Abstract
Background: Optimal strategies for quality care of breast cancer survivors include providing value in each visit and appropriately utilizing resources. The purpose of this study was to demonstrate the use of Survivorship Care Plans (SCPs) to coordinate follow-up in a multidisciplinary practice and improve access to breast surgeons. Methods: In 2009, our breast surgeons, medical oncologists and nurse practitioners agreed upon guidelines for follow up of breast cancer patients, developed a Survivorship Care Program to follow active treatment and implemented use of SCPs. To improve access to two part-time breast surgeons, guidelines were established to shift follow-up to medical oncologists and nurse practitioners. After diagnosis, patients were given comprehensive SCPs which included recommended follow up visits and testing. Wait times and numbers of new surgical patients were measured before and after use of SCPs. Results: Wait times were measured from call to first appointment. New patients included both benign and malignant breast disease. Implementation of SCPs occurred during 2009. In 2007 and 2008, average wait times were 43.5 days and 28.5 days respectively. Following implementation of SCPs, wait times in 2010 and 2011 were 10 and 9 days respectively. Numbers of new patients seen were 573 and 486 in 2007 and 2008; 571 and 650 new patients were seen in 2010 and 2011. Conclusions: SCPs were useful in re-engineering follow-up habits of clinicians, adding value to each visit and gaining acceptance from established patients regarding recommended surveillance. SCPs contributed to reduced wait times and increase in volume of new patients seen by breast surgeons. Future studies should assess contribution of SCPs to reducing unnecessary tests and improving compliance with ASCO guidelines.
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