scholarly journals Current practice patterns and gaps in guideline-concordant breast cancer survivorship care

2021 ◽  
Author(s):  
Eden R. Brauer ◽  
Elisa F. Long ◽  
Laura Petersen ◽  
Patricia A. Ganz
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Late Effects ◽  
Breast Cancer Survivors ◽  
Practice Patterns ◽  
Survivorship Care ◽  
Care Guidelines ◽  
Composite Scores

Abstract Purpose Breast cancer-specific survivorship care guidelines for the more than 3.8 million survivors in the U.S. are available, but implementation in clinical practice remains challenging. We examined current practice patterns and factors associated with guideline-concordant survivorship care among oncologists. Methods A national sample of medical oncologists, recruited using two databases, participated in a survey focused on practice patterns for breast cancer survivorship care. A “survivorship care composite score” was calculated for each respondent based on provision of services recommended in the survivorship guidelines. Descriptive statistics and multivariable linear regression analyses examined associations between physician and practice characteristics and composite scores. Results The survey was completed by 217 medical oncologists, with an overall response rate of 17.9% and eligibility rate of 56.9% for those who responded. Oncologists reported high engagement in evaluation of disease recurrence (78%). Performed less frequently were the provision of survivorship care plans (46%), assessment of psychosocial long-term and late effects (34%), and screening for subsequent cancers (34%). Lack of survivorship care training (p = 0.038) and not routinely informing patients about potential late effects (p = 0.003) were significantly associated with poorer survivorship care composite scores. Conclusions Despite the availability of disease-specific survivorship care guidelines, adherence to their recommendations in clinical practice is suboptimal. Survey results identified key gaps in survivorship care for breast cancer survivors, particularly related to subsequent primary cancers and psychosocial long-term and late effects. Implications for Cancer Survivors Improving the delivery of comprehensive survivorship care for the growing population of breast cancer survivors is a high priority. Disease-specific clinical guidelines for cancer survivorship provide valuable recommendations, but innovative strategies are needed to integrate them into the care of long-term breast cancer survivors.

scholarly journals Cardiotoxicity screening of long‐term, breast cancer survivors—The CAROLE (Cardiac‐Related Oncologic Late Effects) Study

2021 ◽  
Author(s):  
Lindsay L. Puckett ◽  
Shahryar G. Saba ◽  
Sonia Henry ◽  
Stacey Rosen ◽  
Elise Rooney ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Late Effects ◽  
Breast Cancer Survivors

scholarly journals Survivorship Care Focus Group Discussions for Breast Cancer Survivors and Primary Care Clinicians

2021 ◽  
pp. 1-4
Author(s):  
Hillary Klonoff-Cohen ◽  
Hillary Klonoff-Cohen ◽  
Mounika Polavarapu
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Focus Group ◽  
Cancer Survivors ◽  
Nurse Practitioners ◽  
Late Effects ◽  
Primary Care Physicians ◽  
Breast Cancer Survivors ◽  
Survivorship Care ◽  
Psychological Consequences

Purpose: This is the first pilot study to examine survivors’ experiences and primary care physicians and nurse practitioners’ knowledge and behaviour practices with respect to late effects (e.g., fatigue, chemobrain, lymphodema, cardiac problems, reproductive, infertility and sexual health issues, bone problems, and pain). Methods: Two separate focus groups consisting of 5 breast cancer survivors and 5 primary care physicians and nurse practitioners recruited from a local hospital in Central Illinois answered predetermined questions about cancer survivorship care. We intentionally limited the sample in order to conduct a detailed discussion (90 minutes) to gain every participant’s perspective. Results: Breast cancer survivors expressed a void in discussion and lack of knowledge among their primary care physicians regarding late effects as well as psychological consequences, referrals to support groups, and availability of resources (e.g., finances), thereby negatively affecting survivors’ quality of life. A primary care clinician (PCC) focus group revealed a service gap for mental health services for all patients, knowledge deficit about late effects, and lack of awareness of patient resources. Both cancer survivors and PCCs were extremely supportive about a shared care survivorship model between oncology and primary care. All focus group participants were unequivocally receptive about enhancing survivorship care throughout a cancer survivor’s lifetime. Conclusion: Complementing cancer survivorship care with primary care clinicians in the areas of late effects, in addition to psychological consequences, screening, and lifestyle habits will enhance a cancer survivor’s health-related quality of life.

Improving patient participation in a breast cancer survivorship program at a safety net hospital.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 60-60
Author(s):  
Shakuntala Shrestha ◽  
Pam Khosla ◽  
Janos Molnar ◽  
Maria Eugenia Corona ◽  
Sofia M Garcia
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Breast Cancer Survivors ◽  
Safety Net ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Breast Cancer Survivorship ◽  
Safety Net Hospital

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).

scholarly journals Communicating Risks of Adjuvant Chemotherapy for Breast Cancer: Getting Beyond the Laundry List

2019 ◽  
Vol 15 (2) ◽  
pp. e98-e109 ◽  
Author(s):  
Eden R. Brauer ◽  
Elisa F. Long ◽  
Joy Melnikow ◽  
Peter M. Ravdin ◽  
Patricia A. Ganz
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Focus Groups ◽  
Cancer Survivors ◽  
Late Effects ◽  
Breast Cancer Survivors ◽  
Theoretical Domains Framework ◽  
Long Term Effects ◽  
Medical Oncologists

PURPOSE: According to the Institute of Medicine, high-quality cancer care should include effective communication between clinicians and patients about the risks and benefits, expected response, and impact on quality of life of a recommended therapy. In the delivery of oncology care, the barriers to and facilitators of communication about potential long-term and late effects, post-treatment expectations, and transition to survivorship care have not been fully defined. PATIENTS AND METHODS: We collected qualitative data through semistructured interviews with medical oncologists and focus groups with breast cancer survivors and applied the Theoretical Domains Framework to systematically analyze and identify the factors that may influence oncologists’ communication with patients with breast cancer about the long-term and late effects of adjuvant therapy. RESULTS: Eight key informant interviews with medical oncologists and two focus groups with breast cancer survivors provided data. Both oncologists and patients perceived information on long-term effects as valuable in terms of improved clinical communication but had concerns about the feasibility of inclusion before treatment. They described the current approaches to communication of therapy risks as a brief laundry list that emphasized acute adverse effects and minimized more long-term issues. We describe the barriers to communication about potential long-term effects from the perspectives of both groups. CONCLUSION: This study provides insight into oncologists’ communication with patients with breast cancer regarding the potential long-term and late effects of adjuvant chemotherapy and about setting realistic expectations for life after treatment. Opportunities to improve oncologists’ communication about the potential toxicities of therapy, particularly regarding long-term and late effects, should be examined further.

Implementing a Survivorship Care Plan for Patients With Breast Cancer

2008 ◽  
Vol 26 (5) ◽  
pp. 759-767 ◽  
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.

Change in patient-reported outomes over time from breast cancer diagnosis.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 210-210
Author(s):  
C. E. Hill-Kayser ◽  
C. Vachani ◽  
M. K. Hampshire ◽  
G. A. Di Lullo ◽  
J. M. Metz
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Cancer Diagnosis ◽  
Late Effects ◽  
Breast Cancer Survivors ◽  
Breast Cancer Diagnosis ◽  
Survivorship Care ◽  
Convenience Sample ◽  
Patient Reported ◽  
Over Time

210 Background: Breast cancer survivors may be at risk for significant late effects after treatment. Understanding the patterns of change over time of patient reported outcomes (PRO) is often very challenging. Methods: Patient-reported data was gathered via a convenience sample frame from breast cancer survivors utilizing a publically available, free, Internet-based tool for creation of survivorship care plans. Available at www.livestrongcareplan.com and through the OncoLink website, the tool allows survivors to enter data regarding diagnosis, demographics, treatments received, and late effects experienced, and provides them with customized guidelines for future care. All data has been maintained anonymously with IRB approval. Results: 1,145 breast cancer survivors were queried with regard to PRO. Median age at diagnosis (dx) was 49 yrs, and median current age 52 yrs. Of users, 98% reported having had surgery; of these 56% underwent mastectomy and 49% lumpectomy (5% both). Similarly, 59% underwent sentinel LN biopsy, and 47% axilary dissection. Of the same cohort, 88% received chemotherapy and/or hormonal treatment, and 70% radiation therapy. The median time from dx until use of the care plan tool was 2 years (range 0-33 years). Late effects reported by survivors ≤ 2 and > 2 years from diagnosis are shown (see table). Overall, survivors ≤ 2 years from dx were more likely to note changes in skin color or texture; those > 2 years from diagnosis were more likely to note osteopenia, lymphedema, and sexual changes. Patient reported cognitive changes, arm pain/numbness/tingling, and loss of shoulder flexibility did not differ between the two groups. Conclusions: This anonymous tool uses a convenience sample frame to gather PRO after breast cancer diagnosis/ treatment. PRO varied significantly with time since dx, with more late effects reported > 2 years from dx. This information may be of use during patient counseling and survivorship care delivery. [Table: see text]

The CAROLE (CArdiac Related Oncologic Late Effects) Study: A Phase II, single-arm feasibility trial.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11569-11569 ◽  
Author(s):  
Lindsay Puckett ◽  
Shahryar Saba ◽  
Sonia Henry ◽  
Stacey Rosen ◽  
Elise Rooney ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Phase Ii ◽  
Late Effects ◽  
Breast Cancer Survivors ◽  
Feasibility Trial ◽  
Cardiac Screening ◽  
Long Term Survivors ◽  
Clinical Trial Information

11569 Background: Long-term breast cancer survivors are at risk of late effects from cardiotoxic (tox) radiation (RT) and chemotherapy (chemo). However, there is a paucity of data to recommend appropriate cardiac screening for those ~10 years (yrs) after diagnosis (dx). This phase II, single arm study assessed multimodality screening in a heterogeneous cohort of long-term survivors. Methods: Our prospective, single center pilot study enrolled 201 (of 200 planned) eligible patients (pts): age 18-65 at dx, with treatment (tx) for breast cancer (any stage/tx) in 2004-2011 (≥6 yrs prior), with no cardiac disease (dz) at dx. The primary endpoint was presence of any cardiac dz (preclinical or clinical) on electrocardiogram (EKG), echocardiogram (echo), or coronary artery calcium CT (CAC CT); secondary endpoint included clinical (clin) dz alone. Subgroups assessed were: no tox chemo or RT (no tox), tox RT (left-sided) alone, tox chemo (anthracycline) alone, and both tox chemo and tox RT (tox chemoRT). Results: After enrollment (6/2017-7/2018), 200 pts had sufficient data for analysis. Median age was 50 (29-65) at dx, 63 (37-77) at imaging, and interval (dx to imaging) was 11.5 (6.7-14.5) yrs. There were 44% no tox, 31.5% tox RT, 16% tox chemo, and 8.5% tox chemoRT pts. Among all pts, 77.6% displayed evidence of any cardiac dz, 51.5% had clin dz. Per modality, rates of any and clin dz were: 27.1%/10% EKG, 50.0%/25.3% echo, and 50.8%/45.8% CAC CT. Among subgroups, these rates were: 73.9%/53.4% no tox, 82.5%/58% tox RT, 75%/38.7% tox chemo, and 82.4%/35.3% tox chemoRT (NS on χ2 test, p = .58/p = .15). Multivariable logistic regression with tox RT, tox chemo, and age as covariates, showed no significant tox RT (NS) or tox chemo effect (NS), however, increasing age was significantly associated with higher incidence of cardiac dz (p < 0.01; OR = 1.12 per yr, 95% CI: 1.07-1.18). Conclusions: Among pts with a median of > 10 yrs post breast cancer tx, multimodality CAROLE screening was feasible and showed high rates of cardiac dz (any/clin = 77.6%/51.5%) among all subgroups, including those without tox tx. This study provides evidence for long-term cardiac screening in a diverse group of breast cancer survivors and provides a novel pathway for evaluation. Clinical trial information: NCT03235427.

Evaluating the prevalence of cardiovascular risk factors among breast cancer survivors and the outcomes of cardio-oncology referrals by a breast cancer survivorship clinic.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 107-107
Author(s):  
Jennifer R. Klemp ◽  
Lori Ranallo ◽  
Catie Knight ◽  
Carol J. Fabian ◽  
Christie A. Befort
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cancer Survivors ◽  
Cardiovascular Risk Factors ◽  
Cancer Survivorship ◽  
Breast Cancer Survivors ◽  
Breast Cancer Survivorship ◽  
Term Care

107 Background: Breast cancer survivors have a 4x increased incidence of cardiovascular disease (CVD) compared to women never treated for breast cancer and cardiac events are the 2nd most common cause of death in long-term survivors. Attention to reducing the risk of CVD should be a priority for the long-term care of breast cancer survivors. This study was undertaken to describe cardiovascular risk factors in breast cancer survivors, and the cardio-oncology referral patterns and outcomes from cardio-oncology screening visits. Methods: 356 female breast cancer survivors seen at the University of Kansas Breast Cancer Survivorship Center between 2006 and 2012 who completed an initial intake visit were evaluated for cardiovascular risk factors and referrals to cardio-oncology. An expanded list of cardiovascular factors was used: BMI > 25, Diabetes, HTN, HLD, Current/Past Smoker, Family Hx of MI < 60 years, Exercise < 150 min/wk, Ejection Fraction < 50%, and exposure to cardio-toxic breast cancer treatment. Breast cancer survivors without evidence of metastatic disease were on average 57.8 +/-11.0 years old, underwent standard treatment regimens, and were approximately 7.5 years from their initial diagnosis. Results: 13% were already followed by a cardiologist, 21% were referred to cardio-oncology, and 66% were not referred at their initial survivorship visit. There were significant differences in the average number of risk factors between those not referred to cardio-oncology (4.36 +/-1.89), and those referred to cardio-oncology (5.68+/-1.8), and between those already followed by cardiologist (5.91+/-1.75), p < 0.001 and p < 0.0001, respectively. The most common risk factors were BMI >25, elevated HDL, exercise <150 min/wk, and exposure to an anthracycline. The most common outcomes following a cardio-oncology visit included further diagnostic tests, medication changes, or a return visit. Conclusions: These findings demonstrate the need to determine how to include treatment related risk factors along with traditional cardiovascular risk factors in assessing and managing cardiovascular risk in breast cancer survivors.

Development of a personalized follow-up care algorithm for Medicare breast cancer survivors.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 204-204
Author(s):  
Stephanie B. Wheeler ◽  
Lisa Spees ◽  
Caitlin B. Biddell ◽  
Jason Rotter ◽  
Justin G. Trogdon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Late Effects ◽  
Breast Cancer Survivors ◽  
Financial Burden ◽  
Specialty Care ◽  
Prediction Algorithm ◽  
Survivorship Care ◽  
Healthcare Needs

204 Background: The rapidly growing number of cancer survivors in the US have substantial healthcare needs requiring surveillance and care for the late and long-term effects of cancer treatment and comorbidities. Lacking a clear system of care, experts recommend a personalized approach to survivorship care. The objective of this study was to test a clinical prediction algorithm to distinguish low-complexity breast cancer survivors who may be suited to self-manage their survivorship care and be followed by their primary care provider (PCP) from survivors who require specialty care. Methods: We used the Surveillance and Epidemiology End Results (SEER) registry – Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data to identify women diagnosed with stage 0-3 breast cancer between 2003 and 2011. Cross-validated random forest machine learning models separately estimated survivors’ independent risk of all-cause death, cancer-specific death, recurrence, or severe late effects within 3 years following treatment completion. The absence of these outcomes identified survivors as potentially eligible for self-management and PCP care. Predictors included measures of baseline health status and health care utilization, patient socio-demographic characteristics, cancer characteristics, and financial burden. Results: Among the 4,516 survivors in the primary cohort, 82% were white, and the mean (SD) age was 75.1 (7.8) years. Almost 50% were diagnosed with Stage I breast cancer, followed by 25.2% with Stage 2, 19.3% with Stage 0, and 5.6% with Stage III. Within the 3-year follow-up period, 372 (8.2%) survivors died (111 or 2.5% from cancer), 665 (14.7%) experienced recurrence, and 488 (10.8%) were hospitalized due to severe late effects. Predicting all-cause death resulted in 91.9% out-of-sample accuracy, a 37.6% improvement over an uninformed model. Important predictors across outcomes included age, geographic region, diagnosis year, financial burden, comorbidities, and cancer stage. Conclusions: Survivors requiring specialty care are characterized by higher comorbidity, lower educational attainment, and advanced age, suggesting that, in addition to cancer characteristics, personalized care pathways developed in response to our findings must account for social and contextual factors as well.

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