Breast Cancer Survivorship Care Research Articles

Unveiling inequities in representation: Racial disparities in supportive care breast cancer clinical trial enrollment.

1605 Background: Supportive care is an integral part of breast cancer survivorship care. However, not much is known if there is adequate representation of racial minorities in supportive care breast cancer (BC) clinical trials (CTs). Methods: We conducted a systematic review of supportive care CTs for patients with BC using Covidence. A search of clinicaltrials.gov identified 2695 CTs, of which 173 met inclusion criteria. The SEER database was used as a racial distribution data reference for patients with BC. One-sample proportion tests were performed to assess adequacy in racial representation among supportive care CTs and by intervention type. Results: Of 173 supportive care CTs, 133 (77%) trials reported race-specific data. Characteristics of supportive care CTs based on intervention type and race are shown (Table). Although no statistically significant differences in frequencies of Black participants in supportive BC CTs overall were observed compared to the US population (11% vs 12%, p= 0.40), they were underrepresented in symptom management CTs specifically (8% vs 12%, p= 0.004). When stratified based on diet/physical activity CTs, Black participants were overrepresented in the study population (18% vs 11%, p= <0.001). Asian participants were underrepresented in the overall study population compared to the US population (5% vs 7%, p= 0.01). However, within psycho-oncology CTs, there was an overrepresentation of Asian participants in the study population (21% vs 7%, p = <0.001). No significant differences in enrollment frequencies of Black and Asian participants were found in cognitive health, complementary and alternative medicine, education/communication, and sexual health interventional CTs. Conclusions: Our findings highlight inadequate representation of Asian participants in supportive care BC CTs and Black participants in symptom management CTs. This study is limited in that ethnicity was not included in this analysis. Strategies are needed to promote recruitment of diverse individuals in these settings so that we can more accurately generalize findings from supportive care BC CTs. [Table: see text]

Abstract PO3-27-07: Age at diagnosis and the food environment are associated with postdiagnosis weight gain among Black American breast cancer survivors in Maryland

Abstract Background: Weight management is now included in the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines due to its clinical impact on breast cancer (BC) survivorship outcomes. While numerous individual-level risk factors for weight gain after BC diagnosis have been identified, such as younger age at diagnosis, cancer stage, and cancer treatments (chemotherapy), there are limited data on the impact of neighborhood-level factors associated with weight change postdiagnosis among Black BC survivors. Methods: Utilizing social media recruitment strategies and survivor networks, we recruited 100 Black female BC survivors to complete an online survey, including demographic, clinical characteristics, and lifestyle factors, between January 5, 2022, and August 18, 2022. To capture the food environment, we utilized the 2023 Food Environment Index County Health Rankings, which accounts for access to healthy foods due to proximity and income (considering the distance an individual lives from a grocery store or supermarket, locations for health food purchases in most communities, and the inability to access healthy food because of cost barriers). The index ranges from 0 (worst) to 10 (best). Our outcome of postdiagnosis weight gain was calculated as percent weight change from time at diagnosis to time of survey, calculated as ([weight at survey – weight at diagnosis]/weight at diagnosis) × 100. Participants were grouped into mutually exclusive categories of stable weight (within ± 3%) or weight loss (≤-3%) compared to weight gain (≥ 3%). Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated for the associations between clinical factors, county-level food environment index, and postdiagnosis weight gain. Results: The average ages at time of survey and at primary BC diagnosis were 58.6 years (standard deviation [SD]= 10.1) and 49.1 years (SD=10.2), respectively. Most women (70%) were diagnosed with invasive BC and only 22% were currently undergoing treatment at the time of the survey. While only 7% reported being obese at the time of BC diagnosis, 54% reported being obese at the time of survey which was on average 9 years post-BC diagnosis; and while 61 women had weight loss or stable weight, 34 women experienced weight gain postdiagnosis. Among the 95 women included in multivariable models who reported weight and height measurements for calculating weight change, women ≥50 years of age at BC diagnosis (versus < 50 years) were 3.43 times more likely to gain weight after diagnosis (95% CI 1.13-11.50). Women living in counties with a Food Environment Index ≥8.8 (median cut-point compared to < 8.8) were significantly less likely to experience weight gain (aOR 0.11; 95% CI 0.01-0.90). Stage and BC treatments were not significantly associated with weight gain. Conclusions: Our study findings demonstrate the importance of evaluating the food environment during BC survivorship and longitudinal monitoring of weight postdiagnosis to mitigate weight gain among Black BC survivors. Our findings will be used to inform a larger prospective study and future interventions among this population. Citation Format: Avonne Connor, Katherine Ho, Kate Dibble, Kala Visvanathan. Age at diagnosis and the food environment are associated with postdiagnosis weight gain among Black American breast cancer survivors in Maryland [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-07.

Identifying priority areas to support primary care engagement in breast cancer survivorship care: A Delphi study.

Existing approaches in cancer survivorship care delivery have proven to be insufficient to engage primary care. This study aimed to identify stakeholder-informed priorities to improve primary care engagement in breast cancer survivorship care. Experts in U.S. cancer survivorship care delivery were invited to participate in a 4-round online Delphi panel to identify and evaluate priorities for defining and fostering primary care's engagement in breast cancer survivorship. Panelists were asked to identify and then assess (ratings of 1-9) the importance and feasibility of priority items to support primary care engagement in survivorship. Panelists were asked to review the group results and reevaluate the importance and feasibility of each item, aiming to reach consensus. Respondent panelists (n = 23, response rate 57.5%) identified 31 priority items to support survivorship care. Panelists consistently rated three items most important (scored 9) but with uncertain feasibility (scored 5-6). These items emphasized the need to foster connections and improve communication between primary care and oncology. Panelists reached consensus on four items evaluated as important and feasible: (1) educating patients on survivorship, (2) enabling screening reminders and monitoring alerts in the electronic medical record, (3) identifying patient resources for clinicians to recommend, and (4) distributing accessible reference guides of common breast cancer drugs. Role clarity and communication between oncology and primary care were rated as most important; however, uncertainty about feasibility remains. These findings indicate that cross-disciplinary capacity building to address feasibility issues may be needed to make the most important priority items actionable in primary care.

A scoping review of web-based, interactive, personalized decision-making tools available to support breast cancer treatment and survivorship care.

We reviewed existing personalized, web-based, interactive decision-making tools available to guide breast cancer treatment and survivorship care decisions in clinical settings. The study was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR). We searched PubMed and related databases for interactive web-based decision-making tools developed to support breast cancer treatment and survivorship care from 2013 to 2023. Information on each tool's purpose, target population, data sources, individual and contextual characteristics, outcomes, validation, and usability testing were extracted. We completed a quality assessment for each tool using the International Patient Decision Aid Standard (IPDAS)instrument. We found 54 tools providing personalized breast cancer outcomes (e.g., recurrence) and treatment recommendations (e.g., chemotherapy) based on individual clinical (e.g., stage), genomic (e.g., 21-gene-recurrence score), behavioral (e.g., smoking), and contextual (e.g., insurance) characteristics. Forty-five tools were validated, and nine had undergone usability testing. However, validation and usability testing included mostly White, educated, and/or insured individuals. The average quality assessment score of the tools was 16 (range: 6-46; potential maximum: 63). There was wide variation in the characteristics, quality, validity, and usability of the tools. Future studies should consider diverse populations for tool development and testing. There are tools available to support personalized breast cancer treatment and survivorship care decisions in clinical settings. It is important for both cancer survivors and physicians to carefully consider the quality, validity, and usability of these tools before using them to guide care decisions.

Breast cancer survivorship.

Breast cancer survivorship care transitions from active treatment to focus on surveillance and health maintenance. This review article discusses the crucial aspects of breast cancer survivorship, which include cancer surveillance, management of treatment side effects, implementation of a healthy lifestyle, and psychosocial support.

Care for breast cancer survivors in Asian countries: A review of sexual dysfunction.

Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.

Stakeholders’ involvement in the development and planning of an intervention aimed at integrated care for breast cancer survivors with pain complaints: practical insights and challenges

Background: Persisting pain complaints are prevalent among breast cancer survivors and can become complex in nature, increasing the need for both pain prevention and treatment in an integrated manner. 
 Objective: Managing (chronic) pain requires complex models of care, provided by an interdisciplinary team of healthcare providers. However, the majority of breast cancer survivors with pain complaints are not monitored in an interdisciplinary manner. There is a lack of systematic, integrated, and coordinated follow-up care for breast cancer survivors experiencing pain. Therefore, we developed an intervention that follows a step-wise care model, aimed at timely and adequate pain management among breast cancer survivors. But, to achieve change in pain prevention and treatment, various stakeholders at multiple levels should be involved and addressed.
 Methods: To develop such an intervention and plan for its implementation and evaluation, we followed an intervention mapping approach. As such, we involved relevant stakeholders during the different stages of the development and planning process including breast cancer survivors, healthcare providers from various disciplines, representatives of professional associations who help realize sustainable implementation and adoption of the intervention, and experts in education. Throughout the duration of the research project, a steering group was also periodically consulted and their feedback was requested on the results of each project stage and as a preparation for the next stages.
 Results: To involve these stakeholders and strive for co-design, we used different methods and levels of participation. For example, stakeholders contributed to the identification of current needs and possible barriers in the implementation of the intervention in practice. Additionally, the relevancy and feasibility of the developed intervention components was evaluated before implementation. Their input also helped determine which analyses and outcome measures should be prioritized when assessing the impact of the intervention. The stakeholders’ feedback was collected through asynchronous and synchronous focus groups, and online questionnaires.
 Conclusions: This study can inform others about how to prepare for the development, implementation, and evaluation of an intervention while taking into account stakeholders’ perspectives, experiences, and needs. We would also like to share our practical insights, our challenges related to co-design, and future opportunities to achieve a higher level of stakeholder participation.

Adapting and implementing breast cancer follow-up in primary care: protocol for a mixed methods hybrid type 1 effectiveness-implementation cluster randomized study

BackgroundAdvances in detection and treatment for breast cancer have led to an increase in the number of individuals managing significant late and long-term treatment effects. Primary care has a role in caring for patients with a history of cancer, yet there is little guidance on how to effectively implement survivorship care evidence into primary care delivery.MethodsThis protocol describes a multi-phase, mixed methods, stakeholder-driven research process that prioritizes actionable, evidence-based primary care improvements to enhance breast cancer survivorship care by integrating implementation and primary care transformation frameworks: the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and the Practice Change Model (PCM). Informed by depth interviews and a four round Delphi panel with diverse stakeholders from primary care and oncology, we will implement and evaluate an iterative clinical intervention in a hybrid type 1 effectiveness-implementation cluster randomized design in twenty-six primary care practices. Multi-component implementation strategies will include facilitation, audit and feedback, and learning collaboratives. Ongoing data collection and analysis will be performed to optimize adoption of the intervention. The primary clinical outcome to test effectiveness is comprehensive breast cancer follow-up care. Implementation will be assessed using mixed methods to explore how organizational and contextual variables affect adoption, implementation, and early sustainability for provision of follow-up care, symptom, and risk management activities at six- and 12-months post implementation.DiscussionStudy findings are poised to inform development of scalable, high impact intervention processes to enhance long-term follow-up care for patients with a history of breast cancer in primary care. If successful, next steps would include working with a national primary care practice-based research network to implement a national dissemination study. Actionable activities and processes identified could also be applied to development of organizational and care delivery interventions for follow-up care for other cancer sites.Trial registrationRegistered with ClinicalTrials.gov on June 2, 2022: NCT05400941.

Evolving adjuvant estrogen therapy prescribing among breast oncology workforce.

1546 Background: An oncologist shortage and rising number of breast cancer survivors has created a strained workforce. Care models that incorporate advanced practice providers (APPs) are recommended to meet this rising demand, particularly during survivorship. The objective of this study is to describe the evolving oncology workforce using anti-estrogen prescribing as a surrogate for breast cancer survivorship care. Methods: We used Medicare Part D Public Use Files to identify prescribers of anti-estrogen therapy from 2013 to 2020. We included medications primarily prescribed in the adjuvant setting for estrogen receptor positive breast cancer, including anastrozole, letrozole, exemestane, tamoxifen, raloxifene, fulvestrant, and toremifene. We assessed the volume of physician and APP prescribers and claims by provider type using descriptive statistics and logistic regression. Individual prescribers were included if they had more than 10 claims. Results: The overall number of anti-estrogen claims did not change significantly from 2013 to 2020, with an average of 3,224,361 annually. There was a significant increase in APP prescribers from 7,815 (8.6%) in 2013 to 12,961 (18.3%) in 2020. There was a reduction in physician prescribers by 24,815 (9.7%) over the same period with an overall net decrease of total prescribers of 19,669 (21.7%). The average annual claims per individual prescriber rose from 2013 to 2020 (Physicians: 2013: 37.5 to 2020: 45.2, p < 0.001; APP: 2013: 28.2 to 2020: 37.0, p < 0.001). The percentage of claims attributed to APP prescribers rose substantially from 6.6% in 2013 to 15.5% in 2020. This represents an increase from 220,000 prescriptions in 2013 to over 480,000 in 2020. Conclusions: Our results indicate an ongoing shift in the provider composition responsible for delivering breast cancer survivorship care. Over the time frame analyzed, there was no significant change in number of prescription claims annually, but an overall decrease in providers. Thus, the rise in APP prescribers is not driven by an increased prescribing volume, but rather seems to reflect an evolving surgical oncology workforce. This has significant implications for the future access to and delivery of timely high-quality cancer care.[Table: see text]

Abstract 30: Development of a Breast Cancer Survivorship Health System Needs Assessment Questionnaire (BSH-Q) for Malaysian Health Institutions

Abstract Purpose: There is a need to develop and implement a Breast Cancer Survivorship Care Plan in Malaysia based on the available healthcare resources and services. The objective of the study is to develop a Breast Cancer Survivorship Health System Needs Assessment Questionnaire (BSH-Q) using the Delphi method. Methods: The three rounds of e-Delphi surveys were conducted from November, 2020 to April, 2021. Development of BSH-Q was accomplished amongst key stakeholders (multidisciplinary healthcare professionals involved in cancer care in public hospitals, NGOs and breast cancer survivors). The first Delphi round was intended to explore the barriers, facilitators and needs of healthcare providers focused on five main survivorship care domains. The questions were open ended, allowing expert participants to brainstorm their ideas. Delphi round two involved a ranking exercise of the newly developed questionnaire based on the first Delphi round. A five point Likert scale was used to rate the importance of each item. This was followed with a pilot study to determine the feasibility of the research process, and face validity of the questionnaire. The pilot study was tested on healthcare providers working in University Malaya Medical Centre representing the five respective domains: Rehabilitation, life-style, psychosocial, financial, and genetic counselling. The participants were selected based on their involvement in managing the healthcare issues related to the five domains. Results: A total of 55 participants responded to the Delphi survey. Following the first Delphi survey, a total of 95 questions were developed in the domains of psychosocial, lifestyle, financial, rehabilitation, genetic counselling, cancer surveillance and management. In the second Delphi survey, 39 participants responded, they selected a total of 196 questions as important and finally 182 relevant questions were developed for the final BSH-Q version. The newly developed BSH-Q underwent a pilot study with no major modifications to the questionnaire. Conclusion: The Delphi survey method is suitable to develop the BSH-Q questionnaire. The newly developed BSH-Q is a valuable tool for Malaysia to analyse existing services in the country to provide a needs assessment too for the development of an implementation framework cancer survivorship care in Malaysia. Citation Format: Tania Islam, Syahidatul Akmal Azmi, Suniza Jamarish, Fatiha Hana Shaharuddin, Julia Patrick Engkasan, Nur Aishah Taib. Development of a Breast Cancer Survivorship Health System Needs Assessment Questionnaire (BSH-Q) for Malaysian Health Institutions [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 30.

Strategies to support primary care involvement in the care of patients with a history of breast cancer: A Delphi study.

e24040 Background: Although healthcare leaders in the US support an active role for primary care (PC) in the care of patients with a history of breast cancer, the nature of this role remains unclear. Methods: We invited 40 innovators in breast cancer survivorship care to participate in a 4-round online Delphi panel to identify strategies for defining and fostering PC’s role in breast cancer survivorship. Innovators included primary care physicians, oncologists, researchers and policy makers from government and professional organizations participating in survivorship care programs in the US. Round 1 elicited strategies for improving PC’s role in survivorship care. To reduce the number of strategies and participant burden in subsequent rounds, Round 2 asked panelists to prioritize the top 10 strategies they perceived to be most crucial for implementation. Round 3 asked panelists to assess the importance and feasibility of the previously ranked strategies on a 1 -9 scale. In the final round, panelists were asked to review the group results (medians, IQRs) and reevaluate the importance and feasibility of each strategy in an effort to reach consensus. The RAND/UCLA Appropriateness Method determined the final group rating for each strategy. Results: Of the 40 invited, 23 responded to the email and were included. In Round 1, panelists (n = 23) collectively identified 31 unique strategies to support survivorship care. In Round 2, two of the 31 strategies were unranked by any of the 23 panelists and were eliminated from subsequent rounds. In Round 3, panelists’ (n = 15) evaluated importance and feasibility and revealed three strategies to be most important (scored 9) but with uncertain feasibility (scored 5 or 6). All three strategies emphasized the need to foster connections between primary care and oncology: (1) define clear roles and responsibilities for oncology and primary care, (2) train oncologists about how primary care can address survivorship care needs, (3) create clear pathways for communicating/sharing information with oncology. In Round 4, panelists (n = 20) confirmed the most important strategies and evaluated five strategies as both important and feasible, targeting a range of approaches including EHR-based strategies (e.g., enable screening reminders, monitoring alerts, automated messaging within EHRs in PC), patient education (e.g., educate patients on survivorship), and resource development/distribution (e.g., distribute accessible clinician reference guides detailing common breast cancer drugs and effects). Conclusions: Although innovators identified important and feasible strategic initiatives at various levels of implementation, they agreed that the most important strategies were those that clarified roles and improved communication between oncology and PC but these were not feasible, indicating the need to invest resources to build capacity between PC and oncology.

"How to start that conversation?": Experiences of developing a virtual simulation about sexual health care for breast cancer survivors.

Virtual simulation (VS) is an innovative and engaging knowledge translation strategy that can improve healthcare providers' knowledge and skills. However, there is no known literature published related to the use of simulation to improve cancer survivorship care. In this paper, we describe our experience of developing a VS to educate primary healthcare professionals about sexual health disturbances among breast cancer survivors. Based on literature in other contexts, this VS may help increase health professionals' knowledge and skills needed to assist breast cancer survivors with sexual health concerns. Our VS development experience can be used to encourage and guide other researchers planning to develop similar interventions in the future.

“How to start that conversation?”: A virtual simulation about sexual health care for breast cancer survivors

La simulation virtuelle (SV) est une stratégie innovante et proactive d’application pratique de la théorie qui peut améliorer les connaissances et le savoir-faire des professionnels de la santé. Toutefois, aucun article n’a été publié à ce jour sur l’utilisation de la simulation pour améliorer les soins aux survivants du cancer. Le présent article décrit notre expérience de création d’une SV pour former les professionnels de la santé aux problèmes sexuels vécus par les femmes traitées pour un cancer du sein. Si on extrapole à partir des recherches effectuées dans d’autres contextes, la SV permettrait de bonifier les connaissances et compétences dont les professionnels ont besoin pour accompagner les survivantes ayant des préoccupations de nature sexuelle. Notre expérience de développement de SV pourra motiver et guider d’autres chercheurs qui souhaitent eux aussi déployer des interventions similaires. Mots-clés : innovation infirmière, jeu de simulation virtuelle, survivants du cancer, soins primaires

Abstract 749: The impact of multimorbidity on the relationship between breast cancer tumor characteristics and survivorship care experiences among older women: A SEER-CAHPS analysis

Abstract Our study examined the associations between breast cancer tumor characteristics and self-reported survivorship care experiences stratified by multimorbidity among older female breast cancer survivors in the United States. Utilizing the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program and the Centers for Medicare and Medicaid Services’ Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data linkage from 2000-2019. Breast cancer (BC) survivors (N=19,017) were aged ≥65 years at CAHPS survey who completed a survey after diagnosis of primary site invasive BC. Adjusted multivariable linear regression models were used to estimate beta (β) and standard error (SE) coefficients of the relationships between tumor characteristics (extent of disease: localized, regional, distant; estrogen receptor [ER] status: ER+, ER-, missing/unknown) and several CAHPS composite and rating outcomes, overall and stratified by multimorbidity (BC only, 2-5 chronic conditions, ≥6 chronic conditions). Women were on average 76.3 years (SD=7.14) of age at survey and 4.65 years (SD=3.51) since BC diagnosis. Most survivors were non-Hispanic white (78.1%), had ≥6 chronic conditions (38.1%), were diagnosed with localized BC (80.5%) and/or ER+ tumors (56.9%). Survivors with regional BC at diagnosis reported significantly higher mean scores on Getting Needed Care (β=1.00, SE=0.46, p=0.03), and with distant BC reported significantly lower mean scores on Physician Communication (β=-1.92, SE=0.92, p=0.03) compared to those with localized BC. When stratified by multimorbidity, survivors with distant stage compared to localized, and with 2-5 chronic conditions reported significantly higher mean scores for Getting Needed Care (β=3.85, SE=1.96, p=0.04), while this association was inverse and not statistically significant (β=-2.72, SE=1.87, p=0.14) among survivors with BC only (p-interaction=0.01). While the overall associations between ER status and the CAHPS outcomes were not statistically significant, we observed significant statistical interactions by multimorbidity for the following association: among survivors with BC only, survivors with ER- tumors reported lower Health Plan Ratings (β=-1.89, SE=0.73, p=0.009) compared to survivors with ER+ tumors, while this association was positive however, marginally statistically significant (β=1.63, SE=0.86, p=0.05) among survivors with ≥6 conditions (p-interaction=0.002). BC survivors who are diagnosed with advanced stage and aggressive tumor phenotypes, such as ER- BC, experience different survivorship care experiences when they are also managing multiple chronic conditions. Remarkably, our results demonstrate that women with distant stage breast cancer and multimorbidity reported higher score on getting the care they need. Citation Format: Kate E. Dibble, Zhengyi Deng, Avonne E. Connor. The impact of multimorbidity on the relationship between breast cancer tumor characteristics and survivorship care experiences among older women: A SEER-CAHPS analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 749.

Clinical Application of Liquid Biopsy-Based Circulating Tumor DNA for Follow-Up Care in Breast Cancer Management: Lessons from Other Solid Cancers

Early detection of relapse following successful curative-intent breast cancer surgery is an essential strategy for survival. Unfortunately, conventional screening via radiological imaging and tissue biopsies may be confounded by tumor size. Moreover, tissue biopsy is comparably invasive, clinically challenging, and predisposes medical and mental health complications. The use of liquid biopsies for postoperative screening in breast cancer survivors has been explored as a safer and easier alternative. The increasing popularity of the minimally invasive approach is due to its simplicity in accessing and obtaining the analyte and its lower associated costs. Using circulating tumor DNA (ctDNA) as a novel marker, the method enables real-time monitoring of disease-free survival and detection of potential cancer recurrence through cancer-specific alterations in ctDNA release from cancer cells and its short half-life. The promising clinical applications of ctDNA have fueled interest in developing new biomarkers with superior sensitivity for earlier detection of cancer recurrence, leading to the improved efficacy and efficiency of treatments and management. However, establishing this less invasive screening tool remains a challenge. In this review, we discuss the state-of-the-art in ctDNA-based liquid biopsies with a focus on the recent progress, challenges, and future directions of this technique for clinical applications in the follow-up care of breast cancer survivors.

Treatment-related side effects among Hispanic and non-Hispanic white long-term breast cancer survivors by tamoxifen use and duration.

To determine the associations between ethnicity, age at diagnosis, obesity, multimorbidity, and odds of experiencing breast cancer (BC) treatment-related side effects among long-term Hispanic and non-Hispanic white (NHW) survivors from New Mexico and explore differences by tamoxifen use. Lifestyle and clinical information including self-reported tamoxifen use and presence of treatment- related side effects were collected at follow-up interviews (12-15years) for 194 BC survivors. Multivariable logistic regression models were used to examine associations between predictors and odds of experiencing side effects overall and by tamoxifen use. Women ranged in age at diagnosis (30-74, M = 49.3, SD = 9.37), most were NHW (65.4%) and had in-situ or localized BC (63.4%). Less than half reportedly used tamoxifen (44.3%), of which 59.3% reported using > 5years. Overall, survivors who were overweight/obese at follow-up were 5.42 times more likely to experience treatment-related pain (95% CI 1.40-21.0) compared to normal weight survivors. Survivors with multimorbidity, compared to survivors without, were more likely to report treatment-related sexual health issues (aOR 6.90, 95% CI 1.43-33.2) and poorer mental health (aOR 4.51, 95% CI 1.06-19.1). The statistical interactions between ethnicity and overweight/obese with tamoxifen use were significant (p-interaction < 0.05) for treatment-related sexual health issues. Our results demonstrate that survivors with overweightness/obesity or multimorbidity may be more likely to experience BC treatment-related side effects. Tamoxifen use modifies associations between ethnicity, being overweight/obese, and sexual health issues following treatment. The likelihood of experiencing treatment-related side effects were more favorable for those on tamoxifen or those who had used tamoxifen for longer durations. These findings highlight the importance of fostering side effect awareness and applying appropriate interventions to assist with disease management throughout BC survivorship care.

Partners in surviving: Holistic care for breast cancer survivors and caregivers

Partners in surviving: Holistic care for breast cancer survivors and caregivers

Abstract C116: Racial/ethnic disparities in perceived quality of breast cancer survivorship care among older women by general health status: A SEER-CAHPS study

Abstract Purpose: We aimed to outline the extent of racial/ethnic disparities in perceived quality of cancer survivorship care among older breast cancer survivors in the United States. Methods: We utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Results program (SEER) and the Center for Medicare and Medicaid Services Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data linkage from 2000-2019. 19,017 female breast cancer survivors aged ≥65 years at survey with a prior diagnosis of primary invasive breast cancer were included. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression to determine the relationship between race/ethnicity (non-Hispanic white [NHW; referent], non-Hispanic Black [NHB], non-Hispanic Asian [NHA], Hispanic) and perceived quality of survivorship care (excellent in Getting Care Quickly, Getting Needed Care, Physician Communication, Getting Needed Prescription Drugs, and Overall Care, Health Plan, and Physician ratings), and usually/always having Enough Time with Physician, overall and by perceived general health status (excellent/very good, good, fair/poor). Results: Most survivors were NHW (78.1%) while the minority were NHB (8.1%), NHA (6.5%), or Hispanic (6.2%). Survivors reported an average of 76.3 years at survey (SD=7.14) and 4.65 years (SD=3.51) since diagnosis. Overall, NHB survivors were significantly less likely to report excellent for Overall Care (aOR, 0.80, 95% CI, 0.71-0.91) and usually/always having Enough Time with Physician (aOR, 0.74, 95% CI, 0.58-0.93) compared to NHW survivors. NHA survivors were significantly less likely to report excellent Getting Care Quickly (aOR, 0.75, 95% CI, 0.63-0.88), Getting Needed Care (aOR, 0.79, 95% CI, 0.63-0.99), Physician Communication (aOR, 0.84, 95% CI, 0.73-0.97), and Overall Care rating (aOR, 0.76, 95% CI, 0.67-0.87) compared to NHW survivors. The aORs for Hispanic survivors varied depending on outcome. When stratified by general health status, NHB compared to NHW survivors were significantly more likely (aOR, 1.30, 95% CI, 1.05-1.62) to report excellent in Getting Needed Care among those who reported good general health, but this disparity was not observed among those who reported excellent/very good general health (p-interaction=0.04). Compared to NHW survivors, NHB were significantly more likely (aOR, 1.54, 95% CI, 1.14-2.08) to report excellent Health Plan ratings among those who reported excellent/very good general health but not among those who reported good (p-interaction=0.03) or fair/poor general health (p-interaction=0.01). There were no significant interactions between general health status and NHA or Hispanic group for any outcome. Conclusion: These findings can be used to inform future interventions, care, and physician education throughout breast cancer survivorship. Citation Format: Kate E. Dibble, Zhengyi Deng, Avonne E. Connor. Racial/ethnic disparities in perceived quality of breast cancer survivorship care among older women by general health status: A SEER-CAHPS study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C116.

Development and pilot testing of a decision aid for navigating breast cancer survivorship care

BackgroundThe predominant oncologist-led model in many countries is unsustainable to meet the needs of a growing cohort of breast cancer survivors (BCS). Despite available alternative models, adoption rates have been poor. To help BCS navigate survivorship care, we aimed to systematically develop a decision aid (DA) to guide their choice of follow-up care model and evaluate its acceptability and usability among BCS and health care providers (HCPs).MethodsWe recruited BCS aged ≥ 21 years who have completed primary treatment and understand English. BCS receiving palliative care or with cognitive impairment were excluded. HCPs who routinely discussed post-treatment care with BCS were purposively sampled based on disciplines. Each participant reviewed the DA during a semi-structured interview using the ‘think aloud’ approach and completed an acceptability questionnaire. Descriptive statistics and directed content analysis were used.ResultsWe conducted three rounds of alpha testing with 15 BCS and 8 HCPs. All BCS found the final DA prototype easy to navigate with sufficient interactivity. The information imbalance favouring the shared care option perceived by 60% of BCS in early rounds was rectified. The length of DA was optimized to be ‘just right’. Key revisions made included (1) presenting care options side-by-side to improve perceived information balance, (2) creating dedicated sections explaining HCPs’ care roles to address gaps in health system contextual knowledge, and (3) employing a multicriteria decision analysis method for preference clarification exercise to reflect the user’s openness towards shared care. Most BCS (73%) found the DA useful for decision-making, and 93% were willing to discuss the DA with their HCPs. Most HCPs (88%) agreed that the DA was a reliable tool and would be easily integrated into routine care.ConclusionsOur experience highlighted the need to provide contextual information on the health care system for decisions related to care delivery. Developers should address potential variability within the care model and clarify inherent biases, such as low confidence levels in primary care. Future work could expand on the developed DA’s informational structure to apply to other care models and leverage artificial intelligence to optimize information delivery.

Stakeholders' Experiences and Perspectives Regarding Care Quality for Women With Breast Cancer: A Systematic Review.

The considerable growth in the number of patients with breast cancer leads to substantial pressure on healthcare services; however, the main measures that will evaluate what is important to the key stakeholders in improving the quality of breast cancer care are not well defined. This study aimed to synthesize providers' and patients' experiences and perspectives regarding barriers and quality breast cancer care in health services. PubMed, Scopus, MEDLINE, Web of Knowledge, and the Cochrane Library databases were searched, and articles published in English up to August 2020 were screened. Two reviewers independently screened all articles. Data were obtained directly from different stakeholder groups including patients, health providers, and professionals. The search strategy identified 21 eligible articles that met inclusion criteria and reported perspectives of 847 health providers and 24 601 patients regarding healthcare quality. Health providers and patients with breast cancer noted information needs, psychosocial support, responsibility for care, and coordination of care as important quality improvement characteristics of the healthcare system. Shifting to high-quality breast cancer care would likely be a complicated process, and there is a need for the cancer care services to consider important characteristics of quality cancer care as a care priority, that is, to be responsive. Breast cancer survivorship care programs and interventions may need to consider the barriers or common challenges to care noted in this review, especially regarding information sharing and the need for social support and care cooperation.