as oncology nurses from six hospitals in Beijing and Henan province in China.The third survey was also conducted among cancer survivors from Beijing Anti Cancer Group between January and February 2016.All the three survey studies above were collaborated between China and the US for questionnaire design and methodology design to specifically investigate participants’ attitudes and knowledge towards cancer survivorship care.The main outcomes of these survey studies were Chinese cancer survivors’ willingness to use TCM during cancer survivorship care,and their previous TCM utilization,as well as Chinese oncologists/nurses’ willingness towards referring TCM to cancer survivors during survivorship care.Main impact factors were Chinese cancer survivors’needs and unmet needs towards survivorship care,understanding of different roles,preferred information resources and attitudes towards receiving survivorship care services;as well as Chinese oncologists/nurses’ cared survivors’ needs,formal survivorship services and attitudes towards offering survivorship services to cancer survivors.The qualitative study was conducted by a qualitative deep interview study among staffs and health providers related to cancer survivorship care at Memorial Sloan-Kettering Cancer Center(MSKCC)in the US.The main contents of the interview were the history of cancer survivorship services in MSKCC,the service model and format.ResultsThe results of cross-sectional studies showed that 80%of the cancer survivors were willing to use TCM among survivorship care,ranking the first place among six treatment methods.Survivors who had more perceived needs were more willing to use TCM(adjusted odds ratio[AOR]1.33,P<0.001).Survivors with specific nutritional and symptom needs had more willingness of using TCM(all P<0.05).Doctors were the most important role(91%agreed)and most welcomed information resource in survivorship care according to survivors in our study(86%preferred).The more promote factors of receiving survivorship care of the survivors,the more they were willing to use TCM(AOR 1.42,P =0.001).In addition,the more survivors wanted to spend more money on survivorship care,the more they were willing to use TCM(P<0.001).Among all the oncologists,67%of them were willing to refer TCM treatments to cancer survivors during survivorship care.Age>40,from higher level hospitals,caring more on survivors’ needs,more pervious survivorship service and more promote factors of offering such services were related to more willingness of refer TCM to survivors(all P<0.05).Among all the nurses,75%were willing to refer TCM to cancer survivors.Caring more on survivors’ needs,more pervious survivorship service and more promote factors of offering such services were related to more willingness of refer TCM to survivors during survivorship nursing(all P<0.05).In addition,among all the survivors,90%had use TCM herbal medicine,65%had used patent herbal medicine,20%had used diet therapy,10%experienced Qigong,5.5%had use acupuncture.67%of the survivors had use 2 or more than 2 different types of TCM treatments.74.8%had used TCM for more than one year.Among them,33.2%had used for more than 5 years.Over 80%of survivors had different expectations towards TCM use.Among them 96.4%expected that TCM could help them promote immune system,ranking the highest,whereas 83.2%expected TCM could cure cancer,ranking the lowest.As to the barriers,lower than 20%on average of survivors concerned about the scientific evidence and side effects of TCM,while over or near 50%of survivors had barriers on decocting herbs,hard to find good TCM doctors and too long treatment period.The longer pervious TCM treatments,the more multiple types of TCM treatments were,the lower unmet needs of cancer survivors would be(all P<0.05).Also different aspects of cancer survivors’ unmet needs had relationship with different TCM utilization.The qualitative study showed that nurse-led cancer survivorship clinic is the key service of cancer survivorship care at MSKCC.Nurse practitioner provides cancer survivorship care plan to cancer survivors based on their disease,needs and evidence-based medicine.They also play an important role in connecting different resources and services from other health providers.Social workers also are very important to meet cancer survivors’ needs in psychosocial needs.In addition,the current raised the initial concept about establishing integrative TCM and comprehensive cancer survivorship care model based on TCM’s characteristics,Chinese cancer survivors’ needs and experiences from other countries.The study also initially formed a framework of such model as well as detailed plan including team building,assessment,and personalized cancer survivorship care plan.ConclusionOur study reveals cancer survivors’ high willingness of using TCM during survivorship care.In addition,such willingness is highly associated with cancer survivors’ socioeconomic status,physical and psychological needs,social supports and information resources.Chinese oncologists and nurses are open to refer TCM to cancer survivors.By carrying out more scientific studies and improving TCM services,we could help better meet Chinese cancer survivors’ expectations and address their barriers.Our study also provides initial ideas and frameworks on establishing integrative TCM cancer survivorship care model.