Quality of cancer follow-up care: a focus on Latina breast cancer survivors

Background: Cancer survivorship is an unremitting struggle for breast cancer patients, as the consequence of complex treatment processes and its multitude of residual and late emerging side effects, have a significant impact on their quality of life (QOL). Unique issues of survivorship include those related to physical, psychological, social, and spiritual well-being of women. Amid a growing population of breast cancer survivors (BCs) worldwide, supportive care research is assuming greater importance in breast cancer care. Focus of survivorship research is to identify issues impacting QOL of the cancer survivors so that supportive care services can be tailored to their specific needs. Role of individual survivor's issues have been widely reported but a comprehensive picture is lacking. Aim: This study was conducted with the aim to identify important survivorship issues adversely affecting QOL of women after breast cancer treatment. Main objectives were to (1) estimate prevalence of various survivorship issues (2) assess QOL of survivors by using FACT-B and SF-36 questionnaires (3) study impact of time elapsed since treatment on survivorship issues and QOL scores (4) identify most important issues from the perspective of impact on QOL. Methods: This descriptive, hospital based, cross sectional study was conducted in 230 breast cancer survivors and a group of 112 healthy age-matched-controls, in an academic healthcare setting in northern India. A checklist of 14 commonly reported survivorship issues, and questionnaires for QOL assessment were administered to participants. Main outcome measures were (1) frequencies of survivorship issues and QOL scores among three groups divided on the basis of time elapsed since treatment (< 2 year follow-up, 2-5 year follow-up and > 5 year follow-up) (2) association of survivorship issues with QOL scores (3) stepwise regression analysis to identify issues with most significant impact on QOL of survivors. Results: Breast cancer survivors showed an improvement in their QOL over time which was sustained in long term survivors. However their quality of life remains poorer, compared with healthy women, irrespective of the duration of follow-up. The most prevalent survivorship issues were fatigue (60%), restriction of shoulder movement (59.6%), body and joint pain (63.5%), chemotherapy induced cessation of menstruation (73.3%) and loss of sexual desire (60%). However the issues which had maximum adverse effect on QOL scores were emotional distress, fatigue, postmastectomy chronic pain, cessation of menstruation, body and joint pain, vaginal dryness and sleep disturbances. Conclusion: Thus in this study, emotional distress and cancer related fatigue were found to be the chief determinants of poor QOL. Further premature menopause, with its attendant systemic symptoms, vulvo-vaginal atrophy and sexual dysfunction emerged as a key contributor to poor QOL in BCs.

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Long-term quality of life after breast cancer: comparison of 8-year survivors with population controls.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.2.487 ◽

1998 ◽

Vol 16 (2) ◽

pp. 487-494 ◽

Cited By ~ 207

Author(s):

M Dorval ◽

E Maunsell ◽

L Deschênes ◽

J Brisson ◽

B Mâsse

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cancer Survivors ◽

Social Functioning ◽

Breast Cancer Survivors ◽

Consecutive Series ◽

Improve Quality

PURPOSE Quality of life of breast cancer survivors 8 years after diagnosis was compared with that among similarly aged women who had never confronted cancer (controls). METHODS Survivors of a consecutive series of 227 breast cancer patients first treated in 1984 were approached for this study. Random-digit dialing was used to identify controls with the same age and residential distribution as the survivors. Quality of life was assessed in terms of physical health, functional status, psychologic distress, and social functioning. RESULTS Participation was obtained from 96% (n = 124) of 129 eligible survivors and 61% (n = 262) of 427 potentially eligible controls. Consistently smaller proportions of survivors reported positive quality-of-life outcomes compared with controls, but these differences were generally small and nonsignificant statistically. When limited to women who remained free of disease over the entire follow-up period (n = 98), survivors' quality of life was similar to that among controls, with the exception of arm problems and sexual satisfaction for those women who lived with a partner. In contrast, survivors who developed recurrence or new primary breast cancer (n = 26) experienced a worse quality of life in all domains except social functioning. CONCLUSION In most domains and for women without further disease events after diagnosis, quality of life does not seem to be permanently and globally impaired by breast cancer. Consequently, breast cancer survivors who remain free of disease probably do not need organized late psychosocial follow-up to improve quality of life. However, arm problems and sexuality are two areas in which additional effort may be still needed to improve quality of life of long-term survivors.

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Feasibility of group follow-up visit for breast cancer survivors

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19603 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19603-19603

Author(s):

C. O. Ruud ◽

K. Francis ◽

C. Stephens ◽

M. H. Rajab

Keyword(s):

Breast Cancer ◽

Patient Satisfaction ◽

Cancer Survivors ◽

Cancer Patients ◽

Social Worker ◽

Breast Cancer Survivors ◽

Breast Cancer Patients ◽

Group Visit ◽

Follow Up Care

19603 Background: The ASCO 2006 guidelines specify that regularly scheduled follow-up care of breast cancer survivors should be the standard. Follow up care is a “teachable moment” to train survivors in positive habits. A group visit model at the Cleveland Clinic proved feasible and improved patient satisfaction for other diseases. Our objectives include assessing the feasibility of an adapted group follow-up visit for the care of breast cancer patients and patient satisfaction. Methods: A feasibility study targeting breast cancer patients who completed primary therapy and were scheduled for a routine appointment. We mailed letters inviting patients to a follow-up group visit. Patients were divided into 3 groups, each scheduled for a separate (90–120 minute). During the first half of the visit, participants were divided into three groups; 5-minute physician exam, nurse review of medications and vital signs, and instruction by a social worker. Groups were rotated. During the second half the doctor, nurse, and social worker met with all participants in one room starting with an educational presentation about fatigue and exercise. Each participant was subsequently interviewed by the physician in the presence of their peers. Shared complaints were investigated first. Patients rated their satisfaction with the different parts of the visit on a scale of 1–5. Participants were surveyed pre- and post- education session and asked if they would participate again. Participants were allowed to bring a family member or friend. Results: 29 (29.6 %) out of 98 consented and 22 (22.5%) attended;10 in first visit, 5 in second visit and 7 in last visit. Average age 61±8, ranged from 46–72 years. Most participants were satisfied with all parts of the group visit, except two in the first group were less satisfied with the check in process and moving between rooms. Comparing the pre- vs. post- educational session surveys showed an improved understanding of the importance of fatigue or exercise. 17 (77%) out of 22 participants agreed to participate in another group visit. Conclusion: Group visit format is feasible and provides patient satisfaction. No significant financial relationships to disclose.

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Breast cancer survivors perception of family physician (FP) or specialist as principal provider of routine follow-up care.

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.9090 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. 9090-9090 ◽

Cited By ~ 2

Author(s):

E. Grunfeld ◽

M. N. Levine ◽

J. Julian ◽

A. Folkes ◽

G. R. Pond ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Family Physician ◽

Breast Cancer Survivors ◽

Follow Up Care

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Guideline-concordant surveillance and follow-up care among low-income patients with breast cancer: The role of primary care medical homes.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.171 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 171-171

Author(s):

Stephanie B. Wheeler ◽

Racquel Elizabeth Kohler ◽

Ravi K. Goyal ◽

Kristen Hassmiller Lich ◽

Alexis Moore ◽

...

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Cancer Survivors ◽

Cancer Survivorship ◽

Low Income ◽

Breast Cancer Survivors ◽

Breast Cancer Survivorship ◽

Medical Homes ◽

Follow Up Care

171 Background: Community Care of North Carolina (CCNC) initiated an innovative medical home (MH) program in the 1990s to improve primary care in Medicaid-insured populations. CCNC has been successful in improving asthma, diabetes, and cardiovascular outcomes, but has not been evaluated in the context of cancer care. We sought to determine whether MH enrollment was associated with guideline-concordant surveillance and follow-up care among breast cancer survivors. Methods: Using state cancer registry records matched to Medicaid claims, we identified women ages 18-64 diagnosed with stage 0, I, or II breast cancer from 2003-2007 and tracked their CCNC enrollment. Using published American Society for Clinical Oncology breast cancer survivorship guidelines to define our outcomes, we employed multivariate logistic regressions to examine correlates of receipt of surveillance mammogram and at least two physical exams within 15 months post-diagnosis. Results: In total, 840 women were included in our sample. Approximately half were enrolled in a CCNC MH during the study period, 38% were enrolled for more than 7 months post-diagnosis. Enrollment in a MH for at least 7 months post-diagnosis was strongly associated with receiving guideline-recommended surveillance mammogram (p<0.01) and at least 2 physical exams (p<0.01) within 15 months post-diagnosis. Conclusions: Results suggest that MH enrollment is associated with higher quality breast cancer survivorship care among women insured by Medicaid. Given the growing population of cancer survivors and increased emphasis on primary care MH, more research is needed to explore how medical homes can enhance and ensure the provision of guideline-recommended care during cancer survivorship.

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Follow-up care of breast cancer survivors: Survey of patients and analysis of treatment data in a German breast cancer centre.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.15_suppl.e20602 ◽

2015 ◽

Vol 33 (15_suppl) ◽

pp. e20602-e20602

Author(s):

Stefan Feiten ◽

Jan Dünnebacke ◽

Vera Friesenhahn ◽

Jochen Heymanns ◽

Hubert Koeppler ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Cancer Centre ◽

Follow Up Care ◽

Treatment Data

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Evaluation of a risk-based approach to follow-up care for breast cancer survivors: From oncology specialist to primary care provider (PCP).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6529 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6529-6529

Author(s):

Kathleen Keenan ◽

Megan Dunne

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Care Pathway ◽

Cancer Center ◽

Educational Strategies ◽

Transition Clinic ◽

Follow Up Care ◽

Mitigating Factors

6529 Background: The number of cancer survivors in the Unites States is expected to exceed 18 million by the year 2020. Predicted care demands coupled with an anticipated shortage of oncologists have led to alternate follow up care models and providers. This nurse practitioner- (NP) led survivorship team was charged with developing a risk-based discharge plan for the > 8,000 breast cancer survivors in our survivorship clinic at this NCI-designated cancer center. Methods: In collaboration with breast oncologists and surgeons, a risk-based strategy to identify and transition eligible survivors to their PCPs was developed. Low risk was determined by: stage, absent disease and significant late-effects, and time since diagnosis. Interventions: Evidence supporting the willingness, availability and expectations of PCPs to provide follow-up care to cancer survivors was reviewed. Criteria for eligibility were developed; patient and PCP educational documents were created. Continued breast cancer screening at our center was offered with results sent directly to PCP. Outreach educational programs were provided to local PCP groups to build relationships and provide breast specific follow up recommendations. To promote communication and collaboration between NP and PCP prior to and at the time of transition, clinic notes were shared after each survivorship visit. A comprehensive transition note including detailed follow-up recommendations was provided at the time of transition. Patients were assured of rapid return to the oncology provider in the event of recurrence or cancer related issue. Results: 5080 patients were offered transition, with 3642 accepting. Mitigating factors and facilitators to transition for both patients and PCP will be discussed and educational strategies to overcome barriers will be described. Conclusions: Transition of breast cancer survivors’ care to PCPs is successful approximately 56% of the time. Key factors include seamless communication among providers and early discussions with patients to set expectations and normalize the transition early in the care pathway.

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Factors Related to Underuse of Surveillance Mammography Among Breast Cancer Survivors

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.4174 ◽

2006 ◽

Vol 24 (1) ◽

pp. 85-94 ◽

Cited By ~ 101

Author(s):

Nancy L. Keating ◽

Mary Beth Landrum ◽

Edward Guadagnoli ◽

Eric P. Winer ◽

John Z. Ayanian

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Repeated Measures ◽

Breast Cancer Survivors ◽

Geographic Region ◽

Fee For Service ◽

Factors Associated ◽

Follow Up Care ◽

Surveillance Mammography

Purpose Many older breast cancer survivors do not undergo annual mammography despite guideline recommendations. We identified factors associated with underuse of surveillance mammography and examined whether variation was explained by differences in follow-up care. Patients and Methods We used Surveillance, Epidemiology, and End Results-Medicare data to identify a population-based sample of 44,511 women fee-for-service Medicare enrollees aged ≥ 65 years who were diagnosed with stage I or II breast cancer in 1992 to 1999 who underwent primary surgical therapy. We assessed factors associated with mammography during months 7 to 18, 19 to 30, and 31 to 42 after breast cancer diagnosis using repeated-measures logistic regression; and we examined whether follow-up care with providers of various specialties explained variation in mammography use. Results Only three quarters of women (77.6%) underwent mammography during months 7 to 18 after diagnosis, and only 56.7% had mammography yearly over 3 years. In multivariable analyses, women who were older, black, unmarried, and living in certain regions were less likely than other women to undergo surveillance mammography (all P < .05). Patients with more visits and patients who continued to see a medical oncologist, radiation oncologist, or surgeon were most likely to have mammograms (P < .001); however, adjusting for visits with providers did not explain the lower mammography rates based on age, race, marital status, and geographic region. Conclusion Many elderly breast cancer survivors do not undergo annual surveillance mammography, particularly women who are older, black, and unmarried, and this underuse was not explained by access to follow-up care. New strategies are needed to increase use of surveillance mammography and decrease variations based on nonclinical factors that are likely unrelated to appropriateness of medical care.

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