Factors associated with spontaneous vaginal birth in nulliparous women: A descriptive systematic review.

Problem: Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally.

Background: There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously.

Aim: To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy.

Improved models of care for cancer survivors.

The number of survivors of cancer is increasing substantially. Current models of care are unsustainable and fail to address the many unmet needs of survivors of cancer. Numerous trials have investigated alternate models of care, including models led by primary-care providers, care shared between oncology specialists and primary-care providers, and care led by oncology nurses.

Treatable but not curable cancer in England: a retrospective cohort study using cancer registry data and linked data sets.

Objectives: This study estimates the prevalence of cancers that are categorised as treatable but not curable (TbnC) in England. It provides a quantification of the population and a framework to aid identification of this group to enable the design of tailored support services.

Design: Through consultation with clinical and data experts an algorithmic definition of TbnC was developed.

Building Personalized Cancer Follow-up Care Pathways in the United States: Lessons Learned From Implementation in England, Northern Ireland, and Australia.

There is a global need to transform cancer follow-up care to address the needs of cancer survivors while efficiently using the health care system to limit the effects of provider shortages, gaps in provider knowledge, and already overburdened clinics; improve the mental health of clinicians; and limit costs to health care systems and patients. England, Northern Ireland, and Australia are implementing an approach that triages patients to personalized follow-up care pathways depending on the types and levels of resources needed for patients' long-term care that has been shown to meet patients' needs, more efficiently use the health care system, and reduce costs. This article discusses lessons learned from these implementation efforts, identifying the necessary components of these care models and barriers and facilitators to implementation of this care.

Implementing personalized pathways for cancer follow-up care in the United States: Proceedings from an American Cancer Society-American Society of Clinical Oncology summit.

A new approach to cancer follow-up care is necessary to meet the needs of cancer survivors while dealing with increasing volume and provider shortages, knowledge gaps, and costs to both health care systems and patients. An approach that triages patients to personalized follow-up care pathways, depending on the type(s) and level(s) of resources needed for patients' long-term care, is in use in the United Kingdom and other countries and has been shown to meet patients' needs, more efficiently use the health care system, and reduce costs. Recognizing that testing and implementing a similar personalized approach to cancer follow-up care in the United States will require a multipronged strategy, the American Cancer Society and the American Society of Clinical Oncology convened a summit in January 2018 to identify the needed steps to move this work from concept to implementation.

Categorising cancers to enable tailored care planning through a secondary analysis of cancer registration data in the UK.

Objectives: The aim of this study is to categorise cancers into broad groups based on clusters of common treatment aims, experiences and outcomes to provide a numerical framework for understanding the services required to meet the needs of people with different cancers. This framework will enable a high-level overview of care and support requirements for the whole cancer population.

Setting And Participants: People in the UK with 1 of 20 common cancers; an estimated 309 000 diagnoses in 2014, 1 679 000 people diagnosed in a 20-year period and still living in 2010 and 135 000 cancer deaths in 2014.

Addressing future challenges for cancer services: part II.

Jane Maher & Gina Radford speak to Gemma Westcott, Commissioning Editor Jane Maher has been Macmillan's Chief Medical Officer since 1999 and now shares the role as Joint Chief Medical Officer with general practitioner Rosie Loftus, reflecting the growing need for specialists and generalists to work more effectively together. She has been an National Health Service (NHS) improvement clinical leader for over 10 years and is a Consultant Clinical Oncologist at Mount Vernon Cancer Centre and Hillingdon Hospital where she has worked for more than 20 years, during which she helped develop nonsurgical oncology services in five district general hospitals. She is a senior Clinical Lecturer at University College London and Visiting Professor in Cancer and Supportive Care at the Centre for Complexity Management at the University of Hertfordshire.

Addressing future challenges for cancer services: part I.

Jane Maher & Gina Radford speak to Gemma Westcott, Commissioning Editor Jane Maher has been Macmillan's Chief Medical Officer since 1999 and now shares the role as Joint Chief Medical Officer with general practitioner Rosie Loftus, reflecting the growing need for specialists and generalists to work more effectively together. She has been a National Health Service (NHS) Improvement Clinical Leader for over 10 years and is a Consultant Clinical Oncologist at Mount Vernon Cancer Centre where she has worked for more than 20 years, during which she helped develop nonsurgical oncology services in five district general hospitals. Jane chaired the Maher Committee for the Department of Health in 1995, led the UK National Audit of Late Effects Pelvic Radiotherapy for the Royal College Of Radiologists (RCR) in 2000 and, most recently, chaired the 'National Cancer Survivorship Initiative, consequences of treatment work stream'.

The role of behavioural modification and exercise in the management of cancer-related fatigue to reduce its impact during and after cancer treatment.

Background: Fatigue is a symptom that can occur during treatment as an acute side effect but can also result in persistent fatigue as a long-term side effect or late effect.

Materials And Methods: We undertook a narrative review of the current literature and discuss the current evidence of assessment of fatigue and we specifically focus on the role of promoting behavioural change and focused rehabilitation to minimise these long-term effects and update the literature relating to this area from 2012 to date.

Results: We suggest there are behavioural change models that can be scaled up to enable patients to manage long-term fatigue using exercise.

Models of cancer survivorship health care: moving forward.

The population of cancer survivors in the United States and worldwide is rapidly increasing. Many survivors will develop health conditions as a direct or indirect consequence of their cancer therapy. Thus, models to deliver high-quality care for cancer survivors are evolving.

Health care policy and cancer survivorship.

The United States and the European Union (EU) vary widely in approaches to ensuring affordable health care coverage for our respective populations. Such variations stem from differences in the political systems and beliefs regarding social welfare. These variations are also reflected in past and future initiatives to provide high quality cancer survivorship care.

Incorporating palliative care into undergraduate curricula: lessons for curriculum development.

Context: It is well recognised that teaching about palliative care, death and dying should begin at undergraduate level. The General Medical Council in the UK has issued clear recommendations for core teaching on the relieving of pain and distress, and care for the terminally ill. However, whereas some medical schools have incorporated comprehensive teaching programmes, others provide very little.

Ear acupuncture for hot flushes--the perceptions of women with breast cancer.

Hot flushes and night sweats are a major problem for women having adjuvant hormonal treatment for breast cancer. We explored using a standardised ear acupuncture protocol delivered in small group clinics as an option to manage these side effects. Qualitative research aimed to elicit the opinions of women who received this treatment.

Sharing experiences of user involvement in shaping new services: the story of a national patient group.

When the Cancer Genetics Pilots Programme was established in 2004, Macmillan Cancer Support undertook to create and facilitate the work of a "National User Reference Group". The purpose of this group was to give service user representatives (patients and carers) from each of the seven pilot projects regular opportunities to meet and share experiences and thus strengthen the influence of patients on the services. Macmillan commissioned a narrative writer to record key aspects of the national user group's work and influence.