Exploring the association between diabetes and breast cancer morbidity: considerations for quality care improvements among Latinas

Abstract Objective Cancer and diabetes are two severe chronic illnesses that often co-occur. In cancer patients, diabetes increases the risk for treatment complexities and mortality. Yet patient-reported outcomes with co-occurring chronic illness are understudied. Design This preliminary study investigated the association of diabetes with breast cancer-related morbidity among underserved Latina breast cancer survivors (BCS). Participants 137 Latina BCS were recruited from the California Cancer Registry and hospitals. Setting and Main Outcome Measure(s): BCS completed a self-administered mailed questionnaire assessing demographic and medical characteristics e.g. Type2 diabetes mellitus (T2DM). Results 28% Latina BCS reported co-occurring T2DM at twice the general population rate. Diabetes was most prevalent among Latina BCS > 65 years (43%). Latina BCS with diabetes were more likely to report advanced cancer staging at diagnosis (P = 0.036) and more lymphedema symptoms (P = 0.036). Results suggest non-significant but lower general health and greater physical functioning limitations among BCS with T2DM. Conclusions This study has relevance for precision population medicine by (i) consideration of routine diabetes screening in Latina BCS, (ii) underscoring attention to disease co-occurrence in treatment planning and care delivery and (iii) informing follow-up care and survivorship care planning e.g. patient self-management, oncology and primarily care surveillance and specialty care. Our findings can inform providers, survivors and caregivers about the impact of disease co-occurrence that influence clinically and patient responsive care for both initial treatment and long-term follow-up care to address disparities.

Download Full-text

Feasibility of a Mobile Phone App and Telephone Coaching Survivorship Care Planning Program Among Spanish-Speaking Breast Cancer Survivors (Preprint)

10.2196/preprints.13543 ◽

2019 ◽

Author(s):

Anna María Nápoles ◽

Jasmine Santoyo-Olsson ◽

Liliana Chacón ◽

Anita L Stewart ◽

Niharika Dixit ◽

...

Keyword(s):

Breast Cancer ◽

Breast Cancer Survivors ◽

Well Being ◽

Care Planning ◽

Survivorship Care ◽

Spanish Speaking ◽

Health Distress ◽

Follow Up Care ◽

Survivorship Care Planning

BACKGROUND Spanish-speaking Latina breast cancer survivors experience disparities in knowledge of breast cancer survivorship care, psychosocial health, lifestyle risk factors, and symptoms compared with their white counterparts. Survivorship care planning programs (SCPPs) could help these women receive optimal follow-up care and manage their condition. OBJECTIVE This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a culturally and linguistically suitable SCPP called the Nuevo Amanecer (New Dawn) Survivorship Care Planning Program for Spanish-speaking breast cancer patients in public hospital settings, approaching the end of active treatment. METHODS The 2-month intervention was delivered via a written bilingual survivorship care plan and booklet, Spanish-language mobile phone app with integrated activity tracker, and telephone coaching. This single-arm feasibility study used mixed methods to evaluate the intervention. Acceptability and feasibility were examined via tracking of implementation processes, debriefing interviews, and postintervention satisfaction surveys. Preliminary efficacy was assessed via baseline and 2-month interviews using structured surveys and pre- and postintervention average daily steps count based on activity tracker data. Primary outcomes were self-reported fatigue, health distress, knowledge of cancer survivorship care, and self-efficacy for managing cancer follow-up health care and self-care. Secondary outcomes were emotional well-being, depressive and somatic symptoms, and average daily steps. RESULTS All women (n=23) were foreign-born with limited English proficiency; 13 (57%) had an elementary school education or less, 16 (70%) were of Mexican origin, and all had public health insurance. Coaching calls lasted on average 15 min each (SD 3.4). A total of 19 of 23 participants (83%) completed all 5 coaching calls. The majority (n=17; 81%) rated the overall quality of the app as “very good” or “excellent” (all rated it as at least “good”). Women checked their daily steps graph on the app between 4.2 to 5.9 times per week. Compared with baseline, postintervention fatigue (B=–.26; P=.02; Cohen d=0.4) and health distress levels (B=–.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5). CONCLUSIONS We found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors.

Download Full-text

The Impact of Primary Care Physicians on Follow-up Care of Underserved Breast Cancer Survivors

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2013.06.120345 ◽

2013 ◽

Vol 26 (6) ◽

pp. 628-636 ◽

Cited By ~ 12

Author(s):

R. C. Maly ◽

Y. Liu ◽

A. L. Diamant ◽

A. Thind

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Cancer Survivors ◽

Primary Care Physicians ◽

Breast Cancer Survivors ◽

Follow Up Care ◽

The Impact

Download Full-text

The impact of patient-reported outcomes on loss to follow-up care after bariatric surgery

Surgical Endoscopy ◽

10.1007/s00464-021-08352-x ◽

2021 ◽

Author(s):

Alexandra Jacobs ◽

Paige Martinez ◽

Ellen Morrow ◽

Anna Ibele

Keyword(s):

Bariatric Surgery ◽

Patient Reported Outcomes ◽

Loss To Follow Up ◽

Patient Reported ◽

Follow Up Care ◽

The Impact

Download Full-text

Mammography Surveillance and Mortality in Older Breast Cancer Survivors

Journal of Clinical Oncology ◽

10.1200/jco.2006.09.9572 ◽

2007 ◽

Vol 25 (21) ◽

pp. 3001-3006 ◽

Cited By ~ 85

Author(s):

Timothy L. Lash ◽

Matthew P. Fox ◽

Diana S.M. Buist ◽

Feifei Wei ◽

Terry S. Field ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Cancer Mortality ◽

Breast Cancer Survivors ◽

Care Delivery ◽

Breast Cancer Mortality ◽

The United States ◽

Stage I ◽

Early Stage Disease

Purpose There are more than 2,000,000 breast cancer survivors in the United States today. While surveillance for asymptomatic recurrence and second primary is included in consensus recommendations, the effectiveness of this surveillance has not been well characterized. Our purpose is to estimate the effectiveness of surveillance mammography in a cohort of breast cancer survivors with complete ascertainment of surveillance mammograms and negligible losses to follow-up. Patients and Methods We enrolled 1,846 stage I and II breast cancer patients who were at least 65 years old at six integrated health care delivery systems. We used medical record review and existing databases to ascertain patient, tumor, and therapy characteristics, as well as receipt of surveillance mammograms. We linked personal identifiers to the National Death Index to ascertain date and cause of death. We matched four controls to each breast cancer decedent to estimate the association between receipt of surveillance mammogram and breast cancer mortality. Results One hundred seventy-eight women died of breast cancer during 5 years of follow-up. Each additional surveillance mammogram was associated with a 0.69-fold decrease in the odds of breast cancer mortality (95% CI, 0.52 to 0.92). The protective association was strongest among women with stage I disease, those who received mastectomy, and those in the oldest age group. Conclusion Given existing recommendations for post-therapy surveillance, trials to compare surveillance with no surveillance are unlikely. This large observational study provides support for the recommendations, suggesting that receipt of surveillance mammograms reduces the rate of breast cancer mortality in older patients diagnosed with early-stage disease.

Download Full-text

Moving from a ‘One Size Fits All’ to Personalized Follow-Up in Breast Cancer Survivors—Connecting Patient-Reported Outcomes with Economic Considerations

Breast cancer: Global quality care ◽

10.1093/med/9780198839248.003.0029 ◽

2019 ◽

pp. 307-316

Author(s):

Carmen Dirksen ◽

Merel Kimman ◽

Manuela Joore ◽

Liesbeth Boersma

Keyword(s):

Breast Cancer ◽

Economic Evaluation ◽

Patient Reported Outcomes ◽

Care Delivery ◽

Process Of Care ◽

Patient Reported ◽

Related Quality ◽

Health Related ◽

Economic Considerations

Abstract: In the Netherlands, two studies were performed to investigate the effectiveness of several alternative follow-up strategies in terms of patient-reported outcomes (health-related quality of life and satisfaction), and to address economic considerations in breast cancer follow-up care. This chapter describes the economic evaluation of four follow-up strategies after breast cancer treatment. As such, it provides an example of the application of economic methods to evaluate the relative value of breast cancer care. Whereas economic evaluation is outcome-focused, the process of care delivery is also a major determinant of patient value. Insight into patients’ preferences for outcome and process is crucial in order to tailor care to individual patients’ needs. Therefore, in a second study, patients’ preferences for the process of care delivery were evaluated.

Download Full-text

Sources of variation in follow-up expenditure after radical cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.335 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 335-335

Author(s):

Goutham Vemana ◽

Joel Vetter ◽

Ling Chen ◽

Gurdarshan Singh Sandhu ◽

Seth A. Strope

Keyword(s):

Radical Cystectomy ◽

Practice Patterns ◽

Care Delivery ◽

Total Variance ◽

Office Visits ◽

Recommended Care ◽

Patient Level ◽

Follow Up Care ◽

The Impact

335 Background: Follow-up care after radical cystectomy is poorly defined with extensive variation in practice patterns. We sought to determine sources of these variations in care as well as examine the economic impact of standardization of care to guideline recommended care. Methods: Using linked SEER-Medicare data from 1992 to 2007, we determined follow-up care expenditures (time and geography standardized) for 24 months after surgery. Accounted costs included office visits, imaging studies, urine tests and blood work. A multilevel model was implemented to determine the impact of region, surgeon, and patient factors on care delivery. We then compared the actual expenditures on care in the Medicare system (interquartile range) to the expenditures if patients received care recommended by current clinical guidelines. Results: Expenditures over 24 months of follow-up were calculated per month and per patient. The mean and median monthly expenditures were $33 and $21 respectively (minimum $0, maximum $429, 25th to 75th percentile $9 to $43). The total variance of expenditure situated at the surgeon-level and SEER region-level was 9.9% and 4.0% respectively. After accounting for the region, the total variance of expenditure situated at the patient-level and surgeon-level was 14.95% and 7.81% respectively. The assessed cost of guideline follow-up recommendations varied from 0.78-9.05 times the calculated Medicare costs. The guideline recommended cost of follow-up was higher than actual Medicare expenditures in all but one category. Conclusions: While some regional and surgeon-level variations in care were found, most variation in expenditure on follow-up care was at the patient-level, largely based on comorbidity, node positivity, chemotherapy status, readmission rates, and final cancer stage. Standardization of care to current established guidelines would create larger expenditures for the Medicare system than current practice patterns.

Download Full-text

Exploring Interactive Survivorship Care Plans to Support Breast Cancer Survivors: Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/23414 ◽

2020 ◽

Vol 9 (12) ◽

pp. e23414

Author(s):

Akshat Kapoor ◽

Priya Nambisan

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Self Management ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Breast Cancer Survivorship ◽

Care Plans ◽

The Impact

Background Breast cancer is the most common form of cancer among American women, accounting for 23% of all cancer survivors nationally. Yet, the availability of adequate resources and tools for supporting breast cancer survivors has not kept up with the rapid advancement in treatment options, resulting in unmet supportive care needs, particularly among low-income and minority populations. This study explores an alternative means of delivering breast cancer survivorship care plans (SCPs), with the aim of improving survivor morbidity, patient knowledge, and self-management of treatment-related symptoms, as well as addressing inconsistencies in follow-up care visits. Objective The overall goal of this study is to improve the uptake of SCP recommendations via an educational intervention for breast cancer survivors, to improve treatment-related morbidity, patient knowledge, self-management, and adherence to follow-up visits. The specific aims of the study are to (1) evaluate the feasibility of the online SCP, and (2) assess the impact of the online SCP on survivorship outcomes. Methods We will enroll 50 breast cancer survivors who have completed initial breast cancer treatment into a 2-armed, randomized, waitlist-controlled pilot trial, and collect data at baseline and 6 months. For the first aim, we will use mixed methods, including surveys and personal interviews among the intervention group, to determine the feasibility of providing an online, interactive SCP (called ACESO) based on the survivors’ online user experience and their short-term adoption. For the secondary aim, we will compare the 2 groups to assess the primary outcomes of survivor knowledge, self-efficacy for self-management, perceived peer support, and adherence to SCP-recommended posttreatment follow-up visits to oncology and primary care; and the secondary outcomes of treatment-related morbidity (body weight, fatigue, depression, anxiety, sexual function, distress, and sleep quality). We assess these outcomes by using measurements from validated instruments with robust psychometric properties. Results We have developed and refined the online breast cancer survivorship plan, ACESO, with consultation from breast cancer oncologists, nurses, and survivors. Approval for the study protocol has been obtained from the Institutional Review Board. An advisory board has also been established to provide oversight and recommendations on the conduct of the study. The study will be completed over a period of 2 years. Conclusions The results of this pilot study will inform the feasibility and design of a larger-scale pragmatic trial to evaluate the impact of an online breast cancer SCP on treatment-related morbidity and self-efficacy for self-management. International Registered Report Identifier (IRRID) PRR1-10.2196/23414

Download Full-text

Feasibility of group follow-up visit for breast cancer survivors

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19603 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19603-19603

Author(s):

C. O. Ruud ◽

K. Francis ◽

C. Stephens ◽

M. H. Rajab

Keyword(s):

Breast Cancer ◽

Patient Satisfaction ◽

Cancer Survivors ◽

Cancer Patients ◽

Social Worker ◽

Breast Cancer Survivors ◽

Breast Cancer Patients ◽

Group Visit ◽

Follow Up Care

19603 Background: The ASCO 2006 guidelines specify that regularly scheduled follow-up care of breast cancer survivors should be the standard. Follow up care is a “teachable moment” to train survivors in positive habits. A group visit model at the Cleveland Clinic proved feasible and improved patient satisfaction for other diseases. Our objectives include assessing the feasibility of an adapted group follow-up visit for the care of breast cancer patients and patient satisfaction. Methods: A feasibility study targeting breast cancer patients who completed primary therapy and were scheduled for a routine appointment. We mailed letters inviting patients to a follow-up group visit. Patients were divided into 3 groups, each scheduled for a separate (90–120 minute). During the first half of the visit, participants were divided into three groups; 5-minute physician exam, nurse review of medications and vital signs, and instruction by a social worker. Groups were rotated. During the second half the doctor, nurse, and social worker met with all participants in one room starting with an educational presentation about fatigue and exercise. Each participant was subsequently interviewed by the physician in the presence of their peers. Shared complaints were investigated first. Patients rated their satisfaction with the different parts of the visit on a scale of 1–5. Participants were surveyed pre- and post- education session and asked if they would participate again. Participants were allowed to bring a family member or friend. Results: 29 (29.6 %) out of 98 consented and 22 (22.5%) attended;10 in first visit, 5 in second visit and 7 in last visit. Average age 61±8, ranged from 46–72 years. Most participants were satisfied with all parts of the group visit, except two in the first group were less satisfied with the check in process and moving between rooms. Comparing the pre- vs. post- educational session surveys showed an improved understanding of the importance of fatigue or exercise. 17 (77%) out of 22 participants agreed to participate in another group visit. Conclusion: Group visit format is feasible and provides patient satisfaction. No significant financial relationships to disclose.

Download Full-text