Abstract P3-08-13: Short-term impact of a breast cancer survivorship clinic in a public hospital setting

Abstract

Abstract Background: Breast cancer survivors struggle with physical and emotional changes from their cancer treatment. Despite growing momentum of survivorship care nationally, many still fail to receive appropriate long-term care. The Avon Cares for Life Survivorship Clinic, based at Olive View-UCLA Medical Center, a university-affiliated county hospital serving socioeconomically disadvantaged patients, provides care for breast cancer patients. The clinic is run by a bilingual nurse practitioner who provides comprehensive survivorship care including a needs assessment, on-going medical management, and consultative referrals. Our goals were to assess a cohort of indigent breast cancer survivors treated in the clinic and describe their burden of active morbidities along with the short-term impact a survivorship consultation had on pain, mental health and healthy behaviors. Methods: 43 consecutive breast cancer survivors receiving survivorship consultation were enrolled (May-Dec 2011). A bilingual research assistant administered a formal needs assessment (baseline, n = 43), and measured changes in pain (scale 0-10), mental health (Mental Health Inventory-5), perceived health (World Health Organization), and healthy behaviors (adapted from Memorial Sloan Kettering questionnaires) at baseline and 3 month follow-up (n = 36). For one quarter of patients this was the first survivorship clinic visit. Results: 62.8% were Hispanic, mean age was 54 years (sd 9.2), and mean time from diagnosis was 6.9 years (sd 4.4). The majority suffered from emotional changes (74%), over half had fatigue (55.8%), and numbness/tingling (58.1%). Pain was reported in 39.5% with mean score of 5.4 (scale 0-10). Most patients (95%) reported more than one symptom (n = 4). 50.0% reported poor or fair quality of health and only 11.1% had excellent or very good quality of health. Positive as well as negative short-term changes were noted from baseline as compared to the 3 month follow-up. Outcomes Assessed: 3 month Follow-upOutcomeImprovedNo ChangeWorsenedPain16.7%77.8%5.5%Mental Health50.0%8.3%41.7%Perceived Quality of Health47.2%47.2%5.6% Five patients were referred to social work at the time of the baseline clinic visit. All patients reported that the services received from the clinical social worker were helpful. There were no significant differences in health behaviors at the 3 month follow-up (exercise and nutrition). Conclusions: Formal assessment shows broad needs and high burden of morbidities present in indigent breast cancer survivors. Incorporating a bilingual social worker to address psychosocial concerns had a positive impact on the mental health status. This is one example of how referring to essential consultative services is paramount. Thorough assessment of this population helps provide a comprehensive patient-centered approach to addressing survivors’ physical and emotional needs in this post-treatment phase. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-13.