Breast cancer survivorship care during the COVID-19 pandemic within an urban New York Hospital System

e17542 Background: Tremendous advances in detection and treatment have improved breast cancer survival rates. However, with nearly 22.4 million people worldwide living with cancer, optimal survivorship care has become a major focus of health care professionals (HCPs) and patient advocates. The Breast Cancer Survivorship Alliance (BCSA) is a group of HCPs and patient advocates dedicated to enhancing patient survivorship care and encouraging HCPs to look beyond the diagnosis and treatment of breast cancer. Methods: To identify educational needs in breast cancer survivorship, a 25-question survey was fielded at the 2007 San Antonio Breast Cancer Symposium. Electronic and print surveys were available at the Y-Me National Breast Cancer Organization and AstraZeneca booths. Results: Of the 516 respondents, 29% were from the United States, 63% were from the rest of the world, and 8% did not specify a location. A total of 73% were physicians, 7% were oncology nurses, nurse practitioners, or physician assistants, and 20% represented other aspects of breast cancer care (e.g., advocates and patients). The survey revealed a lack of consensus on the definition of cancer survivor, with only 26% of respondents selecting the definition established by the National Coalition for Cancer Survivorship (ie, from the moment of cancer diagnosis and for the balance of life). More than half (i.e., 51%) defined cancer survivor as a patient who has been disease-free for 5 years. Overall wellness promotion, adherence, and management of treatment-related side effects were ranked as the 3 most essential aspects of survivorship care. While most practices engage in posttreatment survivorship counseling, only 16% provide patients with an end-of-treatment summary or survivorship care plan. Most respondents indicated that their institution has a survivorship program in place (39%) or in development (30%). Conclusions: Although progress has been made in understanding and implementing survivorship care, additional education is needed to optimize care of breast cancer survivors. [Table: see text]

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Preferences for breast cancer survivorship care by rural/urban residence and age at diagnosis

Supportive Care in Cancer ◽

10.1007/s00520-019-05134-z ◽

2019 ◽

Vol 28 (8) ◽

pp. 3839-3846

Author(s):

Kathryn E. Weaver ◽

Chandylen L. Nightingale ◽

Julia A. Lawrence ◽

Jennifer Talton ◽

Sally Hauser ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivorship ◽

Age At Diagnosis ◽

Survivorship Care ◽

Breast Cancer Survivorship ◽

Urban Residence

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Breast cancer survivorship visits: Presenting concerns and resulting recommendations.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20553 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20553-e20553

Author(s):

Carrie Tompkins Stricker ◽

Linda A. Jacobs ◽

SarahLena Panzer ◽

Steven C Palmer

Keyword(s):

Breast Cancer ◽

Cancer Survivorship ◽

Breast Cancer Survivors ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Breast Cancer Survivorship ◽

Risk Of Recurrence ◽

Provider Perceptions ◽

Care Plans ◽

Patient Concerns

e20553 Background: Survivorship care plans (SCPs) are mandated for cancer patients following initial cancer therapy. However, appropriate content, processes, and outcomes of survivorship visits are not yet defined. Neither the concerns that patients bring to these visits nor the degree to which they recall information given by providers is known. As part of a multicenter pilot study of breast cancer survivorship visits, we examined patient concerns at time of presentation for such visits, as well as patient and provider perceptions of resulting recommendations. Methods: We assessed post-treatment breast cancer survivors’ (BCSs’) survivorship concerns prior to a survivorship visit at 1 of 9 cancer centers associated with the LIVESTRONG Survivorship Center of Excellence Network. Following that visit we queried providers as to what referrals and recommendations were made during the visit. Three months later we asked patients to report what recommendations were made by providers. We then examined prevalence of patient concerns and agreement between patients and providers concerning survivorship visit recommendations for managing health. Results: 103 BCS at 9 centers participated. BCS most endorsed concerns were reducing risk of recurrence (81.4%), receipt of appropriate breast cancer follow up care (57.4%), weight loss (55.5%), risk for second cancers (54.9%), fatigue/sleep management (50.0%), and symptoms important to report to providers (50.0%). Although exercise was recommended to 63% of participants by providers, patients recalled this correctly only 79% of the time (Kappa = .16, ns). Moreover, there was a generally poor concordance between provider-reported and patient-recalled recommendations, with kappas ranging from 0.46 for recommendations about tobacco/alcohol to -0.11 for general health recommendations. Conclusions: Survivors report an array of concerns ranging from a risk of recurrence (81.4%) to concerns about peripheral neuropathy and lymphedema (51%). Survivors and providers, however, show little concordance concerning recommendations made visits. Provision of personalized survivorship care plans may improve agreement between survivors and providers concerning health recommendations.

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

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.60 ◽

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).

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