Breast Cancer Survivorship Care Plans Research Articles

Outcomes and Satisfaction After Delivery of a Breast Cancer Survivorship Care Plan: Results of a Multicenter Trial

Outcomes and Satisfaction After Delivery of a Breast Cancer Survivorship Care Plan: Results of a Multicenter Trial

Adherence to a breast cancer survivorship care plan.

e20610 Background: In 2006 the Institute of Medicine issued recommendations for individualized survivorship care plans (SCP). In response, in 2009, an interdisciplinary team at an ambulatory breast...

Breast cancer survivorship care plan not cost effective in Canada

Breast cancer survivorship care plan not cost effective in Canada

Abstract OT2-5-02: Randomized trial evaluating a coordinated survivorship care program for early stage breast cancer

Abstract Background: Prior studies suggest that many breast cancer survivors use substantial medical resources but still do not receive all guideline-recommended care. Poorly coordinated care may result in unnecessary visits and testing, and may drive up medical costs without improving outcomes. Data are mixed regarding the ability of survivorship care plans to improve the quality of cancer survivorship care. Trial Design: Randomized (1:1) 2-arm study of a coordinated survivorship care program (including a breast cancer treatment summary and survivorship care plan shared with the patient and mailed to her providers, as well as phone calls from a patient navigator to the patient every three months for one year) compared with standard follow-up care. Participants are asked to complete a survey at baseline and one year later, and medical record review is performed at the end of a year to collect data on medical care received during the first year of survivorship care. Cost data will be acquired via institutional billing systems. Specific Aims: To assess the effects of the coordinated survivorship care program compared to standard follow-up care on patients’ receipt of redundant care, receipt of guideline-directed care, and cost of care. The primary endpoint for the study is: -The proportion of patients in each group who have 2+ office visits that include breast or chest wall exams (not including by plastic surgeons) within 30 days of each other in the absence of a new breast/chest wall complaint during the year of follow-up. The secondary endpoints for the study include: -The proportion of age-appropriate health services (mammograms, gynecologic exams, bone density tests, colon cancer screening, cardiovascular screening) performed for each patient -The number and cost of imaging, lab, and other tests -The number of MD/NP visits -Changes between baseline and 1-year in survey data: Lasry Fear of Recurrence score, anxiety/depression (GHQ-12), quality of life (SF-12), satisfaction with care (PSQ-18), satisfaction with study participation, and understanding of follow-up. Eligibility Criteria: English-speaking, women age 18 or older with recently diagnosed stage 0-3A breast cancer who are planning to receive follow-up medical oncology care through Dana-Farber Cancer Institute (DFCI), with a primary care provider who uses the same electronic medical record. Patients are excluded if more than 30 days have elapsed since the end of active treatment (EATD, defined as the final breast surgery, chemotherapy, radiation, or visit to decide about one of these, whichever was last, excluding reconstructive surgeries and visits). Statistical Methods: Descriptive statistics will assess the primary and secondary endpoints. For the primary endpoint, the proportion (95% CI) of patients in each arm who receive 2+ breast/chest wall exams within 30 days during the year following the EATD will be determined. With a sample size of 50 per arm, the maximum width of the 95% CI will be 29%. Target accrual (met between 1/14/11-4/25/13): 100 Contact information: katieruddy@gmail.com. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT2-5-02.

Patient Satisfaction With Breast and Colorectal Cancer Survivorship Care Plans

Cancer survivors face several challenges following the completion of active treatment, including uncertainty about late effects of treatment and confusion about coordination of follow-up care. The authors evaluated patient satisfaction with personalized survivorship care plans designed to clarify those issues. The authors enrolled 48 patients with breast cancer and 10 patients with colorectal cancer who had completed treatment in the previous two months from an urban academic medical center and a rural community hospital. Patient satisfaction with the care plan was assessed by telephone interview. Overall, about 80% of patients were very or completely satisfied with the care plan, and 90% or more agreed that it was useful, it was easy to understand, and the length was appropriate. Most patients reported that the care plan was very or critically important to understanding an array of survivorship issues. However, only about half felt that it helped them better understand the roles of primary care providers and oncologists in survivorship care. The results provide evidence that patients with cancer find high value in personalized survivorship care plans, but the plans do not eliminate confusion regarding the coordination of follow-up care. Future efforts to improve care plans should focus on better descriptions of how survivorship care will be coordinated.

High Level Use and Satisfaction with Internet-Based Breast Cancer Survivorship Care Plans

High Level Use and Satisfaction with Internet-Based Breast Cancer Survivorship Care Plans

Survivorship care plan assessment checklist (SCPAC): A tool to evaluate breast cancer survivorship care plans.

6117 Background: Breast cancer survivors are at risk for recurrence and late effects. Fragmented survivorship care, including poor communication with PCPs, precludes optimal prevention, detection, and management. The Institute of Medicine (IOM) called for provision of survivorship care plans (SCPs) at end of cancer therapy in order to improve care coordination, and provided guidelines for essential components. Many institutions provide SCPs, but heterogeneity between documents makes it difficult to assess comparability, completeness, and to develop outcomes studies taking these into account. We developed a tool to allow rating of SCP concordance with IOM recommendations and facilitate research. Methods: An interdisciplinary team (Oncologist, NPs, Psychologists) derived a checklist assessing presence/absence of IOM-recommended SCP components. An iterative process of item review and mapping to recommendations was performed until consensus. Dual raters then used this tool to independently assess 65 completed SCPs (11 different formats) from 13 cancer centers and community affiliates within the LIVESTRONG Survivorship Centers of Excellence to assess reliability. Results: The final measure contained 92 items covering 2 subscales: 1) treatment summary (TS), and 2) care plan (CP). TS subscale consisted of 13 informational domains summarizing cancer therapy, including toxicities, psychosocial care, genetic testing. CP subscale had 10 domains: 4 detailed possible long-term effects; 4, surveillance and additional testing; 2, referrals and health promotion. For the TS subscale, inter-rater reliability within TSs was good (M kappa = 0.76, [SD = 0.12]; range = 0.42-0.97), as was reliability across total scores (r = 0.96). For the CP subscale, inter-rater reliability was also good (M kappa = 0.66 [0.16]; range = 0.33-1.0), as was reliability across total scores (r = 0.91). Conclusions: Concordance with IOM recommendations for SCP information can be easily and reliably assessed with the SCPAC. The SCPAC allows evaluation of SCP fidelity to IOM recommendations, comparison of differing SCPs, and should facilitate research and insights into the utility of SCPs including their various information types.

Innovation in Survivor Care

The Centering Cancer Survivorship (CCS) follow-up care program is an innovation in healthcare delivery that meets the needs of cancer survivors and cancer centers. Piloted in a breast cancer clinic, the program provides an avenue for provision of psychological support and health-promotion activities, as well as surveillance for recurrence or late effects. The program empowers each survivor by enlisting her to produce a written breast cancer survivorship care plan for personal use and to share with her primary care provider. Concurrently, this innovation should enhance the viability of the primary cancer center by freeing appointment slots for oncologists who provide expensive therapies to newly diagnosed patients. The CCS program's central feature is the implementation of a multidisciplinary clinic designated specifically for breast cancer survivors in which follow-up care is provided through a group visit medical model. This model of care provides opportunities for health assessment, patient empowerment, and patient education within a framework of social support from peers with similar issues. The group visit model may be well suited to addressing the unique chronic healthcare needs of breast cancer survivors. Further evaluation is needed to verify cost-benefit analysis.

The Potential of Survivorship Care Plans in Primary Care Follow-up of Minority Breast Cancer Patients

When the clinical care of minority breast cancer survivors is transferred from oncology settings to primary care, quality of care may be compromised if their primary care providers do not have adequate cancer treatment records and follow-up care guidelines. Survivorship care plans (SCPs) given to survivors before they transition to primary care settings are designed to improve the transfer of this information. This study examined these issues in a sample of minority breast cancer survivors. During four focus groups with minority breast cancer survivors, data were collected about the types of information survivors remember receiving from their oncologists about follow-up health care needs. Survivors were also asked their opinions on the value and content of a survivorship care plan. Minority breast cancer survivors received variable amounts of information about their cancer treatments. They were dissatisfied with the amount of information they received on cancer-related side-effects, including race-specific information. The American Society of Clinical Oncology's breast cancer survivorship care plan was viewed as important, but too highly technical and limited in information on side-effects and self-care approaches. Survivorship care plans may help increase information transfer from oncologists to patients and primary care providers, but the content of care plans needs to be adapted to minority patients' concerns. Primary care physicians may be challenged by survivors to explain recommended surveillance guidelines and to respond to untreated physical and psychosocial problems.

Implementing a Survivorship Care Plan for Patients With Breast Cancer

Breast cancer survivors account for 23% of the more than 10 million cancer survivors in the United States today. The treatments for breast cancer are complex and extend over a long period of time. The post-treatment period is characterized by gradual recovery from many adverse effects from treatment; however, many symptoms and problems persist as late effects (eg, infertility, menopausal symptoms, fatigue), and there may be less frequent long-term effects (eg, second cancers, lymphedema, osteoporosis). There is increasing recognition of the need to summarize the patient's course of treatment into a formal document, called the cancer treatment summary, that also includes recommendations for subsequent cancer surveillance, management of late effects, and strategies for health promotion. This article provides guidance on how oncologists can implement a cancer treatment summary and survivorship care plan for breast cancer survivors, with examples and linkage to useful resources. Providing the breast cancer treatment summary and survivorship care plan is being recognized as a key component of coordination of care that will foster the delivery of high-quality cancer care.