Abstract P3-08-07: Survivorship care planning – When is intervention most effective?

Abstract

Abstract Introduction: Cancer survivors experience late and long-term effects, though post-treatment follow-up is generally focused on monitoring for disease recurrence. Survivors may hesitate to volunteer symptom concerns for fear of burdening their providers with ‘insignificant complaints.’ Survivorship care plans (SCPs) have been recommended by the IOM and mandated by the American College of Surgeons as a means of improving outcomes and enhancing communication between survivors and providers. To date, however, little research has evaluated the effect of SCPs on patient-reported outcomes, and less has examined the optimal timing of SCP interventions. This study examined symptom burden, quality of life (QoL), health concerns, use of SCP materials and differences by time since diagnosis in a pre-post quasi-experimental design. Method: 139 breast cancer survivors completed assessments prior to and 3 months following a structured SCP visit at one of seven LIVESTRONG™ affiliated survivorship programs. Measures at both time points included global and individual symptom burden, QoL (SF-12), cancer-specific and general health worry, personal survivorship concerns, and family/genetic Survivorship Concerns. Patients also reported use of SCP materials for informational, decisional, and communication Support at follow-up. Subjects were grouped according to time since diagnosis into two categories: near term (≤ 24 months, n = 84), long term (> 24 Month, n = 55) survivors. Results: Global symptom burden decreased following SCP intervention (p < .001). Participants reported decreased pain (p = .001), fatigue (p < .001), disturbance from hot flashes (p = .02), emotional concern (p = .02), and numbness/neuropathy (p = .006), and a trend toward decreased cognitive disturbance (p = .09). Near term survivors reported marginally greater decrease in global symptom burden relative to long term survivors (p = .08), and in the specific areas of cognitive difficulties (p = .05), fatigue (p = .006), and emotional concerns (p = .10). Although there were no differences over time in physical functioning on the SF-12, near term survivors reported worse mental health than long term survivors (p = .008). Across groups, cancer-specific worry, general health worry, personal survivorship concerns, and family/genetics concerns did not change over time. However, near term survivors reported more cancer-specific worry (p = .03) and marginally greater family/genetics concern than long term subjects (p = .10). Near term survivors were also more likely to use their SCP documents for informational (p = .02) and decisional (p = .08) support following their SCP visit. Discussion: Although limited by a quasi-experimental design, results suggest that SCPs may have a beneficial effect on symptom burden generally, with physical symptoms of pain, fatigue and neuropathy most responsive to care.. Much of the benefit appears to accrue to near term survivors. Moreover, near term survivors report more concerns relative to long term survivors, and are more likely to use SCP materials following visits. If these findings are replicated in better controlled studies, survivorship care will provide greater benefit in the first two years after completion of treatment. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-07.