Current practice patterns and gaps in guideline-concordant breast cancer survivorship care

Eden R Brauer,Laura Petersen,Elisa F Long,Patricia A Ganz

doi:10.1007/s11764-021-01152-1

Abstract

PurposeBreast cancer-specific survivorship care guidelines for the more than 3.8 million survivors in the U.S. are available, but implementation in clinical practice remains challenging. We examined current practice patterns and factors associated with guideline-concordant survivorship care among oncologists.MethodsA national sample of medical oncologists, recruited using two databases, participated in a survey focused on practice patterns for breast cancer survivorship care. A “survivorship care composite score” was calculated for each respondent based on provision of services recommended in the survivorship guidelines. Descriptive statistics and multivariable linear regression analyses examined associations between physician and practice characteristics and composite scores.ResultsThe survey was completed by 217 medical oncologists, with an overall response rate of 17.9% and eligibility rate of 56.9% for those who responded. Oncologists reported high engagement in evaluation of disease recurrence (78%). Performed less frequently were the provision of survivorship care plans (46%), assessment of psychosocial long-term and late effects (34%), and screening for subsequent cancers (34%). Lack of survivorship care training (p = 0.038) and not routinely informing patients about potential late effects (p = 0.003) were significantly associated with poorer survivorship care composite scores.ConclusionsDespite the availability of disease-specific survivorship care guidelines, adherence to their recommendations in clinical practice is suboptimal. Survey results identified key gaps in survivorship care for breast cancer survivors, particularly related to subsequent primary cancers and psychosocial long-term and late effects.Implications for Cancer SurvivorsImproving the delivery of comprehensive survivorship care for the growing population of breast cancer survivors is a high priority. Disease-specific clinical guidelines for cancer survivorship provide valuable recommendations, but innovative strategies are needed to integrate them into the care of long-term breast cancer survivors.

Highlights

With more than 280,000 breast cancer diagnoses in the United States (U.S.) annually—15 percent of all new cancer cases—and continued improvements in early detection
Clinical guidelines for cancer survivorship care have been developed by multiple organizations, including the American Cancer Society (ACS), National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO)
Between October, 2018 and April, 2020, we attempted to contact a random sample of medical oncologists from the commercial database (n = 1500) and subsequently the ASCO pool (n = 899) about study participation (Figure 1)

Summary

Introduction

With more than 280,000 breast cancer diagnoses in the United States (U.S.) annually—15 percent of all new cancer cases—and continued improvements in early detection. In addition to metastatic cancer recurrence, survivors are at risk for subsequent primary cancers [4], comorbid conditions [5], and a wide range of physical and psychosocial long-term and late effects [6, 7]. Recognizing the need for diseasespecific recommendations, ACS and ASCO collaboratively developed survivorship care guidelines for major cancer types, including breast cancer, to facilitate the translation of evidence into clinical practice [8]. These guidelines provide breast cancer-specific information through a framework of the essential domains of survivorship care: (a) surveillance for disease recurrence, (b) subsequent cancer screening, (c) management of long-term and late physical and psychosocial effects, and (d) health promotion and care coordination

Results

Discussion

Conclusion