Toward Developing Survivorship Care Plans for Breast Cancer Patients at High Risk for Radiation-Related Cardiac Effects

52 Background: It is widely accepted that providing survivorship care plans leads to improvements in outcomes for cancer survivors. Treatment summaries are now part of ASCO and NCCN survivorship guidelines. We faced a unique challenge of implementing the survivorship care plan at the Jones Clinic as a small independent practice. The Jones Clinic consists of three full time physicians and two full time nurse practitioners. We see approximately 850 new patients per year. Methods: As a part of ASCO’s quality training program, we focused on the stage I – III (early stage) breast cancer patients who completed their initial therapy. We formed a team, identified the barriers, created a flow diagram of the process, assigned roles for each individual member and finally implemented the process. Results: The major issues identified were lack of provision in the electronic medical record (EMR) system for survivorship and lack of standardized data entry process. We created a system in the EMR for survivorship data entry and extraction of such data in a document. Since July 2015, one hundred percent of breast cancer patients completing adjuvant therapy at the Jones Clinic have received a survivorship treatment summary and a plan of care. The care plan is also shared with their primary care provider. Importantly, creating a survivorship document required less than 10 minutes of the provider’s time. Conclusions: We are now able to provide our patients with a survivorship care plan and address survivorship issues within thirty days of completion of therapy. Creating the care plan requires minimal time from the providers. Our new process meets ASCO guidelines for survivorship care plans and no additional staffing was needed. We now plan to provide a survivorship care plan to all oncology patients treated with curative intent.

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Use of telemedicine in the delivery of survivorship care plans among breast cancer survivors: Lessons learned at Kaiser Permanente East Bay.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.77 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 77-77 ◽

Cited By ~ 1

Author(s):

Pamela Kim Washington ◽

Heather Tews ◽

Dan-Thanh Nguyen ◽

Leeina Wade ◽

Trang Phan ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Lessons Learned ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Breast Cancer Patients ◽

Kaiser Permanente ◽

Care Plans ◽

Follow Up Care

77 Background: Beginning in 2015, the National Accreditation Program for Breast Centers (NAPBC) requires accredited facilities to provide Survivorship Care Plans (SCP) to breast cancer patients treated with curative intent. Here we describe lessons learned with the use of telemedicine in the delivery of SCPs at Kaiser Permanente East Bay. Methods: SCP implementation followed a two-step process: patients who are diagnosed and complete treatment in 2016 are given a SCP at their last surgical or medical oncology appointment (YTD, n=8); 2) patients diagnosed in 2015 who completed treatment in 2015-2016 were contacted by a physician assistant and offered an appointment by telephone or in-person to deliver the care plan (n=152). Both clinic and telemedicine appointments consist of a detailed review of treatment received, post-treatment follow-up care, discussion of health education resources, and provision of referrals as appropriate. Patients also have the opportunity to ask questions about treatment and follow-up care. Results: Among patients diagnosed in 2015 who were offered a TAV or in-person visit, 44.0% preferred a telephone appointment. Actual appointment duration ranged from 10 to 30 minutes. Lack of co-payment and fees associated with transportation as well as loss of income due to taking time off work were the primary factors cited choosing telemedicine over in-person clinic appointments. Interestingly, no differences in member satisfaction scores for in-person vs. telephone visits were observed. Conclusions: Findings suggest telemedicine may be effective in the delivery of SCPs. Similar to rural settings, use of telemedicine in urban settings has a unique capacity to increase service to breast cancer patients.

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The Potential of Survivorship Care Plans in Primary Care Follow-up of Minority Breast Cancer Patients

Journal of General Internal Medicine ◽

10.1007/s11606-009-1012-y ◽

2009 ◽

Vol 24 (S2) ◽

pp. 467-471 ◽

Cited By ~ 51

Author(s):

Mary Ann Burg ◽

Ellen D. S. Lopez ◽

Amy Dailey ◽

Mary Elspeth Keller ◽

Brendan Prendergast

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Cancer Patients ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Breast Cancer Patients ◽

Care Plans

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Survivorship care plans for breast cancer patients: understanding the quality of the available evidence

Current Oncology ◽

10.3747/co.24.3632 ◽

2017 ◽

Vol 24 (6) ◽

pp. 446 ◽

Cited By ~ 3

Author(s):

V. D'Souza ◽

H. Daudt ◽

A. Kazanjian

Keyword(s):

Breast Cancer ◽

Stress Reduction ◽

Knowledge Synthesis ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Breast Cancer Patients ◽

Emotional Challenges ◽

Care Plans ◽

Methodologic Quality

Aim The overall goal of the present study was to contribute to consistency in the provincial approach to survivorship care planning through knowledge synthesis and exchange. Our review focused on the research concerning the physical and emotional challenges of breast cancer (bca) patients and survivors and the effects of the interventions that have been used for lessening those challenges.Methods The psychosocial topics identified in bca survivorship care plans created by two different initiatives in our province provided the platform for our search criteria: quality of life (qol), sexual function, fatigue, and lifestyle behaviours. We conducted an umbrella review to retrieve the best possible evidence, and only reviews investigating the intended outcomes in bca survivors and having moderate-to-high methodologic quality scores were included.Results Of 486 reports retrieved, 51 reviews met the inclusion criteria and form part of the synthesis. Our results indicate that bca patients and survivors experience numerous physical and emotional challenges and that interventions such as physical activity, psychoeducation, yoga, and mindfulness-based stress reduction are beneficial in alleviating those challenges.Conclusions Our study findings support the existing survivorship care plans in our province with respect to the physical and emotional challenges that bca survivors often face. However, the literature concerning cancer risks specific to bca survivors is scant. Although systematic reviews are considered to be the “gold standard” in knowledge synthesis, our findings suggest that much remains to be done in the area of synthesis research to better guide practice in cancer survivorship.

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