Reported Concerns and Acceptance of Information or Referrals Among Breast Cancer Survivors Seen for Care Planning Visits: Results from the University of Wisconsin Carbone Cancer Center Survivorship Program

Author(s):  
Leah Cha ◽  
Amye J. Tevaarwerk ◽  
Elena M. Smith ◽  
Thevaa Chandereng ◽  
Karol J. Huenerberg ◽  
...  
2012 ◽  
Vol 21 (2) ◽  
pp. 97-105 ◽  
Author(s):  
Kathleen A Griffith ◽  
Renee Royak-Schaler ◽  
Kim Nesbitt ◽  
Min Zhan ◽  
Adriane Kozlovsky ◽  
...  

Breast cancer survival rates are lower in African Americans (AAs) than in Caucasians, owing in part to a higher prevalence of obesity in the former, which increases the risk of recurrence and mortality. The Women’s Intervention Nutrition Study (WINS) found that Caucasian women who followed a low-fat eating plan experienced a lower rate of cancer recurrence than women who maintained their usual diets. The purpose of this study was to test the feasibility of a WINS plan tailored to the cultural needs of AA breast cancer survivors. This feasibility pilot study was conducted at a university National Cancer Institute-designated comprehensive cancer center outpatient clinic with AA breast cancer survivors. The culturally specific WINS (WINS-c) plan included eight individual counseling sessions, five educational group meetings, and follow-up telephone calls over a 1-year period. Outcome measures included dietary fat, triglyceride, insulin and glucose levels, and fruit and vegetable intake. Participants ( n = 8) had a mean age of 61.1 years (standard error of the mean (SEM) 3.1 years) and a mean BMI of 32 kg/m2 (SEM 4.25 kg/m)2. Baseline daily fat consumption decreased from 64.6 g (range 36.8–119.6g) to 44.0 g (21.6–73.4g) at 52 weeks ( p = 0.07). Mean daily consumption of fruits and vegetables increased by 36% and 15%, respectively. Mean triglyceride levels decreased at 12 months ( p < 0.05). Sustained hyperinsulinemia was noted in most participants, including those without diabetes. Mean calcium and vitamin D consumption decreased over the 1-year study period. In AA breast cancer survivors, the WINS-c program resulted in a trend toward reduced fat consumption and may represent a sustainable approach in this population for improvement of diet quality after breast cancer.


2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 967-967
Author(s):  
X Chen ◽  
C Chiu ◽  
HT Cheung ◽  
ME White ◽  
X Chen ◽  
...  

Abstract Objectives To establish the preferences and perceived barriers related to physical activity and diet programming of breast cancer survivors (BCS) to inform the development of Information and Communication Technology (ICT)-based lifestyle interventions. Methods This was a cross-sectional study of 197 BSC aged 18 years or older and diagnosed with ductal carcinoma in situ (DCIS) or Stage I-IV breast cancer. The BCS were recruited during routine oncology appointments at a Midwestern cancer center. A survey was conducted to query survivors’ level of interest in, preferences for, and perceived barriers to participating in an exercise and dietary intervention program, with a specific emphasis on ICT-based programming. Results Overall, 85% of BCS reported they would consider participating in exercise and diet intervention research. Approximately 45% of participants reported that they had received diet and/or exercise information as part of their cancer care. However, only 15% of the participants received such information from healthcare professionals with the appropriate expertise (e.g., Dietitian, Exercise Specialist). Over two-thirds of the participants reported frequent use of mobile devices and the internet, and 80% indicated comfort using these devices (e.g., tablet, smart phone). The top three preferred formats for an ICT-based diet and exercise intervention program were “website”, “mobile apps” and “e-mails”. Older participants (&gt;60 years) were more likely to report a preference for e-mails while younger participants (&lt;60 years) were more likely to report a preference for websites or mobile apps. The most common perceived barriers to participation in a lifestyle intervention included fatigue, family responsibility and work. Conclusions Most BCS in this study were interested in exercise and diet interventions and would be comfortable with an ICT-based format with a preference for delivery via websites, mobile apps or e-mails. Future ICT-based lifestyle interventions should be designed with consideration of BCS’ age, barriers, facilitators and other characteristics. Funding Sources USDA-NIFA Hatch Project 1,011,487


2018 ◽  
Author(s):  
Talya Laufer ◽  
Bryan Lerner ◽  
Anett Petrich ◽  
Anna M Quinn ◽  
Leah Ernst ◽  
...  

BACKGROUND As of 2016, almost 16 million individuals were cancer survivors, including over 3.5 million survivors of breast cancer. Because cancer survivors are living longer and have unique health care needs, the Institute of Medicine proposed a survivor care plan as a way to alleviate the many medical, emotional, and care coordination problems of survivors. OBJECTIVE This pilot study for breast cancer survivors was undertaken to: (1) examine self-reported changes in knowledge, confidence, and activation from before receipt to after receipt of a survivor care plan; and (2) describe survivor preferences for, and satisfaction with, a technology-based survivor care plan. METHODS A single group pretest-posttest design was used to study breast cancer survivors in an academic cancer center and a community cancer center during their medical visit after they completed chemotherapy. The intervention was a technology-based survivor care plan. Measures were taken before, immediately after, and 1 month after receipt of the survivor care plan. RESULTS A total of 38 breast cancer survivors agreed to participate in the study. Compared to baseline levels before receipt of the survivor care plan, participants reported increased knowledge both immediately after its receipt at the academic center (<italic>P</italic>&lt;.001) and the community center (<italic>P</italic>&lt;.001) as well as one month later at the academic center (<italic>P</italic>=.002) and the community center (<italic>P</italic>&lt;.001). Participants also reported increased confidence immediately following receipt of the survivor care plan at the academic center (<italic>P</italic>=.63) and the community center (<italic>P</italic>=.003) and one month later at both the academic center (<italic>P</italic>=.63) and the community center (<italic>P</italic>&lt;.001). Activation was increased from baseline to post-survivor care plan at both the academic center (<italic>P</italic>=.05) and community center (<italic>P</italic>&lt;.001) as well as from baseline to 1-month follow-up at the academic center (<italic>P</italic>=.56) and the community center (<italic>P</italic>&lt;.001). Overall, community center participants had lower knowledge, confidence, and activation at baseline compared with academic center participants. Overall, 22/38 (58%) participants chose the fully functional electronic survivor care plan. However, 12/23 (52%) in the community center group chose the paper version compared to 4/15 (27%) in the academic center group. Satisfaction with the format (38/38 participants) and the content (37/38 participants) of the survivor care plan was high for both groups. CONCLUSIONS This study provides evidence that knowledge, confidence, and activation of survivors were associated with implementation of the survivor care plan. This research agrees with previous research showing that cancer survivors found the technology-based survivor care plan to be acceptable. More research is needed to determine the optimal approach to survivor care planning to ensure that all cancer survivors can benefit from it.


JMIR Cancer ◽  
10.2196/12090 ◽  
2019 ◽  
Vol 5 (2) ◽  
pp. e12090
Author(s):  
Talya Laufer ◽  
Bryan Lerner ◽  
Anett Petrich ◽  
Anna M Quinn ◽  
Leah Ernst ◽  
...  

Background As of 2016, almost 16 million individuals were cancer survivors, including over 3.5 million survivors of breast cancer. Because cancer survivors are living longer and have unique health care needs, the Institute of Medicine proposed a survivor care plan as a way to alleviate the many medical, emotional, and care coordination problems of survivors. Objective This pilot study for breast cancer survivors was undertaken to: (1) examine self-reported changes in knowledge, confidence, and activation from before receipt to after receipt of a survivor care plan; and (2) describe survivor preferences for, and satisfaction with, a technology-based survivor care plan. Methods A single group pretest-posttest design was used to study breast cancer survivors in an academic cancer center and a community cancer center during their medical visit after they completed chemotherapy. The intervention was a technology-based survivor care plan. Measures were taken before, immediately after, and 1 month after receipt of the survivor care plan. Results A total of 38 breast cancer survivors agreed to participate in the study. Compared to baseline levels before receipt of the survivor care plan, participants reported increased knowledge both immediately after its receipt at the academic center (P<.001) and the community center (P<.001) as well as one month later at the academic center (P=.002) and the community center (P<.001). Participants also reported increased confidence immediately following receipt of the survivor care plan at the academic center (P=.63) and the community center (P=.003) and one month later at both the academic center (P=.63) and the community center (P<.001). Activation was increased from baseline to post-survivor care plan at both the academic center (P=.05) and community center (P<.001) as well as from baseline to 1-month follow-up at the academic center (P=.56) and the community center (P<.001). Overall, community center participants had lower knowledge, confidence, and activation at baseline compared with academic center participants. Overall, 22/38 (58%) participants chose the fully functional electronic survivor care plan. However, 12/23 (52%) in the community center group chose the paper version compared to 4/15 (27%) in the academic center group. Satisfaction with the format (38/38 participants) and the content (37/38 participants) of the survivor care plan was high for both groups. Conclusions This study provides evidence that knowledge, confidence, and activation of survivors were associated with implementation of the survivor care plan. This research agrees with previous research showing that cancer survivors found the technology-based survivor care plan to be acceptable. More research is needed to determine the optimal approach to survivor care planning to ensure that all cancer survivors can benefit from it.


2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 8-8
Author(s):  
Corinne Daly ◽  
Elisabeth M. Del Giudice ◽  
Rinku Sutradhar ◽  
Lawrence Frank Paszat ◽  
Drew Wilton ◽  
...  

8 Background: Evidence suggests breast cancer patients can be offered follow-up by family physician without concern of important recurrence–related serious clinical events occurring more frequently or quality of life being negatively affected. This study describes population-based patterns of follow-up care in 5-year recurrence-free young breast cancer survivors to determine factors influencing continued oncology follow-up in Ontario, Canada. Methods: We conducted a retrospective population-based cohort study using cancer registry and administrative data. Women diagnosed with an incident breast cancer aged 20-44 between 1992 and 1999, survived for at least 5 years and recurrence-free for 5 years past diagnosis were identified in the Ontario Cancer Registry. Each survivor was matched to 5 control women with the same calendar year of birth and place of residence in Ontario. We determined outpatient physician visits with primary care, medical, radiation and surgical oncology physicians to investigate trends associated with increasing survivorship and compared visit rates to controls. We used negative binomial regression to investigate factors predicting high utilization of oncology services among survivors after 5-year recurrence survival. Results: We identified 4,581 survivors and 22,898 controls. By year 10, 51% breast cancer survivors were still being followed by an oncologist. In the survivors, fewer physician visits were observed among recurrence-free breast cancer survivors as time increased from diagnosis (Visit Rate Ratio [VRR] =0.95, 95% CI: 0.94, 0.96). Breast cancer survivors diagnosed from 1992-1995 had a higher rate of physician visits than those diagnosed from 1996-1999 (VRR = 1.16, 95% CI: 1.07, 1.25). More oncologist visits were associated with patients visiting a female oncologist (VRR = 1.20, 95% CI: 1.09, 1.33) and fewer visits were associated with patients visiting an oncologist who practiced outside of a regional cancer center (VRR = 0.67, 95% CI: 0.58, 0.77). Conclusions: Oncology visits of young breast cancer survivors after 5-year survival were associated with oncologist factors indicating that prolonged oncology follow-up in breast cancer survivors may be driven by practice patterns rather than patients’ needs.


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6529-6529
Author(s):  
Kathleen Keenan ◽  
Megan Dunne

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.


2020 ◽  
Author(s):  
Cecile A. Lengacher ◽  
L. Forest Gruss ◽  
Kevin E. Kip ◽  
Richard R. Reich ◽  
Manolete S. Moscoso ◽  
...  

ABSTRACTMBSR(BC) is known to have a positive impact on psychological and physical symptoms among breast cancer survivors (BCS). However, the cognitive mechanisms of “how” MBSR(BC) works are unknown. The purpose of this study, as part of a larger R01 trial, was to test whether positive effects achieved from the MBSR(BC) program were mediated through changes in increased mindfulness, decreased fear of breast cancer recurrence, and perceived stress. Female BCS >21 years diagnosed with Stage 0-III breast cancer were randomly assigned to a 6-week MBSR(BC) or a Usual Care(UC) regimen. Potential outcome mediators were identified by use of an analysis of covariance (ANCOVA), comparing mean values of outcome variables and potential mediating variables followed by mediational and bootstrap analyses. Among 322 BCS (167 MBSR(BC) and 155 UC), fear of recurrence and perceived stress, but not mindfulness, mediated reductions in anxiety and fatigue at weeks 6 and 12, partially supporting our hypothesis of cognitive mechanisms of MBSR(BC).Support: This study was supported by the National Cancer Institute (Award Number 1R01 CA131080-01A2). This work also has been supported in part by the Biostatistics and Bioinformatics Shared Resource at the H. Lee Moffitt Cancer Center & Research Institute, an NCI designated Comprehensive Cancer Center (P30-CA076292). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. This study protocol was approved by the Institutional Review Board at the University of South Florida to ensure the ethical treatment of participants.Conflict of Interest: The authors have no conflicts to report.Trial Registration:www.ClinicalTrials.gov Registration Number: NCT01177124


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