scholarly journals LUCL reconstruction of the elbow: clinical midterm results based on the underlying pathogenesis

2021 ◽  
Author(s):  
Stephanie Geyer ◽  
Caroline Heine ◽  
Philipp W. Winkler ◽  
Patricia M. Lutz ◽  
Andreas Lenich ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patient Reported Outcomes ◽  
Case Series ◽  
Dash Score ◽  
Patient Reported ◽  
The Impact ◽  
Triceps Tendon ◽  
Tendon Autograft ◽  
Underlying Pathogenesis

Abstract Purpose Traumatic and atraumatic insufficiency of the lateral ulnar collateral ligament (LUCL) can cause posterolateral rotatory instability (PLRI) of the elbow. The influence of the underlying pathogenesis on functional outcomes remains unknown so far. The objective of this study was to determine the impact of the initial pathogenesis of PLRI on clinical outcomes after LUCL reconstruction using an ipsilateral triceps tendon autograft. Methods Thirty-six patients were reviewed in this retrospective study. Depending on the pathogenesis patients were assigned to either group EPI (atraumatic, secondary LUCL insufficiency due to chronic epicondylopathia) or group TRAUMA (traumatic LUCL lesion). Range-of-motion (ROM) and posterolateral joint stability were evaluated preoperatively and at follow-up survey. For clinical assessment, the Mayo elbow performance (MEPS) score was used. Patient-reported outcomes (PROs) consisting of visual analogue scale (VAS) for pain, disability of arm, shoulder and hand (DASH) score, patient-rated elbow evaluation (PREE) score and subjective elbow evaluation (SEV) as well as complications were analyzed. Results Thirty-one patients (group EPI, n = 17; group TRAUMA, n = 14), 13 men and 18 women with a mean age of 42.9 ± 11.0 were available for follow-up evaluation (57.7 ± 17.5 months). In 93.5%, posterolateral elbow stability was restored (n = 2 with re-instability, both group TRAUMA). No differences were seen between groups in relation to ROM. Even though group EPI (98.9 ± 3.7 points) showed better results than group TRAUMA (91.1 ± 12.6 points) (p = 0.034) according to MEPS, no differences were found for evaluated PROs (group A: VAS 1 ± 1.8, PREE 9.3 ± 15.7, DASH 7.7 ± 11.9, SEV 92.9 ± 8.3 vs. group B: VAS 1.9 ± 3.2, PREE 22.4 ± 26.1, DASH 16.0 ± 19.4, SEV 87.9 ± 15.4. 12.9% of patients required revision surgery. Conclusion LUCL reconstruction using a triceps tendon autograft for the treatment of PLRI provides good to excellent clinical outcomes regardless of the underlying pathogenesis (traumatic vs. atraumatic). However, in the present case series, posterolateral re-instability tends to be higher for traumatic PLRI and patient-reported outcomes showed inferior results. Level of evidence Therapeutic study, LEVEL III.

scholarly journals Surgical Management of Insertional Achilles Tendinopathy in the Young and Elderly Result in Similar Clinical Outcomes

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0038
Author(s):  
Huai M. Phen ◽  
Wesley J. Manz ◽  
Joel T. Greenshields ◽  
Danielle Mignemi ◽  
Jason T. Bariteau
Keyword(s):  
Linear Regression ◽  
Clinical Outcomes ◽  
Surgical Management ◽  
Surgical Correction ◽  
Physical Component Score ◽  
Achilles Tendinitis ◽  
Sf 36 ◽  
Patient Reported ◽  
The Impact

Category: Other; Ankle Introduction/Purpose: Insertional Achilles tendinitis (IAT) is a common cause of chronic posterior heel pain. Non-operative treatment has demonstrated evidence of success, with similar failure rates in both the young and the elderly. Surgical management can reproducibly improve patients’ pain and functional status. Older patients are considered to be at a higher risk for surgical complications due to associated comorbidities when compared to patients under the age of 60. The aim of this study is to investigate the impact of comorbidities and peri-operative variables on functional patient reported outcomes following surgical treatment of IAT in those over and under the age of 60. Methods: Retrospective review of prospectively collected data pertaining to a consecutive series of adult patients who underwent surgical management of IAT by a single surgeon (J.B.). Patients were separated into those 60 years of age and younger, and those above 60. Patients undergoing concomitant surgical procedures or revisions were excluded. Patient demographics, co- morbidities, perioperative variables, and post-operative complications were collected. Visual Analogue Scale (VAS), Short Form Health Survey Physical Component Score (SF-36 PCS), wound infection, and recurrence were assessed with a minimum follow-up of 12 months. Statistics were obtained using linear regression mixed models, and chi-squared analysis. Results: 38 operative cases were identified including 17 patients over and 21 patients under 60 years of age (mean 66.8 +/- 5.1yrs, 49.1 +/- 8.4yrs, respectively). There were no significant differences in demographics, rates of co-morbidities, or post-operative infection between the two groups. Both young and elderly groups experienced improvements in mean VAS pain scores at 6 months (3.3 and 2.7, respectively, P = 0.416) and 12 months (5.0 and 4.1, respectively, P = 0.322) post-operatively. SF-36 PCS improvements were also observed in both young and elderly cohorts at 6 (mean 22.1 and 9.3, respectively, P = 0.122) and 12 months (mean 30.4 and 20.4, respectively, P = 0.158). Linear regression analysis showed no statistical difference between the presence of co-morbidities, or age, on clinical outcomes. Conclusion: None of the co-morbidities nor peri-operative variables assessed were linked to increased risk of failed surgical correction of IAT in elderly patients, suggesting surgical correction of IAT in geriatric populations is an appropriate and reproducible treatment option. Further higher-powered studies, with longer follow-up times would be of use to better elucidate the influence of co-morbidities on recurrence.

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

2020 ◽  
Vol 41 (12) ◽  
pp. 1519-1528
Author(s):  
Jonathan Day ◽  
Jaeyoung Kim ◽  
Martin J. O’Malley ◽  
Constantine A. Demetracopoulos ◽  
Jonathan Garfinkel ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
The Mean ◽  
Component Revision

Background: The Salto Talaris is a fixed-bearing implant first approved in the US in 2006. While early surgical outcomes have been promising, mid- to long-term survivorship data are limited. The aim of this study was to present the survivorship and causes of failure of the Salto Talaris implant, with functional and radiographic outcomes. Methods: Eighty-seven prospectively followed patients who underwent total ankle arthroplasty with the Salto Talaris between 2007 and 2015 at our institution were retrospectively identified. Of these, 82 patients (85 ankles) had a minimum follow-up of 5 (mean, 7.1; range, 5-12) years. The mean age was 63.5 (range, 42-82) years and the mean body mass index was 28.1 (range, 17.9-41.2) kg/m2. Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Preoperative, immediate, and minimum 5-year postoperative AP and lateral weightbearing radiographs were reviewed; tibiotalar alignment (TTA) and the medial distal tibial angle (MDTA) were measured to assess coronal talar and tibial alignment, respectively. The sagittal tibial angle (STA) was measured; the talar inclination angle (TIA) was measured to evaluate for radiographic subsidence of the implant, defined as a change in TIA of 5 degrees or more from the immediately to the latest postoperative lateral radiograph. The locations of periprosthetic cysts were documented. Preoperative and minimum 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscales were compared. Results: Survivorship was 97.6% with 2 revisions. One patient underwent tibial and talar component revision for varus malalignment of the ankle; another underwent talar component revision for aseptic loosening and subsidence. The rate of other reoperations was 21.2% ( n = 18), with the main reoperation being exostectomy with debridement for ankle impingement ( n = 12). At final follow-up, the average TTA improved 4.4 (± 3.8) degrees, the average MDTA improved 3.4 (± 2.6) degrees, and the average STA improved 5.3 (± 4.5) degrees. Periprosthetic cysts were observed in 18 patients, and there was no radiographic subsidence. All FAOS subscales demonstrated significant improvement at final follow-up. Conclusions: We found the Salto Talaris implant to be durable, consistent with previous studies of shorter follow-up lengths. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at a minimum 5-year follow-up. Level of Evidence: Level IV, retrospective case series.

Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years’ Follow-up

2018 ◽  
Vol 46 (11) ◽  
pp. 2700-2706 ◽  
Author(s):  
Lukas Willinger ◽  
Lucca Lacheta ◽  
Knut Beitzel ◽  
Stefan Buchmann ◽  
Klaus Woertler ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Constant Score ◽  
Case Series ◽  
Shoulder Function ◽  
Dash Score ◽  
Outcome Scores ◽  
Retear Rate

Background: The retear rate after primary rotator cuff (RC) reconstruction is high and commonly leads to poorer clinical outcomes and shoulder function. In the case of primary failure, revision RC reconstruction (RCR) has become increasingly important to re-create RC integrity and improve outcomes. To date, clinical and structural outcomes after RCR have not been sufficiently investigated and described at midterm follow-up. Hypothesis/Purpose: The purpose was to evaluate the clinical and radiological outcomes after revision RCR. It was hypothesized that revision RCR significantly improves clinical outcomes and that the outcomes positively correlate with tendon integrity on magnetic resonance imaging (MRI). Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent revision RCR between 2008 and 2014 were retrospectively evaluated with a minimum follow-up of 2 years. Outcomes were assessed by a clinical examination, a visual analog scale for pain (VAS), the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Tendon integrity was determined using 3-T MRI and graded according to the Sugaya classification. Results: Thirty-one of 40 patients (77.5%) were available for the final assessment at a mean follow-up of 50.3 ± 20.4 months. Clinical outcome scores significantly improved from preoperatively to postoperatively for the CS (39.7 ± 16.7 to 65.1 ± 19.7; P < .001), ASES (44.2 ± 17.7 to 75.2 ± 24.8; P < .001), and DASH (68.6 ± 15.1 to 21.5 ± 19.1; P < .001). The VAS score decreased from 6.1 ± 1.8 preoperatively to 1.3 ± 1.8 at final follow-up ( P < .001). MRI demonstrated a retear rate of 55.5%. No differences in CS, ASES, and DASH scores were detected between patients with an intact repair and failure. Abduction strength was not significantly different in patients with an intact repair and retears (55.5 N vs 44.0 N, respectively, P = .52). Conclusion: Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. The clinical outcome scores were comparable in patients with an intact repair and those with failed RC healing. Therefore, tendon integrity was not correlated with better clinical outcomes after revision RCR at final follow-up.

scholarly journals Two Year Follow-Up of Patient Reported Outcomes Following Third Generation Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0005
Author(s):  
Thomas L. Lewis ◽  
Robbie Ray ◽  
David Gordon
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Patient Reported Outcomes ◽  
Statistical Significance ◽  
Case Series ◽  
Published Data ◽  
Third Generation ◽  
Specific Patient ◽  
Patient Reported

Category: Bunion Introduction/Purpose: The aim of this study was to explore the 2 year results of third generation (using screw fixation) Minimally Invasive Chevron and Akin osteotomies (MICA) for hallux valgus correction. There is a paucity of published data regarding the outcomes of this relatively new technique. We present the largest series in the literature, using three separate validated patient-reported outcome measures (EQ-5DL, VAS Pain and Manchester Oxford Foot Questionnaire (MOXFQ), for this time point. Methods: A single surgeon case series of patients with hallux valgus underwent primary third generation minimally invasive chevron and akin osteotomies for hallux valgus correction. Between August 2015 and January 2018, 290 MICAs were performed in 203 patients that were eligible for 2 year follow up. Baseline and 2 year post-operative patient reported outcomes were collected for 164 feet in 130 patients (124 females; 6 males). Paired t-tests were used to determine the statistical significance of the difference between pre- and post-operative scores. Results: The mean age was 56.6 (range 29.5-81.0, standard deviation (s.d.) 10.9). At two year follow up, mean MOXFQ scores improved for each domain: Pain; baseline 40.6 (range 0-100, s.d. 22.8), reduced to 11.3 (range 0-75, s.d. 16.0, p<0.001); Walking; 36.0 (range 0-100, s.d. 25.9) reduced to 8.2 (range 0-75.0, s.d. 16.0, p<0.001); Social interaction; 46.7 (range 0-100, s.d. 24.3), reduced to 7.7 (range 0-75.0, s.d. 13.9, p<0.001). Mean VAS Pain score improved from 30.4 (range 0.0-90.0, s.d. 23.6) to 9.4 (range 0.00-70.0, s.d. 15.6, p<0.001). Mean EQ-5D index score improved from 0.750 (range 0.066-1.000, s.d. 0.148) to 0.892 (range 0.410-1.000, s.d. 0.135, p<0.001). Mean EQ-5D VAS score did not significantly improve from 81.9 (range 0-100, s.d. 17.1) to 83.0 (range 0-100, s.d. 18.0, p=0.559). Conclusion: This is the largest prospective case series of short-term patient reported outcomes using a validated assessment method for hallux valgus, following third generation MICA to date. These data show that this technique is effective at improving foot and ankle specific patient reported outcomes at 2 years. This cohort is being followed over the longer term.

scholarly journals The Impact of Pre-Operative Mental Health and Depression on Outcomes after Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Daniel J. Cunningham ◽  
John Steele ◽  
Samuel B. Adams
Keyword(s):  
Mental Health ◽  
Patient Reported Outcomes ◽  
Total Ankle Arthroplasty ◽  
Linear Regression Models ◽  
Ankle Arthroplasty ◽  
Change Scores ◽  
Short Musculoskeletal Function Assessment ◽  
Patient Reported ◽  
The Impact

Category: Ankle Introduction/Purpose: Poor pre-operative mental health and depression have been shown to negatively impact patient- reported outcomes (PROMs) after a broad array of orthopaedic procedures involving the spine, hip, knee, shoulder, and hand. However, the relationship of mental health and patient-reported outcomes in foot and ankle surgery is less clear. The purpose of this study is to characterize the impact of pre-operative mental health and depression on patient-reported outcomes after total ankle arthroplasty. The study hypothesis is that depression and decreased SF36 MCS will be significantly associated with diminished improvement in PROMs after total ankle arthroplasty. Methods: All patients undergoing primary TAA between January 2007 and December 2016 who were enrolled into a prospective, observational study and who had at least 1 to 2-year minimum study follow-up were included. Patients were separated into 4 groups based on the presence or absence of SF36 MCS<35 and diagnosis of depression. Pre-operative to post- operative change scores in the SF36 physical and mental component summary scores (PCS and MCS), Short Musculoskeletal Function Assessment (SMFA) function and bother components, and visual analog scale (VAS) pain were calculated in 1 to 2-year follow-up. Multivariable, main effects linear regression models were constructed to evaluate the impact of SF36 and depression status on pre-operative to 1 to 2-year follow-up change scores with adjustment for age, sex, race, body mass index, current smoking, American Society of Anesthesiologist’s score, smoking, and Charlson-Deyo comorbidity score. Results: As in Table 1, adjusted analyses demonstrated that patients with MCS<35 and depression had significantly lower improvements in all change scores including SF36 MCS (-5.1 points) and PCS (-7.6 points), SMFA bother (6 points) and function scores (5.7 points), and VAS pain (7.5 points) compared with patients that had SF36>=35 and no depression. Patients with MCS<35 and no depression had significantly greater improvement in SF36 MCS (5.3 points) compared with patients that had MCS>=35 and no depression. Patients with MCS>=35 and depression had significantly lower improvement in SF36 MCS (-3.2 points) compared with patients that had MCS>=35 and no depression. Adjusted analyses of minimum 5-year outcomes demonstrated significantly increased improvement in MCS and SMFA function for patients with pre-operative MCS<35 and no depression. Conclusion: Presence of depression and decreased SF36 MCS are risk factors for diminished improvement in PROMs. Patients with depression and decreased MCS should be counseled about their risk of diminished improvement in outcomes compared to peers. As PROM’s become part of physician evaluations, it is becoming increasingly important to identify factors for diminished improvement outside of the physician’s control. [Table: see text]

scholarly journals Clinical Outcomes of ProChondrix® Osteochondral Allograft in the Knee: A Case Series

2021 ◽  
Author(s):  
Michael S. Barnum ◽  
Evan D. Boyd ◽  
Annabelle P. Davey ◽  
Andrew Slauterbeck ◽  
James R. Slauterbeck
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Cartilage Defect ◽  
Femoral Condyle ◽  
Case Series ◽  
Activity Level ◽  
Osteochondral Allograft ◽  
Cartilage Restoration ◽  
Patient Reported

Abstract PurposeFocal articular cartilage injuries are common and may lead to progression of osteoarthritis. The complications associated with traditional treatment strategies have influenced the development of new biotechnologies, such as the ProChondrix® osteochondral allograft. Clinical evidence on the outcomes associated with ProChondrix® osteochondral allografts are limited. Thus, the primary purpose of this study was to evaluate the clinical outcomes following treatment of an isolated cartilage defect with a ProChondrix® osteochondral allograft implant.MethodsRetrospective analysis of patients who underwent a cartilage restoration procedure using ProChondrix® osteochondral allograft has been performed. Patients completed patient-reported outcome surveys which included the Knee injury and Osteoarthritis Outcome Score (KOOS), consisting of the 5 subscales of Pain, Symptoms, Activities of Daily Living, Sports and Recreation, and Quality of Life, the Marx Activity Scale, and the visual analog pain scale.ResultsSix patients underwent a cartilage restoration procedure using ProChondrix® between January 2016 and December 2019. Three males and three females were included with a median age of 33.5 years (range 18–48 years). The median follow-up duration was 15 months (range 9–24 months). There were 4 patellar grafts, 1 medial femoral condyle graft, and 1 lateral femoral condyle graft, with a median defect size of 18.5mm (range 13-20mm). At the most recent clinical follow-up, all six patients were pain free and all patients had returned to pre-op activity level.ConclusionTo our knowledge, this is the first study to report the clinical outcome, activity level, and patient orientated outcomes in a case series of patients following treatment of an isolated cartilage defect with a ProChondrix® osteochondral allograft implant. Our study demonstrates promising short-term results in patient reported clinical outcome scores.

scholarly journals Contribution of First Tarsometatarsal Joint Fusion to Deformity Correction in the Treatment of Adult Acquired Flatfoot Deformity

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Jonathan Day ◽  
Matthew S. Conti ◽  
Nicholas Williams ◽  
Scott J. Ellis ◽  
Jonathan T. Deland ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patient Reported Outcomes ◽  
Interobserver Reliability ◽  
Deformity Correction ◽  
Measurement Information ◽  
Radiographic Parameters ◽  
Metatarsal Angle ◽  
Patient Reported ◽  
Adult Acquired Flatfoot Deformity

Category: Midfoot/Forefoot; Other Introduction/Purpose: Severe adult-acquired flatfoot deformity (AAFD) is often associated with painful medial column collapse at the naviculocuneiform (NC) joint. The purpose of this study was to examine the role of first tarsometatarsal (1st TMT) fusion combined with subtalar fusion in correcting deformity at this joint. Methods: We retrospectively analyzed 40 patients (41 feet) who underwent 1st TMT and subtalar (ST) fusion as part of a flatfoot reconstructive procedure. We assessed six radiographic parameters both preoperatively and at a minimum of 6 months postoperatively, including talonavicular (TN) coverage angle, lateral talo-first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, hindfoot moment arm, and a newly defined navicular-cuneiform incongruency angle (NCIA). Patient-Reported Outcomes Measurement Information System (PROMIS) clinical outcomes were assessed preoperatively and at a minimum 1 year follow-up. Results: The NCIA demonstrated excellent interobserver reliability, with no significant change between pre- and postoperative measurements. All other radiographic parameters, except calcaneal pitch, demonstrated statistically significant improvement postoperatively (p <0.01). Overall, patients had statistically significant improvement in all PROMIS domains (p <0.01), except for depression. Worsening NC deformity was not associated with worse patient-reported outcomes. Conclusion: Our data suggests that when addressing collapse of the medial arch in patients with AAFD, fusion of the 1st TMT joint in combination with other procedures leads to acceptable radiographic and clinical outcomes. There was no change in deformity at the NC joint at short-term follow-up, and patients achieved significant improvement in multiple PROMIS domains. Based on our findings, deformity through the NC joint does not significantly impact clinical outcomes. In addition, the NCIA was established as a reliable radiographic parameter that can be used to assess NC deformity in the presence of talonavicular and/or 1st TMT fusion. [Table: see text]

scholarly journals Clinical Presentation and Outcomes Associated With Fabellectomy in the Setting of Fabella Syndrome

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090372 ◽  
Author(s):  
Travis J. Dekker ◽  
Matthew D. Crawford ◽  
Nicholas N. DePhillipo ◽  
Mitchell I. Kennedy ◽  
W. Jeffrey Grantham ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Case Reports ◽  
Case Series ◽  
High Rate ◽  
Patient Satisfaction Score ◽  
Presenting Symptoms ◽  
Patient Reported ◽  
Outcome Scores

Background: Clinical outcomes pertaining to isolated lateral fabellectomy in the setting of fabella syndrome are limited to small case reports at this time. Purpose: To assess the most common presenting symptoms, clinical outcomes, and satisfaction after fabella excision in the setting of fabella syndrome. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients with a minimum of 21-month follow-up after isolated fabellectomy for fabella syndrome were reviewed retrospectively. Clinical outcome scores of the following domains were collected: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and Lysholm knee survey, along with a simple numeric patient satisfaction score (range, 1-10; 10 = “very satisfied”). Statistical analysis was performed using paired t tests for all clinical outcome data. Results: A total of 11 isolated fabella excisions were included in 10 patients with isolated lateral-sided knee pain in the setting of fabella syndrome (8 males, 2 females), with a mean age of 36.9 years (range, 23-58 years) and a mean follow-up of 2.4 years (range, 21-47 months). A total of 8 patients (80%) were able to return to full desired activities, including sports. Only 5 of 11 (45%) excisions had concomitant lateral femoral condyle cartilage pathology. There were significant improvements across multiple WOMAC domains, and the WOMAC total score improved from 28.5 ± 17.6 preoperatively to 11.6 ± 10.2 postoperatively ( P < .05). Lysholm scores significantly improved from 66.6 ± 23.1 preoperatively to 80.2 ± 13.9 postoperatively ( P = .044). Overall patient-reported satisfaction was 8.8 ± 1.6. Conclusion: Fabella excision in the setting of fabella syndrome demonstrated improvements in clinical outcome scores, high rate of returning to preinjury level of activities, and low risk of complications or need for additional surgical procedures.

Evaluating Survivorship Care Plans: Results of a Randomized, Clinical Trial of Patients With Breast Cancer

2011 ◽  
Vol 29 (36) ◽  
pp. 4755-4762 ◽  
Author(s):  
Eva Grunfeld ◽  
Jim A. Julian ◽  
Gregory Pond ◽  
Elizabeth Maunsell ◽  
Douglas Coyle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Reported Outcomes ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Event Scale ◽  
Care Plans ◽  
Patient Reported ◽  
Secondary Outcomes ◽  
The Impact

Purpose An Institute of Medicine report recommends that patients with cancer receive a survivorship care plan (SCP). The trial objective was to determine if an SCP for breast cancer survivors improves patient-reported outcomes. Patients and Methods Women with early-stage breast cancer who completed primary treatment at least 3 months previously were eligible. Consenting patients were allocated within two strata: less than 24 months and ≥ 24 months since diagnosis. All patients were transferred to their own primary care physician (PCP) for follow-up. In addition to a discharge visit, the intervention group received an SCP, which was reviewed during a 30-minute educational session with a nurse, and their PCP received the SCP and guideline on follow-up. The primary outcome was cancer-related distress at 12 months, assessed by the Impact of Event Scale (IES). Secondary outcomes included quality of life, patient satisfaction, continuity/coordination of care, and health service measures. Results Overall, 408 survivors were enrolled through nine tertiary cancer centers. There were no differences between groups on cancer-related distress or on any of the patient-reported secondary outcomes, and there were no differences when the two strata were analyzed separately. More patients in the intervention than control group correctly identify their PCP as primarily responsible for follow-up (98.7% v 89.1%; difference, 9.6%; 95% CI, 3.9 to 15.9; P = .005). Conclusion The results do not support the hypothesis that SCPs are beneficial for improving patient-reported outcomes. Transferring follow-up to PCPs is considered an important strategy to meet the demand for scarce oncology resources. SCPs were no better than a standard discharge visit with the oncologist to facilitate transfer.

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