Improving the cancer survivorship journey: Developing a survivorship care transition model for rural and underserved low risk breast and gynecologic cancer patients (511)

Abstract

<b>Objectives:</b> The rapid growth of cancer survivors in the United States, in combination with oncology service workforce shortage, creates an urgent need to develop effective survivorship care models. While survivorship programs are required by the Commission on Cancer and endorsed by national cancer organizations, the evidence base supporting specific components and delivery models is still lacking, and novel approaches are especially needed in rural care settings with high concentrations of underrepresented minority populations. Our team is working to create effective and innovative cancer survivorship care models for low-risk breast and gynecologic cancer patients. <b>Methods:</b> We conducted exploratory research among low-risk breast and gynecologic cancer survivors and primary care providers to inform a subsequent intervention of navigated care transitions. We convened a Patient Advisory Board (PAB) to review a structured menu of cancer survivorship issues, including access to primary care services, compliance with screening recommendations, treatment of comorbid conditions and identified the range of desired survivorship resources. We conducted five virtual PAB meetings via ZOOM, and participants completed four surveys. In parallel, we conducted semi-structured qualitative interviews with seven primary care providers (Family Physicians and OB/GYNs) to understand preferences of cancer survivor care transition timing and informational needs. Both PAB and Provider sessions/interviews were transcribed and coded for content and thematic analysis. <b>Results:</b> Participants in the PAB provided insight into survivorship experiences and processes to facilitate earlier care transitions. They emphasized the need to begin survivorship planning at an earlier stage of care and advocated for the creation of tailored documents relevant to the care needs of particular stages (e.g., diagnosis, definitive treatment, care transitions). Lastly, they identified other overlooked care needs, including adverse effects on sexual health. Primary care provider data aligned with PAB findings, including the need to initiate enhanced communication with the oncologists immediately following diagnosis. Additionally, providers expressed confidence in managing survivorship care based on responses to structured vignettes of breast and gynecological cancer patients. <b>Conclusions:</b> This formative research identified key factors with regard to the development of processes and informational resources necessary to support cancer survivorship care transitions among underserved and rural breast and gynecologic cancer patients. In alignment with findings from primary care providers, this model would focus on initiating survivorship support at an early stage of care, include a broad "menu" of potential patient care needs, and ensure provider training and awareness related to surveillance and referral pathways. Further research to test the feasibility of this model is underway.