The impact of arm lymphedema on healthcare utilization during long-term breast cancer survivorship: a population-based cohort study

IntroductionBreast cancer has become a chronic disease due to survival improvement and the need to monitor the side effects of treatment and the disease itself. The aim of the SURBCAN study is to describe comorbidity, healthcare services use and adherence to preventive recommendations in long-term breast cancer survivors and to compare them with those in women without this diagnosis in order to improve and adapt the care response to this group of survivors.Methods and analysisPopulation-based retrospective cohort study using real-world data from cancer registries and linked electronic medical records in five Spanish regions. Long-term breast cancer survivors diagnosed between 2000 and 2006 will be identified and matched by age and administrative health area with women without this diagnosis. Sociodemographic and clinical variables including comorbidities and variables on the use of health services between 2012 and 2016 will be obtained from databases in primary and hospital care. Health services use will be assessed through the annual number of visits to primary care professionals and to specialists and through annual imaging and laboratory tests. Factors associated with healthcare utilisation and comorbidities will be analysed using multilevel logistic regression models. Recruitment started in December 2018.Ethics and disseminationThis study was approved by the Ethics Committee of Parc de Salut Mar. The results of the study will be published in a peer-reviewed journal and will be presented at national and international scientific conferences and at patient associations.Trial registration numberThis protocol is registered in Clinical Trials.gov (identifier: NCT03846999).

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Long-term central venous catheters and infections in older adults with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.125 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 125-125

Author(s):

Allison Nicole Lipitz Snyderman ◽

Kent Sepkowitz ◽

Elena B. Elkin ◽

Laura C. Pinheiro ◽

Peter Bach

Keyword(s):

Breast Cancer ◽

Older Adults ◽

Population Based ◽

Infection Risk ◽

Central Venous Catheters ◽

Care Quality ◽

Central Venous ◽

Increased Risk ◽

The Impact

125 Background: Long-term central venous catheters (CVCs) facilitate venous access to administer intravenous fluids and treatments such as chemotherapy. However, CVCs can also be a source of harmful bloodstream infections, a risk that may be underappreciated. Our objective was to assess the impact of long-term CVC use on the risk of infections in a population-based cohort of cancer patients. Methods: Retrospective analysis using the population-based SEER-Medicare dataset for patients over age 65, diagnosed from 2005 to 2007 with invasive colorectal cancer (n = 36,272), head and neck cancers (n = 8,459), lung cancer (n = 56,770), pancreatic cancer (n = 10,536), or non-Hodgkin lymphoma (n = 14,432), or invasive or non-invasive breast cancer (n = 42,271). Cox proportional hazards regression was used to examine the impact of CVC use on infection risk, with CVC exposure treated as a time-varying predictor. We used multivariable analysis and propensity score methods to control for patient characteristics. Results: Adjusting for demographic and disease characteristics, long-term CVCs significantly increased the risk of infection by at least 40%, across all cancer types (Table). The greatest effect of CVCs on infection risk was in patients with breast cancer. Conclusions: Long-term CVC use is associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs, and targeted strategies to reduce infections for patients requiring their use, are critical to improving cancer care quality. [Table: see text]

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Breast cancer survivorship care: A continuity of care model of delivery.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.116 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 116-116

Author(s):

Jennifer R. Klemp ◽

Lori Ranallo ◽

Catherine J Knight ◽

Mary Williams ◽

Carol J. Fabian

Keyword(s):

Breast Cancer ◽

Health Status ◽

Cancer Survivorship ◽

Continuity Of Care ◽

Post Treatment ◽

Survivorship Care ◽

Breast Cancer Survivorship ◽

Mineral Density

116 Background: With more than 2.9 million BrCa survivors in the US, it is imperative to determine how best to deliver post-treatment survivorship care. National accreditation standards are pushing survivorship care plans, while evidence supporting specific methods of delivery and outcomes are lacking. The University of Kansas Breast Cancer Survivorship Center opened in 2007 as a continuity of care, post-treatment survivorship clinic. We report prospective findings from a group of BrCa survivors from 2007-2013. Methods: Four hundred twenty-four BrCa survivors consented to an IRB approved, longitudinal survivorship registry. Baseline variables on demographics, disease history, summary of cancer treatment, late effects, medications and health status were collected. Follow-up data collection included disease status or new primary cancer, patient’s health status and late/long-term effects. Comparisons from baseline to subsequent visits provided information on changes in key variables over time. Results: Participants were ~57 years old, primarily Caucasian, attended at least some college, made >$40K per year, and 49% were premenopausal at diagnosis. Forty-five women reported having another malignancy and 10 were diagnosed with either a recurrence or a second primary breast cancer while followed in the survivorship center. Significant self-reported symptoms included menopausal symptoms: hot flashes (n=164), vaginal dryness (n=211) and a lack of sexual activity (195). 95% were seen for >1 post-baseline visit. Menopausal symptom interventions, lifestyle recommendations (weight loss and increasing physical activity), referrals to specialists (77% referred for colonoscopy completed colon ca screening; 92% referred attending cardio-oncology screening visit; 100% referred completed a bone mineral density analysis), and lymphedema education and management increased significantly. Conclusions: Multidisciplinary care facilitated through a continuity of care survivorship clinic improves compliance with recommended follow-up and cancer screening, however additional research on the cost and impact of delivering survivorship care is needed to evaluate sustainability and long-term patient outcomes.

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