Cancer Survivorship Clinic Research Articles

Screening for vitamin D insufficiency in pediatric cancer survivors

Corticosteroids increase risk for decreased bone mineral density, which can be worsened by vitamin D insufficiency (VDI) or deficiency (VDD). In the Vanderbilt cancer survivorship clinic, we obtained screening total 25-hydroxy vitamin D levels (VDL) in 171 cancer survivors <23 years old who were treated with prolonged corticosteroids for their cancer, and compared this group to a control group of 97 healthy pediatric patients. VDD was diagnosed in 15.8% and VDI in 34.5% of cancer survivors and VDD/VDI combined was associated with body mass index (BMI) >85th percentile (Odds ratio [OR] = 5.4; P < 0.001), older age (OR = 2.2; P = 0.012), non-Caucasian or Hispanic race (OR = 4.5; P = 0.008) and summer versus winter season (OR = 0.12; P < 0.001). In multivariable analysis, VDI/VDD prevalence did not differ from the control group (VDI/VDD (43.3%)). In the combined survivor/control group multivariable analysis, cancer diagnosis did not increase VDI/VDD risk, but significant associations persisted with elevated BMI (P < 0.001), age (P = 0.004), non-Caucasian or Hispanic race (P < 0.001), and seasonality (P < 0.001). VDD/VDI is equally common in pediatric cancer survivors treated with corticosteroids and healthy children. The impact of VDD/VDI in cancer survivors may be greater due to risk for impaired bone health superimposed on that conferred from corticosteroid exposure. Thus, screening VDLs should be obtained in pediatric cancer survivors treated with corticosteroids, particularly in those with elevated BMI, older age, or non-Caucasian race. Prospective studies evaluating the impact of interventions to minimize VDD/VDI on long-term bone health in survivors are required.

Evaluating the prevalence of cardiovascular risk factors among breast cancer survivors and the outcomes of cardio-oncology referrals by a breast cancer survivorship clinic.

107 Background: Breast cancer survivors have a 4x increased incidence of cardiovascular disease (CVD) compared to women never treated for breast cancer and cardiac events are the 2nd most common cause of death in long-term survivors. Attention to reducing the risk of CVD should be a priority for the long-term care of breast cancer survivors. This study was undertaken to describe cardiovascular risk factors in breast cancer survivors, and the cardio-oncology referral patterns and outcomes from cardio-oncology screening visits. Methods: 356 female breast cancer survivors seen at the University of Kansas Breast Cancer Survivorship Center between 2006 and 2012 who completed an initial intake visit were evaluated for cardiovascular risk factors and referrals to cardio-oncology. An expanded list of cardiovascular factors was used: BMI &gt; 25, Diabetes, HTN, HLD, Current/Past Smoker, Family Hx of MI &lt; 60 years, Exercise &lt; 150 min/wk, Ejection Fraction &lt; 50%, and exposure to cardio-toxic breast cancer treatment. Breast cancer survivors without evidence of metastatic disease were on average 57.8 +/-11.0 years old, underwent standard treatment regimens, and were approximately 7.5 years from their initial diagnosis. Results: 13% were already followed by a cardiologist, 21% were referred to cardio-oncology, and 66% were not referred at their initial survivorship visit. There were significant differences in the average number of risk factors between those not referred to cardio-oncology (4.36 +/-1.89), and those referred to cardio-oncology (5.68+/-1.8), and between those already followed by cardiologist (5.91+/-1.75), p &lt; 0.001 and p &lt; 0.0001, respectively. The most common risk factors were BMI &gt;25, elevated HDL, exercise &lt;150 min/wk, and exposure to an anthracycline. The most common outcomes following a cardio-oncology visit included further diagnostic tests, medication changes, or a return visit. Conclusions: These findings demonstrate the need to determine how to include treatment related risk factors along with traditional cardiovascular risk factors in assessing and managing cardiovascular risk in breast cancer survivors.

Patient experiences and preferences for survivorship care.

110 Background: The optimal method for delivery of care to over 2 million breast cancer survivors in the U.S. remains unclear, with multiple models currently in practice. This study involved a patient-centered investigation of experiences and preferences for breast cancer survivorship care. Methods: We conducted a single-institution, cross-sectional, self-administered survey of needs, experiences, and interests following initial breast cancer care at an academic multidisciplinary breast clinic. For 4 weeks, all patients presenting for routine oncology care were provided a survey at appointment check-in. Analysis is descriptive, with chi square testing used to evaluate demographic correlates of response. Results: 612 surveys were distributed, with a response rate of 66.8%. Median age of respondents was 56 (range 26-93); 71% were white, and 18% identified themselves as black. Over 55% had a college degree. Regarding ongoing care, 63% preferred to see a cancer specialist at least annually, and 30% wanted access to a cancer specialist as needed. Less than 15% preferred referral to a local practice, and less than 15% favored follow-up care from a specialized cancer survivorship clinic. Regarding visit content, over 90% felt assessment for disease recurrence was a priority on follow-up. A majority were interested in emotional and psychological support (52%). Nearly 40% of patients felt that assistance with non-cancer related health issues was very important in oncology clinic follow-up, but only 25% wanted a cancer specialist to provide general medical care. 42% reported receiving a summary of their cancer treatment. 37% reported receiving awritten plan or list of recommendations regarding care needed as a cancer survivor. White patients were less likely than non-white patients to receive a treatment summary (p &lt; 0.02) or a care plan (p&lt;0.005). Age and education were not correlated with receipt of these materials. Conclusions: Patients’ experiences and preferences regarding long-term management of breast cancer are varied. Many patients desire ongoing follow-up with their primary oncology team. Further evaluation of patients’ goals, needs, and an evidence-based approach to follow-up care is needed to guide optimal program design.

Adrenergic signaling and cancer: Deciphering the connections

Amal Melhem-Bertrandta,b,∗ and Anil K. Soodc,d Department of Breast medical Oncology, M.D. Anderson Cancer Center, Houston, TX, USA Breast Cancer Survivorship Clinic, M.D. Anderson Cancer Center, Houston, TX, USA Department of Gynecologic Oncology and Cancer Biology, M.D. Anderson Cancer Center, Houston, TX, USA Center for RNA Interference and Non-Coding RNA, M.D. Anderson Cancer Center, Houston, TX, USA

Health practices and behaviors of childhood cancer survivors not attending a comprehensive survivor clinic.

10063 Background: Little is known regarding the health practices and behaviors of childhood cancer patients who have not received recommended survivorship care, a group that represents the majority of survivors. Methods: Using the Yale Tumor Registry, consisting of patients from Southern Connecticut, we identified patients who were diagnosed from 2000-2011 with an invasive cancer at age ≤18 years, are currently alive and cancer-free at least one year after therapy, live within 100 miles of Yale HEROS Childhood Cancer Survivor Clinic, never previously attended a survivor clinic, and consented to a research study to investigate survivor care. Participants completed postal or on-line surveys regarding health communication preferences, utilization of services, and behaviors. Results: The 68 participants had a mean age of 16.8 (range 6-27) years at evaluation and 6.7 years since diagnosis with 53% female and 50% currently &gt;18 years. Overall, 100% had seen a primary care physician and 71% their pediatric oncologist in the past year. Forty-six percent had also seen a subspecialist with orthopedics (10%), dermatology (9%), endocrinology (6%), and OB/GYN (6%) as the most common specialties; 16% reported two or more subspecialists. Most (83%) had commercial insurance, while 17% had federal insurance. For communication preferences with their providers, willingness to communicate by cell phone, text messages, and email were 59%, 56%, and 87%, respectively. For health behaviors, only 16% of participants met CDC guidelines for fruit and 19.1% for vegetable intake. Among adults, 12% were active smokers. Only 6% of children and 33% of adults met age-specific CDC recommendations for moderate weekly physical activity. Conclusions: Survivors of childhood cancer were overall highly connected to primary care and other health services, despite not participating in survivorship care. However, inadequate diet and physical activity results suggest patients could benefit from behavioral interventions.

Prevalence of vitamin D insufficiency in survivors of childhood cancer

Data on 25-hydroxyvitamin D (25-OH D) status among survivors of childhood cancer are limited. Our aim was to determine the prevalence of and risk factors for 25-OH D insufficiency in a large, diverse population of cancer survivors being followed in a childhood cancer survivor clinic. Retrospective chart review in survivors seen for routine long-term follow-up, who underwent routine screening blood studies including 25-OH D levels. Vitamin D insufficiency was defined as 25-OH D <20 ng/ml. Four hundred eighty-four subjects (234 males) were evaluable for this analysis. Median age at 25-OH D testing was 12.3 years (2.05-36.4) and median age at cancer diagnosis was 3.9 years (0-18). Diagnoses included brain tumors (23.6%), neuroblastoma (21%), and leukemia (17.6%). Mean 25-OH D level was 25.2 ng/ml (SD = 10.37); 29% of subjects were 25-OH D insufficient. In univariate analysis, race, pubertal status, and age at cancer diagnosis were associated with 25-OH D insufficiency (P < 0.05). In multivariate analysis, a model including race and pubertal status provided a good fit for the data. The prevalence of 25-OH D insufficiency in these cancer survivors was high but similar to what has been described in the general population. No cancer specific variables were associated with 25-OH D insufficiency. Since cancer survivors are at a higher risk for subsequent malignancies, cardiovascular disease, and low bone mineral density, all of which may be affected by 25-OH D levels, interventions to improve 25-OH D status in this vulnerable population are needed.

New health conditions identified at a regional childhood cancer survivor clinic visit

Specialty childhood cancer survivorship clinics have been established to screen for potential treatment-related effects. Given the limited empirical data regarding the merit of survivorship clinics, we assessed the frequencies of newly identified, therapy-related effects in survivors who attended Health, Education, Research, Outcomes for Survivors (HEROS) clinic at Yale during 2003-2009. A total of 213 survivors in remission, who were diagnosed with cancer at an age ≤21 years and were ≥3 years after cancer diagnosis, underwent screening based on cancer treatment exposures according to the children's oncology group long-term follow-up guidelines. The frequencies and associated factors of newly identified health conditions were determined. Odds ratios (OR) and their 95% confidence intervals were estimated using multivariate regression models with stepwise selection. Prior to the HEROS clinic visit, 49% of patients had at least one previously known late complication of therapy. After the visit, a total of 98 new health conditions were identified in 73 patients (34%). Newly identified complications in screened patients included pulmonary dysfunction (23%), endocrinopathy (19%), osteoporosis (17%), dyslipidemia (8%), neurologic impairment (4%), cardiovascular deficit (3%) and subsequent cancer (3%). Age at cancer diagnosis (OR = 1.06 [1.00-1.11]), chest irradiation (OR = 2.92 [1.58-5.40]), and history of ≥1 other treatment-related complication(s) (OR = 2.20 [1.18-4.07]) were associated with a higher likelihood of having new conditions identified. Risk-based screening at a specialty childhood cancer survivor clinic detected a substantial number of previously unrecognized, treatment-related health complications in a group of survivors already receiving regular medical care elsewhere.

Evaluation of a breast cancer survivorship clinic that uses a group medical appointment model: Patient program evaluation and financial analysis.

90 Background: Group medical appointments have been shown to improve access, health outcomes and health care utilization rates, as well as self-management skills. A new model of breast cancer survivor care was designed and piloted at Duke Cancer Center. Survivors attended the clinic together in groups of six. An interdisciplinary group visit format in the initial part of the appointment provided surveillance, education and support, as well as formation of an individualized survivorship care plan. The first hour included review of their personal care plan and a 45-minute facilitated discussion. Afterwards, individual visits with the nurse practitioner, and dietitian, physical therapist, or social worker occurred. Methods: A 22-item Likert-type questionnaire sought opinions regarding logistics and the style and function of care delivered. 122 surveys were collected. Descriptive statistics (via SPSS v19) using ANOVA type regression were accomplished. Secondly, a retrospective two-group study of clinic financial data for follow-up patients was done. Revenues from the group medical visit by the NP were compared to those seen traditionally by the MD (N=300). Review of time to third available appointment for each clinician was also recorded. Results: 122 surveys were collected with a 86% response rate. Mean scores for all questions rated at least 4.4 of 5, with the highest score given for the confidence felt in the nurse practitioner (4.93) and the lowest for the acceptability of the wait time in the breast imaging area (4.4). Overall, 98% felt the program provided quality care and 97% were likely to recommend the clinic to other breast cancer survivors. What participants liked most about the program was sharing with other survivors. Cost benefit analysis revealed that revenues and direct costs were nearly equal between delivery models. Time to third available appointment for the primary referring oncologist, dropped from 29.4 to 26.7 days, while the NPs time remained stable at 8.7 days. Conclusions: The group visit model applied to survivor care appears feasible and highly satisfactory to participants.

School Attendance in Childhood Cancer Survivors and Their Siblings

To investigate school absenteeism among childhood cancer survivors and their siblings and examine factors related to absenteeism in survivors. A cross-sectional study was conducted among consecutive cancer survivors attending a large pediatric cancer survivor clinic. Absenteeism rates were obtained for survivors and their closest in age sibling from school report cards. Absenteeism was compared with a population control group of 167752 students using 1-sample t tests. The Child Vulnerability Scale, Pediatric Quality of Life Inventory, and Behavior Assessment System for Children were administered to survivors. Univariate and multiple regression analyses assessed variables associated with days absent. One hundred thirty-one survivors (median age at assessment: 13.4 years, range 8.0-19.2; median age at diagnosis: 9.4 years, range 4.3-17.3) and 77 siblings (median age at assessment: 13 years, age range 7-18) participated. Survivors and siblings missed significantly more school days than the population control group (mean ± SD: 9.6 ± 9.2 and 9.9 ± 9.8 vs 5.0 ± 5.6 days, respectively, P < .0001). Among matched survivor-sibling pairs (N = 77), there was no difference in absenteeism (9.6 ± 9.2 vs 9.9 ± 9.8 days, P = .85). Absenteeism in survivors was significantly associated with a low Pediatric Quality of Life Inventory Physical Health Summary Score (P = .01). Parents' perception of their child's vulnerability and emotional and social functioning were not associated with absenteeism. Childhood cancer survivors and siblings miss more school than the general population. The only predictor of absenteeism in survivors is poor physical quality of health. More research should be devoted to school attendance and other outcomes in siblings of childhood cancer survivors.

Prospectively examining physical activity in young adult survivors of childhood cancer and healthy controls.

This study compares young adult survivors of childhood cancer (YASCC) and young adults without a history of serious illness/injury on physical activity levels and examines psychological predictors of physical activity in survivors over a 2-month period. YASCC participants (n = 117) and healthy controls (n = 148), ages 18-30, recruited during cancer survivorship clinic or primary care clinics completed self-report measures of physical activity, health problems, psychological distress, and health beliefs (Health Perceptions, Satisfaction with Healthcare, Cognitive Competence, and Autonomy). Survivorship providers completed ratings of health problems and treatment intensity for survivors. Survivors had significantly lower levels of physical activity than controls. Family income, survivor-reported health problems and less positive health beliefs were associated with lower rates of physical activity. Provider-reported survivor health problems and ratings of cancer treatment intensity were not related to survivor physical activity. Less positive survivor beliefs about their cognitive competence predicted survivor physical activity 2 months later after accounting for other pertinent demographic, medical and psychological variables. YASCC were significantly less active than healthy controls. YASCC with more self-identified health problems and negative beliefs about their cognitive competence were less physically active. Beliefs about their health and cognitive competencies may be viable areas for assessment and intervention in order to promote increased engagement in physical activity.

P4-12-15: Cancer Survivor Care: An Evaluation of a Group Visit Model of Care for Breast Cancer Survivors at Duke Cancer Center.

Abstract Background: The number of cancer survivors is growing, currently with about 2.5 million breast cancer survivors. (ACS, 2010). The Institute of Medicine report on survivor care stressed care coordination along with attention to survivor concerns as key issues in improving follow-up care. Group visits have been shown to improve access, health outcomes and health care utilization rates, as well as self-management skills. Purpose: This prospective program evaluation measured patients opinions about participation in a group visit clinic. Methods: A new model of breast cancer survivor care was designed and piloted at Duke Cancer Center. Breast cancer survivors who were three years post diagnosis attended the clinic together in groups of six. An interdisciplinary group visit format in the initial part of the appointment provided surveillance, education and support, as well as formation of an individualized survivorship care plan to be shared with the primary care provider. The first hour included review of their personal care plan and a 45-minute facilitated discussion. Afterwards, individual visits with the nurse practitioner, and dietitian, physical therapist or social worker occurred. A 22-item questionnaire designed to ascertain opinions regarding logistics and the style and function of care delivered is being administered to participants. The evaluation tool was approved by a panel of experts; pilot tested and has a reading level of 7.8. Data collection will be complete July 1, 2011. 103 surveys have been collected with a 91% response rate. Preliminary analysis shows high satisfaction with the group visit format. What participants liked most about the program was sharing with other survivors. 86% of participants indicate that they will share the survivorship care plan with their PCP. Only 10% responded that they were not sure they needed this type of follow up now and expressed that it would be more helpful immediately after finishing treatment. Final data will be presented. Barriers and facilitators to implementing this type of care model will be presented. Conclusions: The group visit model applied to a breast cancer survivor clinic appears feasible and highly satisfactory to participants. Implications for practice: Group visits can be considered one option for survivor care. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-15.

A social‐ecological model of readiness for transition to adult‐oriented care for adolescents and young adults with chronic health conditions

Policy and research related to transition to adult care for adolescents and young adults (AYAs) has focused primarily on patient age, disease skills and knowledge. In an effort to broaden conceptualization of transition and move beyond isolated patient variables, a new social-ecological model of AYA readiness for transition (SMART) was developed. SMART development was informed by related theories, literature, expert opinion and pilot data collection using a questionnaire developed to assess provider report of SMART components with 100 consecutive patients in a childhood cancer survivorship clinic. The literature, expert opinion and pilot data collection support the relevance of SMART components and a social-ecological conceptualization of transition. Provider report revealed that many components, representing more than age, disease knowledge and skills, related to provider plans for transferring patients. SMART consists of inter-related constructs of patients, parents and providers with emphasis on variables amenable to intervention. Results support SMART's broadened conceptualization of transition readiness and need for assessment of multiple stakeholders' perspectives of patient transition readiness. A companion measure of SMART, which will be able to be completed by patients, parents and providers, will be developed to target areas of intervention to facilitate optimal transition readiness. Similar research programmes to establish evidence-based transition measures and interventions are needed.

UP-03.116 Creation of a Genitourinary Cancer Survivorship Clinic at a Comprehensive Cancer Center: Start-Up Design and Assessment of Met and Unmet Needs of the Target Population

The Genitourinary (GU) Cancer Center at MD Anderson Cancer Center was selected by the institution to pilot a novel specialty clinic dedicated to the needs of long-term cancer survivors. The objectives were to coordinate all cancer surveillance protocols, and to assess the levels of met and unmet needs of this population.

Quality of Life Assessment in Postoperative Patients with Upper GI Malignancies

By current estimates there are more than 10.8 million cancer survivors in the United States. Increasingly, oncologists are realizing that despite the "success" of cancer therapies, cancer survivors are facing previously unrecognized psychosocial issues related to cancer survivorship. In GI cancers, the medical and surgical oncologists charged with the care of the patient are not well-equipped to deal with these issues. At our institution's GI Cancer Survivorship Clinic, we utilize a multi-disciplinary model, led by surgical oncologists, that includes psychologic and pastoral support as a priority. The goal of this study was to assess our patients' quality of life (QOL) in order to better understand their survivorship needs and to optimize survivor care. Patients with upper GI malignancies undergoing post-treatment evaluation completed the Functional Assessment of Chronic Illness Therapy-Spirituality Scale (FACIT-Sp) questionnaire that includes five domains of QOL: physical well being; social/family well being; emotional well being; functional well being; and spiritual well being. The results of our evaluation of health related QOL in a sample of 99 patients revealed higher self-reported QOL than those seen in a normative sample of cancer patients. Social/family well being was strongly associated with total QOL scores, and married patients reported higher social/family well being, as well as higher overall QOL. Cross-sectional evaluation of health related QOL in our patients revealed higher self-reported QOL than those seen in a normative sample of general cancer patients. Despite aggressive surgical and medical treatment for malignancies with a generally poor prognosis, the results of our pilot study suggest that cancer survivors treated and followed in a multidisciplinary setting can experience acceptable health-related QOL.

Psychological and spiritual well-being of breast cancer survivors in a community-based cancer survivorship clinic.

e19673 Background: Maximizing quality of life (QOL) is an important aspect of care for cancer survivors. In 2006, the Institute of Medicine (IOM) highlighted the need to conduct clinical research in survivors' attitudes regarding care, especially as it may impact access to supportive services. Methods: In 2009, we developed a community-oriented cancer survivorship program at HealthPartners (St. Paul, MN). All patients were asked to complete the previously validated City of Hope QOL instrument (COH-QOL), which incorporates assessment of the four main QOL domains on a 1 to 10 scale. Various supportive services were utilized based on the self-reported survey. Results: So far 40 breast cancer survivors, 90% representing early stage (0-III) disease, have participated. Median time from diagnosis was 1 year (range 0-10 years). The median level of distress at diagnosis was 10, fell to 8 during treatment and 3 after completion of cancer treatment. Overall quality of life was rated highly by the respondents, with a median score of 9. Women expressed low levels of depression and anxiety (median score 3 and 2 respectively). Many survivors reported a change in spiritual life as a result of cancer (median score 7), a positive change in life caused by cancer (median 7.5), and a sense of purpose in life (median score 8). There was no statistical correlation between spiritual activity and overall quality of life (Pearson R = −0.282). Conclusions: Breast cancer survivors face the highest degree of distress at the time of diagnosis, which may be underappreciated by the patient at that time. Therefore, screening tools and appropriate triage should be developed early on in the treatment phase to gather psychological support. Overall quality of life was high in this population. Breast cancer caused several positive changes in lives of the survivors in this study. No significant financial relationships to disclose.

M.D. Anderson Breast Cancer Survivor Clinic

(2010). M.D. Anderson Breast Cancer Survivor Clinic. Oncology Issues: Vol. 25, No. 3, pp. 44-47.

Psychological Outcomes and Health Beliefs in Adolescent and Young Adult Survivors of Childhood Cancer and Controls

PURPOSE The purpose of this study was to compare adolescent and young adult (AYA) pediatric cancer survivors and peers without a history of serious illness on psychological distress, health-related quality of life (HRQOL), health beliefs; examine age at diagnosis and cancer treatment intensity on these outcomes; and examine relationships between number of health problems and the outcomes. PATIENTS AND METHODS AYA cancer survivors (n = 167) and controls (n = 170), recruited during visits to a cancer survivorship clinic and primary care, completed self-report questionnaires of distress, health problems, and health beliefs. For survivors, providers rated treatment intensity and health problems. Results There were no statistically significant differences between survivors and controls in psychological distress or HRQOL. Cancer survivors had less positive health beliefs. Survivors diagnosed as adolescents had significantly greater psychological distress and fewer positive health beliefs than those diagnosed earlier. Survivors with the highest level of treatment intensity had greater anxiety and fewer positive health beliefs than those with less intense treatments. Provider report of current health problems related to survivors' beliefs and mental HRQOL only, whereas patient report of health problems correlated significantly with most psychosocial outcomes and beliefs. CONCLUSION AYA cancer survivors did not differ from peers in psychological adjustment but did endorse less adaptive health beliefs. Survivors diagnosed during adolescence and who had more intensive cancer treatments evidenced poorer psychosocial outcomes. Beliefs about health may be identified and targeted for intervention to improve quality of life, particularly when patient perceptions of current health problems are considered.

Cancer Survivorship Care for the General Internist: Have We Paved the Way for a Smoother Transition?

Cancer Survivorship Care for the General Internist: Have We Paved the Way for a Smoother Transition?

Cancer Survivorship: A New Challenge for Surgical and Medical Oncologists

Increasingly, oncology practitioners are realizing that despite the "success" of cancer therapies, cancer survivors are facing previously unrecognized issues related to survivorship, including physical and psychosocial side-effects of the cancer and its treatment, second cancers, and practical and economic issues related to adjusting to life after their cancer diagnosis. In gastrointestinal cancers, traditionally, the medical and surgical oncologists charged with the care of the patient are not well-equipped to deal with these survivorship issues. At the Penn State Cancer Institute's newly formed Gastrointestinal Cancer Survivorship Clinic, we provide a full array of services to optimize care through a multi-disciplinary approach. By utilizing a multi-disciplinary model with the primary medical and surgical oncologists spearheading the survivorship initiative and psychological and pastoral support as a priority, we hope to optimize cancer survivor care and patient quality of life.

Nurse practitioner-led breast cancer survivorship clinic

e20723 Background: The 2.5 million breast cancer survivors in the US demands increasing awareness of and need for healthcare organizations to address survivorship issues. Cancer survivorship care has become a specialty emphasizing health promotion, disease prevention, and patient satisfaction. It is a natural setting for advanced practice nurses to be leaders. This abstract presents a model for a nurse practitioner-led breast cancer survivorship clinic. Methods: Eligible patients are those previously diagnosed with invasive and/or in situ breast cancer and at least 5 years post-diagnosis without recurrence. Eligible survivors are identified annually through the University of New Mexico Tumor Registry. Clinic notes are reviewed to confirm the patient has not had a recurrence, new diagnosis, or death. Letters are sent to eligible survivors introducing the Breast Cancer Survivorship Clinic (Clinic) and inviting them to participate, and oncologists are encouraged to transfer eligible patients into the Clinic. Results: Eighty-six survivors are currently participating in the Clinic. Survivors are seen on an annual basis after mammogram. Each survivor receives a personalized Survivorship Care Plan at the first visit. The care plan was developed by a multi-disciplinary team of a breast oncologist, psychologist, social worker, nutritionist, and patient educator to provide input on the issues that survivors face. Components of Survivorship Care Plan: pathologic and genetic findings, summary of treatment, bloodwork, bone health, lymphedema, secondary malignancies, health maintenance recommendations, psychological assessment, nutrition/weight assessment. Conclusions: The establishment of the Clinic has several advantages: Breast cancer survivors are being followed in this specialty clinic after 5 years instead of being discharged from the Cancer Center. The Clinic has allowed oncologists more time for patients actively on therapy and more time to accommodate newly diagnosed patients. The Clinic addresses the unique issues faced by long term survivors, which could increase patient satisfaction. A multi-disciplinary team is key to developing a care plan for a survivorship clinic. However, the day-to-day operation of the clinic can be effectively led by a nurse practitioner. No significant financial relationships to disclose.