Use of Survivorship Care Plans to Re-Engineer Breast Cancer Follow-Up

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

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Views of family physicians about survivorship care plans to provide breast cancer follow-up care: exploration of results from a randomized controlled trial

Current Oncology ◽

10.3747/co.22.2368 ◽

2015 ◽

Vol 22 (4) ◽

pp. 252 ◽

Cited By ~ 13

Author(s):

M.A. O'Brien ◽

E. Grunfeld ◽

J. Sussman ◽

G. Porter ◽

M. Hammond Mobilio

Keyword(s):

Breast Cancer ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Family Physicians ◽

Survivorship Care Plan ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Care Plans ◽

Randomized Controlled

Background The U.S. Institute of Medicine recommends that cancer patients receive survivorship care plans, but evaluations to date have found little evidence of the effectiveness of such plans. We conducted a qualitative follow-on study to a randomized controlled trial (rct) to understand the experiences of family physicians using survivorship care plans to support the follow-up of breast cancer patients.MethodsA subset of family physicians whose patients were enrolled in the parent rct in Ontario and Nova Scotia were eligible for this study. In interviews, the physicians discussed survivorship care plans (intervention) or usual discharge letters (control), and their confidence in providing follow-up cancer care.Results Of 123 eligible family physicians, 18 (10 intervention, 8 control) were interviewed. In general, physicians receiving a survivorship care plan found only the 1-page care record to be useful. Physicians who received only a discharge letter had variable views about the letter’s usefulness; several indicated that it lacked information about potential cancer- or treatment-related problems. Most physicians were comfortable providing care 3–5 years after diagnosis, but desired timely and informative communication with oncologists. Conclusions Although family physicians did not find extensive survivorship care plans useful, discharge letters might not be sufficiently comprehensive for follow-up breast cancer care. Effective strategies for two-way communication between family physicians and oncologists are still lacking.

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

10.2196/preprints.23414 ◽

2020 ◽

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 PRR1-10.2196/23414

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Use of survivorship care plans to re-engineer breast cancer follow-up.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.162 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 162-162

Author(s):

Grace Makari-Judson ◽

Sandra Hubbard ◽

Tamara Wrenn

Keyword(s):

Breast Cancer ◽

Nurse Practitioners ◽

Active Treatment ◽

Wait Times ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Care Plans ◽

Medical Oncologists ◽

Before And After

162 Background: Use of survivorship care plans (SCPs) was recommended by the IOM in 2005, but benefits are a subject of ongoing debate. ASCO’s Cost of Cancer Care Task Force cited use of unnecessary imaging and tumor markers in breast cancer follow up amongst the “top five” list to improve quality. Communication with breast cancer survivors about guideline based post-treatment follow-up may be improved with SCPs, however few studies have addressed measurable outcomes. We describe use of SCPs to coordinate follow-up care in a multidisciplinary practice. Methods: In 2009, our breast surgeons, medical oncologists, and nurse practitioners agreed upon guidelines for follow up of breast cancer patients, developed a Survivorship Care Program to follow active treatment and implemented use of SCPs. Prior to 2009, follow up was partly determined at physician discretion and partly patient-driven, often with both medical and surgical providers seeing patients within short spans of time. To improve access to two part-time breast surgeons, guidelines were established to shift follow-up to medical oncologists and nurse practitioners. After diagnosis, patients were given comprehensive SCPs, which included recommended follow-up visits and testing. Wait times and numbers of new surgical patients were measured before and after use of SCPs. Results: Implementation of SCPs occurred during 2009; data from time periods two years before and after SCPs is listed below. Wait times were measured from call to first appointment. New patients included both benign and malignant breast disease. Conclusions: SCPs were useful in re-engineering follow-up habits of clinicians, adding value to each visit and gaining acceptance from established patients regarding recommended surveillance. Patients expressed that uncertainty experienced at the end of active treatment is mitigated by remaining in an environment that can be easily transitioned back to other clinical services. SCPs contributed to reduced wait times and increase in volume of new patients seen by breast surgeons. Future studies should assess contribution of SCPs to reducing unnecessary tests and improving compliance with ASCO guidelines. [Table: see text]

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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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Predictors of receiving survivorship care plans and visits.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12055 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12055-12055

Author(s):

Christine M. Duffy ◽

Harish Saiganesh ◽

Stavroula Chrysanthopoulou ◽

Camille Higel-Mcgovern ◽

Don S. Dizon

Keyword(s):

Breast Cancer ◽

Stage Iv ◽

Rank Test ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Clinical Predictors ◽

Chi Square ◽

Logistic Regression Models ◽

Care Plans ◽

Stage Iv Disease

12055 Background: While the Commission on Cancer has eliminated strict quotas for accreditation, Survivorship Care Plans (SCPs) and/or Survivorship Care Visits (SCV) at treatment completion are encouraged. However, who receives a SCP or SCV, whether it impacts care, and impact of distress on care is unknown. We examined the provision of survivorship care at the Lifespan Cancer Institute (LCI) to determine (1) clinical and distress thermometer scores (DTS) association with SCPs and SCVs; (2) impact of SCV visits on specialty referrals, and (3) demographic and clinical predictors of receipt of SCP and SCV. Methods: We retrospectively reviewed EMR records on 1,960 patients at LCI between 2014-2017 for SCPs and SCVs and extracted demographics, treatment variables, and distress scores. We used T-test or Wilcoxon rank test and Chi-square tests for evaluating the bivariate associations of SCP and SCV with continuous and categorical factors respectively. We fit logistic regression models to assess the adjusted effect of these factors on receipt of SCP and SCV independently. All analyses were performed in R v4.0.2. Results: The mean age was 63.9 (SD=11.8), 67% were female, 51.2% were married or partnered. Breast (38.8%), lung (17.6%), and prostate (13.7%) were the most common cancers. DTS were recorded in 64% with mean of 3.88(SD=3.05): distress was higher in women (4.36, SD=3.01), breast cancer pts (4.53, SD=3.07), gyn (4.22, SD=3.07), pancreatic (4.12, SD=3.41) and anal cancers (4.52, SD=3.47) and in those with Stage IV disease (5.33, SD=3.43). SCPs were completed in 740 (37.8%) patients and of those 65.9% had a SCV. SCV were associated with more specialty referrals for psychiatry, physical therapy, nutrition, and sexual health but not smoking cessation or fiscal services. DTS were associated with increased referral to psychiatry only. The adjusted models (table) showed odds of receiving a SCP were higher in those younger, and having breast cancer v all other cancers, with prostate having lowest odds. For receipt of SCV, odds were higher in those younger, female, and having breast cancer, with prostate and lung having the lowest odds. Conclusions: Gender, age and type of cancer are significant predictors of receipt of SCP and SCV. SCP and SCV patterns may represent patient preferences, but practice patterns and unconscious biases may also play a part suggesting areas for further research and outreach.[Table: see text]

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