Breast Cancer Survivorship Program Research Articles

“Tell me I’m okay”: A cross-sectional quality-of-life assessment of patients in a breast cancer survivorship program.

213 Background: The number of breast cancer survivors is increasing due to improvements in care and an aging population, leading to an increased need for care that addresses the physical and psychological needs of patients after completion of active treatment. The Sunnybrook Breast Cancer Survivorship Program was established to provide comprehensive evidence-based survivorship care and facilitate the transition to family doctors. Despite rising interest in dedicated survivorship care, there is little consensus regarding which individuals are likely to suffer the most long-term impacts of breast cancer treatment. Factors as varied as age, ethnicity, socioeconomic status, and treatment type can influence Quality-of-Life (QoL) outcomes. This cross-sectional assessment uses mixed methods to evaluate QoL trends in the patient cohort. Methods: Current patients of the Sunnybrook Breast Cancer Survivorship Program were asked to complete a baseline information form, as well as the EORTC QLQ-30 and BR-45, two validated measures of QoL for breast cancer patients and survivors. QoL, functional, and symptom domains were calculated from these responses accordingly and analyzed statistically. Patients reported their most bothersome QoL concerns through an open-ended questionnaire, which was analyzed and organized thematically. 99 patients have been recruited to date, of a planned 200. Results: We find that sexual health is of importance for this population, with 50 (50.5%) participants reporting sexual activity. Patients under 50 have poorer sexual functioning scores (p<0.01) as well as more issues with body image (p<0.05) than older survivors. Both married and under-50 patients are significantly more likely to have poorer outlooks on the future (p<0.05; p<0.01). Younger patients also tended to have worse role functioning, cognitive functioning, emotional functioning, and social functioning scores, though these differences were not statistically significant. Thematic analysis of qualitative data showed that patients’ chief concerns were the impact that ongoing side effects had on their daily functioning, impact of treatment on body image, disruptions to work and personal relationships, and strong anxiety about potential recurrence. Conclusions: While it is understood that younger BC survivors face unique challenges, our findings indicate that these obstacles persist into older age groups. In addition to physical side effects, such concerns as body image issues, social strain, and emotional functioning can drive QoL scores for these patients. Notably, many patients endorsed strong anxiety regarding potential recurrence that affected QoL, and identified dedicated survivorship follow-up as an ameliorating factor. Further research should be conducted into the unique needs of under-50 survivors, as well as the role of recurrence anxiety in impacting QoL.

Identifying at risk populations amongst breast cancer survivors and their common symptoms and concerns

PurposeThe survival rate amongst breast cancer survivors (BCS) have been increasing, with a 5-year survival rate of almost 90%. These women face many quality of life (QOL) issues either due to either cancer itself or the complex treatment regimen. Our retrospective analysis aims to identify at risk populations among the BCS and their most common concerns.MethodsThis is a single-institution, retrospective, descriptive analysis of patients who were seen at our Breast Cancer Survivorship Program from October 2016 to May 2021. Patients completed a comprehensive survey which assessed self-reported symptoms, their concerns and degree of worry and recovery to baseline. The descriptive analysis on the patient characteristics included age, cancer stage and treatment type. The bivariate analysis included the relationship between the patient characteristics and their outcomes. Analysis of group differences was completed with Chi-square test. When the expected frequencies were five or less, Fisher exact test was used. Logistic regression models were developed to identify significant predictors for outcomes.Results902 patients (age 26–94; median 64) were evaluated. Majority of women had stage 1 breast cancer. The most common self-reported concerns affecting the patients were fatigue (34%), insomnia (33%), hot flashes (26%), night sweats (23%), pain (22%), trouble concentrating (19%), and neuropathy (21%). Though 13% of BCS felt isolated at least 50% of their time, the majority of patients (91%) reported having a positive outlook and felt that they have a sense of purpose (89%). Younger patients were more likely to worry about their cancer more than 50% of the time (p < 0.0001). Patients that were less likely to return back to at least 50% of their pre-treatment baseline were younger (age ≤ 45) (p = 0.0280), had higher stage breast cancer (Stage 2–4) (p = 0.0061), and had chemotherapy either alone or as part of their multi-modality treatment (p < 0.0001).ConclusionAccording to our study, younger patients, those with higher stage breast cancer and survivors who had chemotherapy may experience significant QOL issues. Fortunately, majority of BCS report a positive and optimistic outlook post treatment. Identifying common concerns after treatments and vulnerable populations are especially important to deliver quality care and to optimize interventions.Implications for Cancer SurvivorsOur study identified the most common self-reported concerns affecting BCS. In addition, our results suggest that younger patients, patients with higher stage breast cancer and survivors who had chemotherapy were more likely to have QOL issues. Despite this, our study showed, the majority of BCS reported positive outlooks and emotions.

Identifying common concerns and predicting vulnerable populations among breast cancer survivors.

e24064 Background: Long-term survival is common after breast cancer treatment with 5-year survival reaching almost 90%. Breast cancer survivors (BCS) face varying degrees of quality of life (QOL) issues depending on their age of diagnosis, disease severity, and treatment. We present a retrospective analysis aimed to describe demographics of BCS, recognize common concerns and identify the vulnerable patients. Methods: This is a retrospective analysis of BCS seen at our Breast Cancer Survivorship Program from October 2016 to May 2021. Patients were given a survey to assess self-reported symptoms following treatment. The descriptive analysis of patient characteristics included age, cancer stage, and treatment type. The bivariate analysis included the relationship between the patient characteristics and their outcomes. Chi-square test was used to analyze group differences. Fisher exact test was employed when any of the expected frequencies was five or less. Logistic regression models were developed to identify significant predictors for outcomes. Results: 902 patients (age 26-94; median 64) were seen. Patient's characteristics studied included cancer stage, age group, and treatment modality. Most common self-reported concerns affecting BCS were fatigue (34%), insomnia (33%), hot flashes (26%), night sweats (23%), pain (22%), trouble concentrating (19%) and neuropathy (21%). Majority of patients (91%) reported having a happy outlook and felt a sense of purpose (89%), but 13% of BCS felt isolated at least 50% of the time. Young survivors (age ≤45) (p = 0.028), higher stage BCS (Stage 2-3) (p = 0.0061) and those who had chemotherapy either alone or as part of their multi-modality treatment (p &lt; 0.0001) were significantly less likely to return back to at least 50% of their pre-treatment baseline (Table). Conclusions: Our study showed that younger BCS, patients with higher cancer stage, and those who underwent chemotherapy are the most vulnerable groups in terms of severity of QOL issues. Identifying vulnerable populations and evaluating common concerns after treatments are important in delivering quality care. Optimizing interventions under standardized approach would help to increase QOL in BCS.[Table: see text]

Survivors Overcoming and Achieving Resilience (SOAR): An 8-week breast cancer survivorship and nutrition program.

e24025 Background: The American Cancer Society (ACS) published Diet and Physical Activity Guidelines in 2020. Emerging evidence suggests that healthy dietary patterns are associated with reduced cancer risk, especially colon and breast. ACS estimates there are 3.5 million breast cancer survivors in the US. The transition from active treatment into survivorship is a critical period where they are uniquely positioned to adapt healthy behaviors, yet there is a lack of empirical research to best guide the transition. Methods: We developed an 8-week breast cancer survivorship program to educate and develop healthy habits. 40 participants were recruited through Moffitt breast and survivorship clinics, social media, and website. Weekly topics were: cancer survivorship, nutrition, emotional health and well-being, exercise, medical management after treatment, grocery store tour, meditation and mindful eating, and moving forward. To assess health-related quality of life (QoL), we used FACT-G Version 4, a validated patient-reported survey with 27 questions and 4 domains of wellbeing (physical, social/family, emotional, and functional) on a 5-point Likert scale (not at all to very much). Similarly, a nutrition questionnaire evaluated the understanding of healthy choices, confidence in making healthy changes, knowing how to purchase healthy foods and read nutrition labels, confidence in preparing healthy foods, and understanding of a plant-based diet. Surveys were administered pre- and post-intervention. Data analysis included those who completed both (n = 30). Pt characteristics and data trends were summarized using descriptive statistics. Paired Wilcoxon rank sum tests were used to assess the significance of the change in scores between surveys. Results: Participant ages ranged from 41 to 77. The majority (34.5%) completed treatment 13-24 months prior. Compared to baseline, greater proportions of participants had positive responses after intervention in all nutrition questions. The nutrition sum was significantly increased by 3.07 (p = 0.0001). There was no significant change in overall QoL (-1.77; p = 0.1178) or sub-domain wellbeing scores. Conclusions: Our 8-week intervention for breast cancer survivors showed significant improvement in nutrition domain. While a small sample size is limiting, it is evident that survivors can improve their confidence in making healthy changes and develop better understanding of a plant-based diet.[Table: see text]

Effect of an e-home based symptom management and mindfulness training program on quality of life in breast cancer survivors: A randomized clinical trial.

12080 Background: The first five years post-treatment for breast cancer are a critical phase, when the survivors may face a multitude of physical and psychosocial problems. We aimed to develop an e-home based symptom management and mindfulness training program to support women with breast cancer in transition to survivorship and to determine its effect on the endpoints including quality of life, symptom distress, psychosocial adjustment, and psychological morbidity. Methods: This parallel 4-arm, superiority randomized clinical trial together with a process evaluation using semi-structured interview recruited women who had completed cancer treatment for stage 0 to 3 breast cancer between 6 months to 5 years previously, from November 2016 through March 2020 at two tertiary hospitals. A total of 593 women were eligible, of these, 402 refused to participate and 191 women were randomized. However, 19 subjects withdrew from the study without completion of baseline assessments. Hence, 172 subjects were included in the intention-to-treat analysis (e-home based breast cancer survivorship program, experimental group; n = 44), comparison group 1 (online symptom management program only; n = 41), comparison group 2 (online mindfulness training program only; n = 44) or the usual care group (n = 43). The e-home based breast cancer survivorship program involved 5 weekly online education module regarding self-management strategies of common symptoms + various online self-administered mindfulness exercises. The primary endpoint included change of Quality of Life-Cancer Survivor Scale (QoL-CS) score measured at 8, 12 and 24 weeks from baseline. Secondary endpoints were changes of Social Support Questionnaire, Breast Cancer Survivor Self-Efficacy Scale, Memorial Symptom Assessment Scale, Psychosocial Adjustment to Illness Scale, Fear of Recurrence Scale, Hospital and anxiety Depression Scale, and Five Facet Mindfulness Questionnaire scores. Results: Of 172 subjects, mean ± SD age was 51.2 ± 9.4 years; 118 (77.7%) were in the first two years of cancer treatment completion; 165 (98.2%) underwent surgery; and 111 (73.5%) treated with adjuvant chemotherapy. All demographic and clinical characteristics were comparable among the four groups ( p&gt;.05). There was no between-group difference in the primary endpoint; QoL-CS scores among groups at 8, 12 and 24 weeks from baseline ( p&gt;.05). Secondary endpoints were also not different among groups ( p&gt;.05). Two main themes; positive impact and gap/barrier, emerged from process evaluation data. Conclusions: In women who were in the first five years post-breast cancer treatment, an e-home based multidimensional cancer survivorship program did not affect outcomes. Nevertheless, the interview data revealed a positive experience in regards to the home-based approach in cancer survivorship care program. Clinical trial information: NCT02931864.

Impact of a novel breast cancer survivorship program on patient-centered outcomes: A single institutional study.

Impact of a novel breast cancer survivorship program on patient-centered outcomes: A single institutional study.

Keep It Healthy! Fit and Flourish a Breast Cancer Survivorship Program

Upon completion participant will be able to assess, educate, and measure follow up factors for patients in cancer survivorship.

A community based consultative survivorship program for breast cancer survivors.

47 Background: Many organizations have recognized the importance of longitudinal care for Breast Cancer Survivors (BCS) as they remained at risk for treatment related side effects (TRSE) that can greatly impact their health and quality of life. Various models of Breast Cancer Survivorship Program (BCSP) have been proposed. In October 2016, we implemented a BCSP using a consultative model with the goals to create a systematic approach to capture patients’ concerns, coordinate on-going care, standardize survivorship recommendations, and track care plan delivery compliance. Methods: Our Survivorship Nurse Practitioner (SNP) meets with patients in a one-on- one consultative visit after receiving electronic referral. Patients are given a comprehensive survey to assess symptoms and concerns following their treatment. Based on survey, SNP provides personalized education about their concerns. SNP also makes appropriate interventions and arranges referrals for supportive care services. After the visit, SNP generates a care plan and a consultative letter detailing the patient’s concerns and provides further recommendations for interventions and follow up care. SNP leads a quarterly Multidisciplinary Conference to educate treating providers and supporting staff regarding TRSE management according to standard guidelines and evidenced based approaches. Results: From Oct 2016-Oct 2017, 252 BCS were seen at our BCSP. BCS reported high satisfaction with better understanding and coping with their symptoms after being seen. 100% of oncology providers reported better understanding about BCS's concerns and felt more confident about TRSE management. Primary providers also reported higher satisfaction with communication across specialty. The ability to identify BCS and to track care plan delivery compliance was also more streamlined. Conclusions: We elected for a consultative approach because it allowed for a dedicate time to review all components of survivorship. It also created a formalized way to better understand the needs of our survivors. In addition, this approach empowered the patients to discuss TRSE with their providers and enabled the care team to integrate survivorship care throughout their subsequent visits.

Identifying vulnerable populations among breast cancer survivors.

176 Background: Long term survival is common after breast cancer treatment with 5-year survival rate reaching almost 90%. Many breast cancer survivors (BCS) face varying degrees of quality of life (QOL) issues depending on their age of diagnosis, severity of their disease, and treatment course. This is a retrospective analysis to describe demographics, QOL concerns, and to identify vulnerable populations among the BCS. Methods: This is a retrospective analysis of BCS seen at our Breast Cancer Survivorship Program from Oct 2016 to Oct 2017. Patients were given a comprehensive survey to assess self-reported symptoms and concerns following their treatment. Chi-square test was used to analyze group differences. The Fisher exact test was employed when any of the expected frequencies was five or less. Results: 252 patients (age 26-93; median 60) were seen. Characteristics are listed in the Table. Most common self-reported concerns affecting BCS were: fatigue (40%), insomnia (38%), hot flashes (29%), night sweats (26%), pain (26%), trouble concentrating (26%), and neuropathy (25%). Majority(87%) reported having a happy outlook and felt that they have a sense of purpose (85%), but about 12% of BCS felt isolated at least 50% of their time. Young cancer survivors (age ≤45) (p&lt;0.0001), higher stage BCS (Stage 2-3) (p=0.0023), and those who had chemotherapy either alone or as part of their multi-modality treatment (p=0.0061) were significantly more likely to worry about their cancer post treatment. The same populations were significantly less likely to return back to at least 50% of their pre-treatment baseline (young cancer survivors p=0.0049; higher stage p=0.0011; chemo+/-other treatments p=0.0012). Conclusions: Majority of BCS report a happy and optimistic outlook post treatment, but some may experience significant QOL issues. Identifying common concerns after treatments and vulnerable populations are especially important to deliver quality care and to optimize interventions. [Table: see text]

Providing Breast Cancer Survivorship: Lessons Learned From a Pilot Project Implementation.

Many cancer survivors have gaps in knowledge of their disease and treatments received. The goal of this project was to evaluate the development and implementation of a pilot breast cancer survivorship program aimed at decreasing the gap in patient knowledge of disease and treatment, from both the staff and patient perspectives. A mixed methods approach used data from multiple sources: (1) historical data, (2) medical record review, (3) a mailed patient questionnaire, (4) 1:1 semistructured telephone interviews with patients, and (5) 1:1 semistructured interviews with staff members. The implementation of the pilot survivorship program resulted in increased patient knowledge of disease and treatments received. The majority of breast cancer survivors (80%) reported that the survivorship packet given at the end of treatment met most or all of their needs, and half reported that they did not feel they needed a 1:1 survivorship visit. The 20 staff interviews validated that most staff (80%) were able to accurately define cancer survivorship and aspects of providing survivorship care; however, 50% reported that they felt they needed more training. The pilot program was successful in increasing patient knowledge. Informal education and written material provided throughout the course of cancer care were found to meet most patient needs. Cancer center staff desire more training on providing survivorship care. Survivorship care may be best provided through educational interventions began at diagnosis and provided on an ongoing basis.

Community and health system partnership.

190 Background: Breast cancer survivors face physical, psychological, medical, social, cultural and spiritual challenges. Services to address these needs are frequently not available or if available unknown. We sought to determine whether formation of a community-based comprehensive breast cancer survivorship program was feasible. Methods: After months of relationship building, the Women’s Breast Health Fund of the Community Foundation of Greater Birmingham (CFGB), awarded funding to support a systematic assessment of available services in the region. Survivors, their loved ones, providers and other national models of care were surveyed and interviewed. Focus groups including a Lesbian, Bisexual, Gay, Transgender, Queer (LGBTQ) group were held. Aggregated results were presented in monthly meetings to executive level hospital administrators from all health systems in the area, the UAB School of Nursing and CFGB. Results: Survivors seek advice from other survivors more than any other source. Gaps in services exist. Breast cancer survivors were often unaware of existing services. Services were not available to some cultural/ethnic groups or loved ones; staff of some services were not culturally sensitive to the needs of survivors. Some services were available to all, while others require payment. There was no source of authoritative, evidence-based information on breast cancer survivorship except for a few providers. After 12 months the group of executives from all health systems committed to support the formation of a community-based comprehensive breast cancer survivorship program designed to assist breast cancer survivors, their loved ones and institutions by providing reliable information about services. Conclusions: Breast cancer survivors, providers, and local health systems all support the development of a comprehensive breast cancer survivorship program. We feel that it will address unmet needs of breast cancer survivors, allowing each institution to address needs for individual patients. By using the breast cancer survivorship program to assess individual needs and to provide information about services for identified needs, we expect repetitive services will be reduced and quality of life for breast cancer survivors will improve.

Effectiveness of a Survivorship Program: An Assessment of Patients With Breast Cancer in a Community Setting

This study assesses the effectiveness of a single institution's breast cancer survivorship program on patient perceptions, quality of life (QOL), and compliance with National Comprehensive Cancer Network (NCCN) guidelines for follow-up. Sampled patients completed all their breast cancer treatment at a single tertiary center. Surveys designed to evaluate QOL were obtained, and retrospective medical record review was conducted to assess NCCN compliance. Survivorship clinic (SC) attendees and nonattendees were matched for age and disease stage for comparison of the outcomes (QOL, NCCN compliance, and overall effectiveness). SC patients (n = 63) tended to perceive their concerns in various categories to be addressed more adequately than did nonattendees (n = 54), with significant differences in the areas of practical concerns (P = .03) and late-term adverse effects (P = .03). There was a significant difference in compliance with three NCCN guidelines (history and physical every 3 to 6 months, annual mammography, and a pelvic examination if on tamoxifen) between survivorship attendees and nonattendees (P < .001, P = .02, and P < .001, respectively). Women who attended an SC used other survivorship support resources more often. Survivorship programs can be time and resource consuming, but our study is one of the first to show that a survivorship program effectively changes patient behavior in important ways. Patients who attended an SC were more likely to be compliant with NCCN-recommended follow-up and to use other survivorship resources and felt their concerns were better addressed. These measures can be used to help us improve our survivorship services and by other institutions to measure the quality and effectiveness of their programs.

Improving patient participation in a breast cancer survivorship program at a safety net hospital.

60 Background: To provide comprehensive services and meet Commission on Cancer (CoC) accreditation requirements, we developed and evaluated a customized breast cancer SCP template and delivery model. Objective: To implement and pilot test survivorship care plan (SCP) delivery for breast cancer survivors. Methods: Clinicians at a safety net hospital partnered with investigators at an academic institution to start a breast cancer survivorship care program. We developed an SCP template that is CoC-complaint and responsive to input gathered in 2 focus groups with breast cancer survivors (n = 12) and interviews with staff (n = 8). Oncologists and nurses identified and referred English-speaking women who had completed breast cancer treatment. Participants completed baseline measures prior to receiving individualized SCPs in a survivorship consultation visit with a dedicated APN. In response to high no-show rates, we expanded clinic scheduling to harmonize with participants' other medical appointments. Interim feasibility results for our ongoing study are presented here. Results: A total of 154 patients were screened to reach target enrollment (n= 80) within 20 months. Participant median age was 60 ± 11; 71% were African American, 14% Hispanic; 11% Non-Hispanic White and 92% had household incomes &lt; $20,000. Average times were: 30 ± 13.4 minutes for abstracting patient clinical information in preparation for the survivorship visit; 25 ± 16 minutes for completing individual SCPs; 22±7.65 minutes to review / deliver the SCPs with patients. The difference in no-show rate between first 3-month recruitment period (clinic limited to one day/week) and next 17 months (clinic appointment expanded to accommodate patients' schedule) was statistically significant, p = 0.028. Conclusions: Tailoring SCP templates and delivery models to the needs of a safety net hospital aided the sustainability of a new survivorship clinic. Patient non-adherence to scheduled visits was significantly improved by expanding clinic hours. Significant clinician time was spent preparing SCPs and a level 4 visit (25 minutes) does not adequately reflect this effort. This study is funded by the American Cancer Society, Illinois Division (Grant# 254698).

Systematic development of a a breast cancer survivorship program at a small independent oncology practice.

52 Background: It is widely accepted that providing survivorship care plans leads to improvements in outcomes for cancer survivors. Treatment summaries are now part of ASCO and NCCN survivorship guidelines. We faced a unique challenge of implementing the survivorship care plan at the Jones Clinic as a small independent practice. The Jones Clinic consists of three full time physicians and two full time nurse practitioners. We see approximately 850 new patients per year. Methods: As a part of ASCO’s quality training program, we focused on the stage I – III (early stage) breast cancer patients who completed their initial therapy. We formed a team, identified the barriers, created a flow diagram of the process, assigned roles for each individual member and finally implemented the process. Results: The major issues identified were lack of provision in the electronic medical record (EMR) system for survivorship and lack of standardized data entry process. We created a system in the EMR for survivorship data entry and extraction of such data in a document. Since July 2015, one hundred percent of breast cancer patients completing adjuvant therapy at the Jones Clinic have received a survivorship treatment summary and a plan of care. The care plan is also shared with their primary care provider. Importantly, creating a survivorship document required less than 10 minutes of the provider’s time. Conclusions: We are now able to provide our patients with a survivorship care plan and address survivorship issues within thirty days of completion of therapy. Creating the care plan requires minimal time from the providers. Our new process meets ASCO guidelines for survivorship care plans and no additional staffing was needed. We now plan to provide a survivorship care plan to all oncology patients treated with curative intent.

Abstract P1-09-14: Improved outcome of breast cancer survivors participating in a multidisciplinary cancer survivorship program at Texas Tech University Health Sciences in El Paso, TX

Abstract Introduction: Breast Cancer (BC) survivors in El Paso, TX include a majority of Hispanics. We have previously reported that these survivors have decreased mental and physical health related Quality of Life (QOL). We sought to determine whether BC survivors would benefit from participating in a comprehensive multidisciplinary BC Survivorship Program at the Garbar Breast Care Center (GBCC), as determined by improvement of performance on the following validated questionnaires: 1) Patient Health Questionnaire 9(PHQ9), 2) General Anxiety Disorder 7 (GAD 7), and SF36 QOL questionnaires. Methods: After IRB approval, we recruited consecutive patients at our institution over 6 months starting October, 2013, and who are within the first 5 years post-diagnosis with Stages I-III BC and have completed surgery, chemotherapy and/or radiation therapy. Survivors were enrolled in the survivorship program staffed by an oncologist, a nurse practitioner, a nutritionist and a clinical psychologist. They participate in individual as well as group sessions. Survivors are initially screened for depression and generalized anxiety disorder using PHQ9 and GAD 7, in addition to assessing the patient’s QOL at baseline, and every 3 months. Survivors are provided with a personalized summary of all received treatment and follow up care plans; dietary counselling and individual meal plans, in addition to in-depth psychological assessment and an intervention using Mindfulness Based Stress Reduction. Results: 47 patients have been recruited so far and all but one completed baseline questionnaires;17 and 7 respectively had 3 and 6 months follow up visits. 94% were Hispanics. Mean age 54 years. 38% of participants were younger than 50 years of age; Stage 1 BC (36%), Stage 2 (36%), and stage 3 (28%) . 80% received chemotherapy ; and 68% had hormone receptor positive BC and received endocrine therapy. The scores at baseline were : PCS representing the mean for the SF-36 QOL Physical Health was 46.0, and the MCS for Mental Health was 44.0, both below the population norm (50.0). Mean scores for GAD 7 was 7.54 and for PHQ 9 7.33, both abnormal (&amp;lt;5 on PHQ9 and GAD 7 are considered normal scores). At 3 months the scores were as follows: PCS 49.71, MCS 45.34, both improved (the higher the better); GAD7 5.18; and PHQ9 6.82 (both improved, the lower the better). At 6 months, same favorable trend continues: PCS 50.07 [SD 5.54, 44.29-53.35]; MCS 49.66 [SD 7.73, 38.93-62.41]; GAD7 5.00 (SD 3.70); and PHQ9 4.57 (SD 3.64). Conclusion: BC survivors are benefiting from participating in the new BC Survivorship Program launched at Texas Tech in El Paso, TX. They have experienced improved mental and physical health related QOL, improved anxiety and depression by GAD7, and PHQ9, with scores reaching near normal values at 6 months into the program which continues to enroll BC survivors. This program represents a culturally appropriate model for Hispanic BC survivors. It is expected to continue to improve the quality of life of these patients, empower them in their transition from cancer treatment to survivorship and lead to improved psychosocial adjustment and normal social functioning with significant implication not only on survivors, but also on their families and the community. Citation Format: Zeina Nahleh, Rebecca Pasillas, Alok Dwivedi, Azadeh Nasrazadani, Rosalinda Heydarian, Luis Sanchez, Indika Mallawaarachchi, Cecilia Ochoa, Edward Saltzstein. Improved outcome of breast cancer survivors participating in a multidisciplinary cancer survivorship program at Texas Tech University Health Sciences in El Paso, TX [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-14.

Making it work: Breast cancer survivorship care at Johns Hopkins.

61 Background: Breast cancer survivor numbers are increasing due to population aging and improved treatment outcomes but many of their long-term health care needs are unmet. Integrated follow-up care strategies that enhance care coordination, education, and access to survivorship resources are needed to provide patients with evidence-based care that addresses medical and psychosocial needs after cancer treatment. Methods: In 2008, we established the Johns Hopkins Breast Cancer Survivorship Program with representation from the Schools of Nursing, Public Health, and Medicine to address the needs of patients completing initial cancer treatment and transitioning to long-term follow-up. Patient educational resources were created within an interactive website ( http://bit.ly/hZfzFi ) including &gt; 35 patient/provider educational video clips, blogs and social media. Activities including provider educational events, educational folders, and trainee curriculum additions have been ongoing. Starting May 2011, Hopkins patients were offered a one-time transition visit with a nurse practitioner focusing on individualized treatment summary/survivorship care plan activities (e.g., cancer screening/surveillance, medical intervention, psychosocial support, and care coordination with non-cancer providers). Results: Our website is averaging 3,000 hits monthly. We have participated in 22 provider/trainee formal educational presentations. In the pilot phase of these transition visits (n=40), age/race breakdown of participants were representative of our breast cancer population (median age 51, range 34-69; 17% African Americans). Our post-visit survey (n=37), 97% found the survivorship visit beneficial and all reported that this one-time consultation helped with transitioning away from treatment. Conclusions: A multidisciplinary patient-centered approach to breast cancer survivorship allowed us to develop comprehensive clinical and educational service models to benefit patients and their cancer/non-cancer providers. This program aims to enhance education, overcome the fragmentation of the health care system, and improve overall health and wellness of breast cancer survivors as they transition to long-term survivorship.

PS2-38: Breast Cancer Survivorship Program for Rural Pennsylvania: Communicate, Connect, and Support

Background Advances in early detection and treatment of breast cancer has changed this disease from a fatal to chronic health condition. Recognition of informed decision-making and choices as the tenet of living well by the survivors motivates the development of credible and easily accessed information resources. Little is reported regarding the challenges specific to women in rural areas. Presently, available resources to encourage self-care are ineffective for women in our region, as evidenced by above the national average age- and stage-adjusted disease specific mortality rate. We have implemented a pilot project that leverages on technology to partner survivors and professionals that emphasize self regulation and health management

Breast Cancer Survivorship Program

Taking CHARGE, a theory-based self-management program, was developed to assist women with survivorship concerns that arise after breast cancer treatment. Few such programs have been evaluated for cultural relevance with diverse groups. This study determined the utility and cultural relevance of the program for African American (AA) breast cancer survivors. Two focus groups were held with AA women (n = 13), aged 41 to 72 years, who had completed primary treatment. Focus group participants assessed the program content, format, materials, and the self-regulation process. Content analysis of audiotapes was conducted using an open, focused coding process to identify emergent themes regarding program relevance and topics requiring enhancement and/or further emphasis. Although findings indicated that the program's content was relevant to participants' experiences, AA women identified need for cultural enhancements in spirituality, self-preservation, and positive valuations of body image. Content areas requiring more emphasis included persistent fatigue, competing demands, disclosure, anticipatory guidance, and age-specific concerns about body image/sexuality. Suggested improvements to program materials included portable observation logs, additional resources, more photographs of younger AA women, vivid colors, and images depicting strength. These findings provide the basis for program enhancements to increase the utility and cultural relevance of Taking CHARGE for AA survivors and underscore the importance of evaluating interventions for racially/ethnically diverse groups.

Competency building for self-management and self-care: evidence informed development of an empowerment course for breast cancer survivors

18626 Purpose: To improve survivorship outcomes by empowering and preparing survivors to self- manage their health. We describe the evidence-informed development of a patient empowerment course “Managing Your Cancer Journey” offered in the Breast Cancer Survivorship Program at Princess Margaret Hospital in Toronto, Canada. Methods: Audio-taped and transcribed focus groups (3; n = 16 patients, August 2004), interviews (n = 8 lymphedema patients, spring 2004, n = 8 patients, spring 2005) were held for patient directed guidance in survivorship course and program development. A comprehensive literature review was conducted to develop a theoretical framework for empowerment. Three main competencies: knowing, navigating and negotiating emerged and were developed into 5 ×1.5 hour classes facilitated by two social workers in collaboration with health professionals and community organizations. Feedback from survivors in a community forum (n = 40) and during piloting with survivors (n = 10) and educators was solicited. Analysis of transcripts and observer/consultant debriefings were analyzed for emergent themes. Results: Respondents recommended program interventions that allowed people to gain mastery or a perceived sense of control over their lives with cancer. Survivors and expert consultants prioritized 3 major domains for the survivorship program: psychosocial support, information provision, and support for dealing with the physical effects of breast cancer. In response, outcome measures for empowerment will include: patient satisfaction, cancer knowledge, self-efficacy in disease management, empowerment, and depression. Conclusions: Ongoing iterative feedback from and piloting with the survivor target audience and embedding the course within the hospital’s strategic plan for patient centred care and competency building are keys to successful course implementation. No significant financial relationships to disclose.