Developing a post-treatment survivorship care plan to help breast cancer survivors understand their fertility

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

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Implementing a Survivorship Care Plan for Patients With Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.14.2851 ◽

2008 ◽

Vol 26 (5) ◽

pp. 759-767 ◽

Cited By ~ 191

Author(s):

Patricia A. Ganz ◽

Erin E. Hahn

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Cancer Treatment ◽

Late Effects ◽

Breast Cancer Survivors ◽

The United States ◽

Care Plan ◽

Survivorship Care Plan ◽

Survivorship Care ◽

Treatment Summary

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

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Cost Effectiveness of a Survivorship Care Plan for Breast Cancer Survivors

Journal of Oncology Practice ◽

10.1200/jop.2013.001142 ◽

2014 ◽

Vol 10 (2) ◽

pp. e86-e92 ◽

Cited By ~ 26

Author(s):

Doug Coyle ◽

Eva Grunfeld ◽

Kathryn Coyle ◽

Gregory Pond ◽

Jim A. Julian ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cost Effectiveness ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Cost Effective ◽

Care Plan ◽

Survivorship Care Plan ◽

Survivorship Care ◽

Effective Use

The authors conclude that this survivorship care plan would be costly to introduce and would not be a cost-effective use of scarce health care resources.

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Evaluation of electronic care plan usage and usefulness among breast cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.83 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 83-83 ◽

Cited By ~ 1

Author(s):

Mary Sesto ◽

William Gray Hocking ◽

Douglas Wiegmann ◽

Thomas Y Yen ◽

Mindy Gribble ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Objective Evaluation ◽

Care Plan ◽

Survivorship Care Plan ◽

Patient Portal ◽

Survivorship Care ◽

Care Plans ◽

Treatment Summary

83 Background: Survivorship care plans (SCP) are recommended to improve communication between breast cancer survivors (BCS), primary care, and oncology. Objective evaluation of survivor access of specific care plan content is challenging as commonly-used formats (e.g., paper or electronic file) prevent tracking of usage. This project aimed to evaluate the usage and usefulness of an electronic survivorship care plan (eSCP) that could track access and pages visited. Methods: We recruited 128 BCS from outpatient oncology clinics. 121 BCS received eSCP access via an online secure patient portal; seven received paper copies and are not included in this analysis. The research team customized the portal to track eSCP usage and page visits during the study period (at least 12 weeks of eSCP access). The eSCP consisted of four internal pages (Guide, Treatment Summary, Followup Plan, and Glossary) plus 21 external hyperlinks to survivorship resources. eSCP usefulness and understandability were evaluated using 10-item Likert scales: 1 (not at all useful/very hard to understand to 10 very useful/very easy to understand). Results: 90 out of 121 (74.38%) participants accessed the eSCP. The majority accessed the eSCP within two days of receiving access (N = 70/90, 77.8%) and visited 1 to 3 times (N = 81/90, 90%). Treatment Summary was the most frequently visited internal page (158 visits by 69 participants). Other page usage: Followup Plan (124 visits by 65 participants), Guide (113 visits by 62 participants), and Glossary (46 visits by 31 participants). 34 participants (37.78%) accessed external pages from the eSCP. Participants perceived the overall care plan as useful (8.78, 95% CI [8.38, 9.19]) and easy to understand (8.81, 95% CI [8.47, 9.16]). Conclusions: We found high usage rates among BCS provided an eSCP and the majority perceived the eSCP as useful and easy to understand. Based on favorable assessment and use, it is reasonable for eSCPs to serve as a tool to facilitate communication and care coordination for survivors, especially as access to and use of mobile device technology and electronic patient health portals increase. Minority and rural survivors access and use of such features may require further research.

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Development of a Survivorship Care Plan (SCP) Program for Rural Latina Breast Cancer Patients: Proyecto Mariposa—Application of Intervention Mapping

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165784 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5784

Author(s):

Eunjeong Ko ◽

María Luisa Zúñiga ◽

Susan I. Woodruff ◽

Yolanda Serra-Martinez ◽

Veronica Cardenas

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Intervention Mapping ◽

Border Region ◽

Care Plan ◽

Survivorship Care Plan ◽

Survivorship Care ◽

Practical Application ◽

Behavioral Theories

Latina breast cancer survivors are less likely to receive a comprehensive Survivorship Care Plan (SCP) than non-Latina Whites. Evidence-based and theory driven interventions are needed to promote a culturally and linguistically responsive SCP. This paper describes the application of Intervention Mapping (IM) in the development of Proyecto Mariposa, a comprehensive SCP program targeting Latina breast cancer survivors living in a rural U.S.–Mexico border region. We conducted a needs assessment using focus groups (n = 40) and individual interviews (n = 4) with stakeholders to elicit their needs and preferences relating to SCPs and SCP aid (Step1). Content analysis of transcripts was conducted using Atlas.ti. The findings informed the development of a matrix of change objectives where we selected specific behavioral theories to ground the practical application of the SCP program (Step 2). We identified behavioral theories and the practical application of behavioral change (Step 3) and designed and developed a comprehensive SCP program which consisted of a culturally—and linguistically—adapted SCP document and animated video as an SCP aid (Step 4). The systematic application of the IM framework resulted in the development of a comprehensive and culturally tailored SCP intervention. Stakeholder active involvement in the cultural tailoring of the program was imperative and strengthens the SCP intervention.

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