Feasibility of delivering survivorship care via lay health educators: A pilot randomized controlled trial among rural cancer survivors

PURPOSE

We tested the feasibility of survivorship care plan (SCP) delivery with/without a lay health educator (LHE) telephone-delivered information session among rural cancer survivors, and their effects on health-related self-efficacy and knowledge of cancer history.

METHODS

Randomized trial of cancer survivors from 3 rural oncology clinics featuring either SCP alone (control) or SCP plus LHE-delivered information session (intervention). Participants completed a questionnaire on health-related self-efficacy and knowledge of cancer-specific medical history. Responses were compared to medical records for accuracy. SCPs were then mailed to participants. Approximately 5 months later, participants completed a follow-up questionnaire. A subset of participants took part in subsequent qualitative interviews about their study experience.

FINDINGS

Of 301 survivors approached, 72 (23.9%) were randomized (mean age 66.4 years; 3.1 years from diagnosis; 62.5% female), and 65 (90.3%) completed the study. Global mental and physical health or self-efficacy scores did not change significantly from baseline to follow-up for either group. In exploratory analyses, self-efficacy increased in participants with inadequate/marginal health literacy in the intervention arm (+0.7, 95% CI = 0.1-1.2; P = .01). Accuracy of knowledge did not improve but was high at baseline (mean 76.0±14.5%). 60.1% and 48.4% of control and intervention participants, respectively, found SCPs definitely/somewhat useful. Qualitative data (n = 20) suggested that SCPs were helpful to patients when primary and oncology care were less integrated.

CONCLUSIONS

An LHE-delivered informational session was feasible but had limited benefit to rural cancer survivors versus delivery of SCP alone but may be of benefit to patients with low health literacy or with less integrated care.

The Association between Survivorship Care Plans and Patient-Reported Satisfaction and Confidence with Follow-Up Cancer Care Provided by Primary Care Providers

Survivorship care plans aim to facilitate a smooth transition from tertiary to primary care settings after primary cancer treatment is completed. This study sought to identify the sociodemographic factors associated with receiving a survivorship care plan and examine the relationship between receiving a plan and confidence in follow-up care delivered by primary care providers. A cross-sectional analysis of the Canadian Partnership Against Cancer's Experiences of Cancer Patients in Transition Study was conducted (n = 9970). Separate adjusted multinomial logistic regression models assessed the relationship between survivorship care plans and follow-up care outcomes. Proportion of survivors more likely to receive a survivorship care plan varied by numerous sociodemographic and medical factors, such as cancer type (colorectal and prostate), gender (male), and education (high school or less). In unadjusted and adjusted models, individuals who received a Survivorship Care Plan had significantly higher odds of: having felt their primary care providers were involved; agreeing that their primary care providers understood their needs, knew where to find supports and services, and were able to refer them directly to services; and were confident that their primary care provider could meet their follow-up care needs.

Colorectal cancer survivorship care plans: Variations in documentation and posttreatment surveillance recommendations

BACKGROUND

Survivorship care plans (SCP) should outline pertinent information about cancer treatment and follow-up.

METHODS

We descriptively analyzed the content of 74 colorectal cancer SCPs completed as part of a randomized, controlled trial of SCPs at an academic and community cancer center. Surveillance recommendations were compared with American Cancer Society, American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines.

RESULTS

SCP information provided in >80% of the plans included participant age, cancer diagnosis, details, and side-effects of treatment (surgery, chemotherapy, radiation) and health promotion recommendations. SCP content documented less frequently included predisposing conditions, genetic counseling/testing information and staging. Posttreatment surveillance recommendations were documented in >90% SCPs. For stage 2-3 cancer, rates of guideline concordant recommendations were 100% for colonoscopy surveillance (Year 1 only), 87% for imaging surveillance, 65% for carcinoembryonic antigen surveillance, and 33% for follow-up visits. Excluding colonoscopy, >15 unique recommendations were listed for each modality across stages and sites, with more variation at the academic site.

CONCLUSIONS

SCPs consistently recorded information about cancer diagnosis and treatment but omitted critical information about cancer-specific details denoting risk. Surveillance recommendations varied considerably between cancer centers. Future work to improve the consistency of surveillance recommendations documented in SCPs may be needed.

Catalyzing Navigation for Breast Cancer Survivorship (CaNBCS) in Safety-Net Settings: A Mixed Methods Study

Purpose

The current number of breast cancer survivors (BCS) in the United States is approximately 3.8 million, and this number is further expected to increase with improvement in treatments. Survivorship care plans (SCPs) are patient-centered tools that are designed to meet cancer survivors' informational needs about their treatment history, recommended health care, and health maintenance. However, the data on SCP benefits remain uncertain, especially in low-income and racial and ethnic minority cancer survivors. Patient navigation is an effective intervention to improve patient adherence and experience of interdisciplinary breast cancer treatment.

Objectives

This study sought to understand the role of lay patient navigators (LPN) in survivorship care planning for BCS in safety-net settings.

Methods

This study is a mixed methods pilot randomized clinical trial to understand the role of patient navigation in cancer survivorship care planning in a public hospital. We invited BCS who had completed active breast cancer treatment within 5 years. LPNs discussed survivorship care planning and survivorship care-related issues with BCS in the intervention arm over a 6-month intervention period and accompanied patients to their primary care appointment. LPNs also encouraged survivors to discuss health care issues with oncology and primary care providers. The primary objective was to assess BCS’ health-related quality of life (HRQOL). The secondary objectives were self-efficacy and implementation. We assessed implementation with 45–60-min semi-structured interviews with 15 BCS recruited from the intervention arm and 60-min focus groups with the oncologists and separately with LPNs.

Results

We enrolled 40 patients, 20 randomized to usual care and 20 randomized to LPN navigation. We did not find a statistically significant difference between the two arms in HRQOL. There was also no difference in self-efficacy between the two arms. Qualitative analysis identified implementation barriers to intervention that may have contributed to less effective intervention.

Implications for Cancer Survivors

Future survivorship care planning interventions need to consider: Cancer survivors’ needs and preferences, the need for dedicated resources, and the role of electronic health records in survivorship care plan delivery.

What are survivorship care plans failing to tell men after prostate cancer treatment?

BACKGROUND

Survivorship care plans contain important information for patients and primary care physicians regarding appropriate care for cancer survivors after treatment. We describe the completeness of prostate cancer survivorship care plans and evaluate the concordance of follow-up recommendations with guidelines.

METHODS

We analyzed 119 prostate cancer survivorship care plans from one academic and one community cancer center, abstracting demographics, cancer/treatment details, and follow-up recommendations. Follow-up recommendations were compared with the American Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network (NCCN) guidelines.

RESULTS

Content in >90% of plans included cancer TNM stage; prostate-specific antigen (PSA) at diagnosis; radiation treatment details (98% of men received radiation); and PSA monitoring recommendations. Potential treatment-specific side effects were listed for 82% of men who had surgery, 86% who received androgen deprivation therapy (ADT), and 97% who underwent radiation. The presence of posttreatment symptoms was noted in 71% of plans. Regarding surveillance follow-up, all guidelines recommend an annual digital rectal exam (DRE). No plans specified DRE. However, all 71 plans at the community site recommended at least annual follow-up visits with urology, radiation oncology, and primary care. Only 2/48 plans at the academic site specified follow-up visits. All guidelines recommend PSA testing every 6-12 months for 5 years, then annually. For the first 5 years, 90% of plans were guideline-concordant, 8% suggested oversurveillance, and 2% were incomplete. In men receiving ADT, ACS and ASCO recommend bone density imaging and NCCN recommends testosterone levels. Of 77 men on ADT, 1% were recommended bone density imaging and 16% testosterone level testing.

CONCLUSIONS

While care plan content is more complete for demographic and treatment summary information, both sites had gaps in reporting posttreatment symptoms and ADT-related testing recommendations. These findings highlight the need to improve the quality of information in care plans, which are important in communicating appropriate follow-up recommendations to patients and primary care physicians.

Perspectives of Survivorship Care Plans Among Older Breast Cancer Survivors: A Pilot Study

The Commission on Cancer’s standard 3.3 represents a paradigm shift in the care of cancer survivors, recommending that survivors receive a treatment summary and survivorship care plan (SCPs). A focus on older breast cancer survivors is needed, as they are the majority of the breast cancer population and their experiences and perspectives of SCPs is limited in the literature. This pilot study utilized a mixed methods approach (focus groups and self-report questionnaire data) to gather information on older (≥65 years) breast cancer survivors’ perspectives of their SCPs, cancer survivorship, and communication with their health-care providers. The questionnaire was completed individually by the participants prior to the focus group and contained items on basic demographics and their health status following cancer treatment. The focus groups indicated that only a minority of women actually developed a SCP. Those who developed a SCP in collaboration with their providers valued the personal care and attention received. However, some participants reported poor communication with their providers and within their health-care team, resulting in frustration and confusion. Participants’ suggestions for ideal SCPs included better education and personalization, particularly in appropriate nutrition and exercise, and managing side effects and comorbidities. Lastly, the women believed that additional long-term care resources, such as health coaches, were important in improving their survivorship. These findings provide insight into enhancing the content, communication, and application of SCPs to improve the survivorship experience of older breast cancer survivors.

Breast Cancer Survivors' Unmet Needs After Completion of Radiation Therapy Treatment

PURPOSE

To identify the unmet needs of breast cancer survivors after radiation therapy.

PARTICIPANTS & SETTING

Patients who received radiation therapy for unilateral breast cancer with six months or longer of follow-up and exhibited no disease progression were eligible for selection to a study conducted at an outpatient radiation therapy academic practice in the southeastern United States.

METHODOLOGIC APPROACH

A qualitative descriptive study was undertaken using semistructured interviews, framed by the five domains of the Survivor Unmet Needs Survey and analyzed using an iterative inductive and deductive process.

FINDINGS

Of the 24 invited patients, 17 agreed to the interview (including one male patient). Themes emerged from the emotional, relationships, and information needs domains.

IMPLICATIONS FOR NURSING

Healthcare providers should perform a comprehensive needs assessment for patients with breast cancer receiving radiation therapy. Self-management assessment instruments may address patients' confidence in managing all phases of radiation therapy side effects.

Factors Influencing Delivery of Cancer Survivorship Care Plans: A National Patterns of Care Study

Nearly half of all Americans will develop cancer at least once in their lifetime. Through improved screening and treatments, the number of cancer survivors is reaching all-time highs. However, survivorship care plans (SCPs) are inconsistently used, denying many survivors access to critical information. This study used 46,408 SCPs generated from 2007 to 2016 and applied machine learning to identify predictors of SCP creation, including cancer type, type of physician, and healthcare center where they received care, as well as regional variations in care plan creation. Identifying these disparities in SCP use is a critical first step in efforts toward expanding access to survivorship care planning. Using a convenience sample of survivors, it is possible to model the factors that predict generation of SCPs either by the survivor or by a healthcare provider. This study identifies several important disparities both survivor intrinsic such as cancer type, as well as treatment associated and geographic differences in SCP generation. Identifying these disparities at the national level across cancer types will allow for more targeted recommendations to improve SCP creation and dissemination in underserved groups.

Adopting patient-centred tools in cancer care: role of evidence and other factors

Background

Randomized controlled trials (rcts) provide limited evidence to support the use of survivorship care plans (scps), but they provide strong evidence for patient decision aids (ptdas). Despite that evidence, the uptake of ptdas has been limited, but scps are being endorsed and implemented in many cancer programs across Canada. The objective of the present study was to illuminate the decision-making processes involved in the adoption of scps and ptdas.

Methods

Informed by the principles of grounded theory, in-depth semi-structured interviews were conducted with clinicians, managers, and administrators who work in cancer care programs across Canada (n = 21). Data were collected and analyzed concurrently, using a constant comparative analysis approach. Data collection ended when theoretical saturation was reached.

Results

For these types of patient-centred tools, participants noted that high-quality research evidence is often unnecessary for adoption decisions. Six key factors contribute to adoption or non-adoption decisions for scps and ptdas:■ Alignment of research evidence with other evidence■ Perceived clinician benefit■ Endorsement by organizations and professional bodies■ Existence of local champions■ Adaptability to local contexts■ Ability to routinize and reach a large patient population.

Conclusions

High-level evidence is not always the main consideration when adopting new tools into practice. And yet, understanding how clinicians and health system decision-makers decide whether and how to adopt new tools is important to optimizing the use of new tools and practices that are supported by research evidence.

A randomized trial of immediate versus delayed survivorship care plan receipt on patient satisfaction and knowledge of diagnosis and treatment

BACKGROUND

Survivorship care plans (SCPs) and care-planning sessions have been recommended for over a decade, yet evidence for their benefit remains mixed. In a randomized trial, changes in survivor knowledge and satisfaction before and after the receipt of an SCP were assessed.

METHODS

Patients with breast cancer who had completed curative-intent treatment were randomized to immediate versus delayed receipt of an individualized SCP. All participants completed the modified Wisconsin Survey of Cancer Diagnosis and Management in Breast Cancer and the Preparing for Life As a New Survivor survey to assess individual knowledge about cancer diagnosis, treatment, side effects, and follow-up as well as satisfaction with communication and care coordination. Surveys were completed at baseline, at 4 weeks (before delayed receipt), and again at 12 weeks (after all participants had received SCPs); the primary outcome was change in knowledge at 4 weeks.

RESULTS

In total, 127 eligible women were randomized. An improvement in individual knowledge was observed between baseline and week 12 for both arms combined (+1.6; 95% confidence interval, 0.9-2.3; P < .001). There was no statistically significant difference in the change in knowledge from baseline through week 4 between the arms. No significant change occurred for satisfaction scores over time.

CONCLUSIONS

This randomized trial of immediate versus delayed SCP receipt demonstrated a small improvement (4%) in survivor knowledge. However, this improvement did not appear to be related to SCP provision. The authors hypothesized that the improvement was because of repeated administration of the knowledge survey. If improved survivor knowledge is a goal, then strategies beyond the 1-time provision and review of an SCP should be explored.

Caring for the continuum of patients with pancreatic cancer: the importance of survivorship care planning

BACKGROUND

Pancreatic cancer is widely recognized as one of the most formidable cancer diagnoses. However, whether aggressive treatment is undertaken or not, it is critical for all care providers to understand the treatment plan. Survivorship care plans are a new trend in improving communication between the providers and the patient.

OBJECTIVES

The current article will outline the pathophysiology, risk factors, diagnosis and prognosis, treatment, and potential complications of pancreatic cancer.

METHODS

The importance of survivorship care planning will be demonstrated through a case study presentation and evidence-based discussion. In addition, a general template for a survivorship care plan has been included.

FINDINGS

Based on a review of current literature and recommendations, it can be concluded that survivorship care planning would be beneficial for all patients with cancer. This simple tool has the potential to improve coordination of care and patient satisfaction.

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

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.

METHODS

A 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.

Multimorbidity and breast cancer

OBJECTIVES

To examine the significance of multimorbidity in breast cancer survivors, to explore multimorbidity in treatment decisions, and survivorship, and to consider multimorbidity assessment in clinical practice.

DATA SOURCES

Literature review; clinical practice guidelines.

CONCLUSION

Multimorbidity influences treatment decisions. Breast cancer survivors report greater multimorbidity compared with other cancer survivors. Multimorbidity increases with age; there may be racial and ethnic differences. Multimorbidity is associated with symptom burden, functional decline, low adherence to surveillance, and early retirement.

IMPLICATIONS FOR NURSING PRACTICE

Clinical practice guidelines do not refer to multimorbidity and patient outcomes. Comprehensive geriatric assessment combined with survivorship care plan may be considered.

How do follow-up care instructions and treatment summaries relate to cancer survivors' cancer-related pain?

CONTEXT

Cancer-related pain is a problem for many cancer survivors. Treatment summaries (TS) and follow-up care instructions (FCI) provided after cancer treatment could reduce pain for cancer survivors.

OBJECTIVES

This study sought to determine how TS and FCI received by cancer survivors relate to cancer survivors' cancer-related pain after treatment completion.

METHODS

Data were from 2010, Behavioral Risk Factor Surveillance System, Cancer Survivorship module, completed by 10 U.S. states and entities.

RESULTS

Pain was reported by 9% of survivors. TS (P = 0.02) and FCI (P < 0.001) were associated with pain. Compared with cancer survivors who had not received TS or FCI, those who received TS had greater odds of pain (odds ratio, 1.57; 95% confidence interval, 1.08-2.28) and those who received FCI had more than twice the odds of pain (odds ratio, 2.36; 95% confidence interval, 1.52-3.67).

CONCLUSION

FCI and TS were related to pain but in the opposite direction than predicted. Those who received TS and FCI were more likely to report pain than those who did not receive FCI and TS. This may be explained by the severity of cancer treatment. It is possible that those who undergo more severe cancer treatments are more likely to receive FCI and TS. Testing this relationship is a logical next step.

Transforming cancer survivorship care through quality improvement initiatives

Oncology nurses must become better prepared to conduct quality improvement projects that will optimize quality of care and patient safety for long-term cancer survivors. The growing interest in survivorship care has led to the availability of multiple versions of cancer survivorship care plans (SCPs). Despite the availability of SCPs, research is lacking evidence-based processes to evaluate whether providers comply with planning and issuing SCPs. In the current article, the authors describe exploratory efforts to monitor the providers' compliance rate in issuing SCPs in diverse disease-specific clinics.

Survivorship care plans: a work in progress

BACKGROUND

Health agencies across the world have echoed the recommendation of the U.S. Institute of Medicine (iom) that survivorship care plans (scps) should be provided to patients upon completion of treatment. To date, reviews of scps have been limited to the United States. The present review offers an expanded scope and describes how scps are being designed, delivered, and evaluated in various countries.

METHODS

We collected scps from Canada, the United States, Europe, the United Kingdom, Australia, and New Zealand. We selected for analysis the scps for which we could obtain the actual scp, information about the delivery approach, and evaluation data. We conducted a content analysis and compared the scps with the iom guidelines.

RESULTS

Of 47 scps initially identified, 16 were analyzed. The scps incorporated several of the iom's guidelines, but many did not include psychosocial services, identification of a key point of contact, genetic testing, and financial concerns. The model of delivery instituted by the U.K. National Cancer Survivorship Initiative stands out because of its unique approach that initiates care planning at diagnosis and stratifies patients into a follow-up program based on self-management capacities.

SUMMARY

There is considerable variation in the approach to delivery and the extent to which scps follow the original recommendations from the iom. We discuss the implications of this review for future care-planning programs and prospective research. A holistic approach to care that goes beyond the iom recommendations and that incorporates care planning from the point of diagnosis to beyond completion of treatment might improve people's experience of cancer care.

Development and evaluation of a survey to assess survivor knowledge change after survivorship care plans: WiSDOM-B (Wisconsin Survey of cancer DiagnOsis and Management in Breast cancer)

The oncology community has increased efforts to inform survivors about long-term risks and planned follow-up after cancer treatment. Survivorship care plans (SCPs) have been recommended since 2005, yet the benefits of implementation are only now being emphasized. SCPs are hypothesized to enhance patient knowledge. The Wisconsin Survey of Diagnosis and Management in Breast Cancer (WiSDOM-B) was developed to measure changes in breast cancer survivor knowledge pre- and postdelivery of an SCP. The WiSDOM-B was developed with input from oncologists (medical, radiation, and surgical), patient advocates, cancer survivors, and survey design experts. Initially, nine patients evaluated survey content, and modifications were made to enhance clarity. Subsequently, 38 patients were enrolled in a randomized pilot trial assessing SCP impact on knowledge of diagnosis, treatment, late effects, and follow-up (WiSDOM-B) and satisfaction with knowledge (existing survey). The WiSDOM-B was developed using feedback from multiple stakeholders. Baseline knowledge was poor and remained stable in the control arm. There was a suggestion of increased survivor knowledge following receipt of SCPs in the intervention arm (68.4 vs. 74.4%). Change was not statistically significant compared with the control arm. Despite knowledge deficits, baseline satisfaction with knowledge was high for both groups, with 100% of patients being satisfied/very satisfied with information provided. Satisfaction did not change significantly following SCP receipt. The WiSDOM-B assesses survivor knowledge of cancer diagnosis, treatment, follow-up, and side effects. It will be a useful tool for future studies assessing the impact of care plans on survivor knowledge.

Implementing survivorship care plans for colon cancer survivors

PURPOSE/OBJECTIVES

To evaluate the feasibility, usability, and satisfaction of a survivorship care plan (SCP) and identify the optimum time for its delivery during the first 12 months after diagnosis.

DESIGN

Prospective, descriptive, single-arm study.

SETTING

A National Cancer Institute-designated cancer center in the southeastern United States.

SAMPLE

28 nonmetastatic colon cancer survivors within the first year of diagnosis and their primary care physicians (PCPs).

METHODS

Regular screening identified potential participants who were followed until treatment ended. An oncology certified nurse developed the JourneyForward™ SCP, which then was delivered to the patient by the oncology nurse practitioner (NP) during a routine follow-up visit and mailed to the PCP.

MAIN RESEARCH VARIABLES

Time to complete, time to deliver, usability, and satisfaction with the SCP.

FINDINGS

During one year, 75 patients were screened for eligibility, 34 SCPs were delivered, and 28 survivors and 15 PCPs participated in the study. It took an average of 49 minutes to complete a surgery SCP and 90 minutes to complete a surgery plus chemotherapy SCP. Most survivors identified that before treatment ended or within the first three months was the preferred time to receive an SCP.

CONCLUSIONS

The SCPs were well received by the survivors and their PCPs, but were too time and labor intensive to track and complete.

IMPLICATIONS FOR NURSING

More work needs to be done to streamline processes that identify eligible patients and to develop and implement SCPs. Measuring outcomes will be needed to demonstrate whether SCPs are useful or not.

Perceptions of survivorship care among South Asian female breast cancer survivors

BACKGROUND AND OBJECTIVES

To explore the perceptions of South Asian (sa) breast cancer survivors concerning their follow-up care, and to determine the optimal content and format of a survivorship care plan (scp) for this population, according to various life stages.

METHODS

A survey was mailed to 259 sa women with a diagnosis of nonmetastatic breast cancer who were 18-85 years of age, 3-60 months post-discharge, and not on active treatment. Descriptive statistics and content analysis were applied to the responses. The data were cross-tabulated by age: group A (<44 years), group B (45-54 years), group C (55-64 years), and group D (>64 years).

RESULTS

We received 64 completed surveys. The compliance rate for adjuvant hormonal therapy was high (86.3%). Most of the respondents (n = 61, 95.4%) had visited their family doctor within several months (0.5-24 months) after discharge. Their main physical effects concern was fatigue, and anxiety concerning health was the main psychosocial impact. Groups A and B were more concerned about physical appearance, depression, and the impact of cancer on family members. Women in the older groups were concerned about family obligations and work issues. Several women (n = 9, 14.1%) described strain on their marriage and on their relationships with family and friends as significant issues. Slightly more than one third (n = 24, 37.5%) experienced a deepening of faith, and almost as many (n = 23, 35.9%) felt that their illness was something that was meant to happen.

CONCLUSIONS

Many of the impacts of breast cancer treatment are shared by women of all ethnic backgrounds. Others-such as high levels of compliance, little reported strain on spousal and family relationships, and the importance of faith-reflect specific cultural variations. These universal and culture-specific themes should all be kept in mind when developing a scp tailored to sa women. The developmental life stage of a woman affects how she views the cancer diagnosis, especially with respect to family, reproduction, and work issues.

Receipt of cancer treatment summaries and follow-up instructions among adult cancer survivors: results from a national survey

PURPOSE

The purpose of this study is to examine reporting of treatment summaries and follow-up instructions among cancer survivors.

METHODS

Using the 2010 National Health Interview Survey, we created logistic regression models among cancer survivors not in treatment (n = 1,345) to determine characteristics associated with reporting treatment summaries and written follow-up instructions, adjusting for sociodemographic, access, and cancer-related factors. Findings are presented for all survivors and those recently diagnosed (≤4 years). We also examined unadjusted associations between written instructions and subsequent surveillance and screening.

RESULTS

Among those recently diagnosed, 38 % reported receiving treatment summaries and 58 % reported written instructions. Among all survivors, approximately one third reported summaries and 44 % reported written instructions. After adjustment, lower reporting of summaries was associated with cancer site, race, and number of treatment modalities among those recently diagnosed, and white vs. black or Hispanic race/ethnicity, breast vs. colorectal cancer, >10 vs. ≤5 years since diagnosis, no clinical trials participation, and better than fair health among all survivors. For instructions, lower reporting was associated with no trials participation and lower income among those recently diagnosed, and increasing age, white vs. black race, lower income, >10 vs. ≤5 years since diagnosis, 1 vs. ≥2 treatment modalities, no trials participation, and at least good vs. fair/poor health among all survivors. Written instructions were associated with reporting provider recommendations for breast and cervical cancer surveillance, and recent screening mammograms.

CONCLUSION

Many recently diagnosed cancer survivors did not report receiving treatment summaries and written follow-up instructions. Opportunities exist to examine associations between use of these documents and recommended care and outcomes, and to facilitate their adoption.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors who have completed therapy should ask their providers for treatment summaries and written follow-up instructions, and discuss with them how their cancer and therapy impact their future health care.

Caring for survivors of breast cancer: perspective of the primary care physician

BACKGROUND AND OBJECTIVES

Increasing numbers of women are surviving breast cancer, and survivorship care is becoming more complex. Primary care physicians provide care for most survivors of breast cancer in the Canadian province of British Columbia. The present study offers insight into the confidence of primary care physicians in their abilities to provide such care. It also explores potential ways to assist those providers in enhancing this aspect of their practice.

METHODS

A questionnaire was mailed to 1000 primary care physicians caring for survivors of breast cancer. The questionnaire explored the perspectives of the responding physicians on their ability to manage various aspects of survivorship care for breast cancer patients, identified preferences for the content and format of communication from oncologists at the time of transition from active oncology treatment to survivorship, and determined the means most commonly used to obtain knowledge about breast cancer. This 1-page, 31-item checkbox and open-answer questionnaire assessed the perceptions of primary care physicians about the care of breast cancer survivors after completion of active treatment and their personal preferences for resources providing information about breast cancer.

RESULTS

The questionnaire response rate was 59%. Primary care physicians reported being most confident in screening for recurrence and managing patient anxiety; they were least confident in managing lymphedema and providing psychosocial counselling. Compared with physicians following fewer survivors of breast cancer, those who followed more breast cancer survivors had higher confidence in managing the biomedical aspects of follow-up and in providing counselling about nutrition and exercise. Most physicians found discharge letters from oncologists to be useful. Point-form discharge information was preferred by 43%; detailed description, by 19%; and both formats, by 38%. The most useful information items identified for inclusion in a discharge letter were a diagnosis and treatment summary and the recommended surveillance and endocrine therapy. Continuing medical education events and online resources were the means most commonly used to obtain knowledge about breast cancer.

CONCLUSIONS

Primary care physicians who provide follow-up for survivors of breast cancer report that they are confident in managing care and satisfied with discharge letters containing a diagnosis and treatment summary, and recommendations for surveillance and endocrine treatment. At the time of patient discharge, additional information about common medical and psychosocial issues in this patient population would be useful to primary care physicians. Preferred means to access current breast cancer information include continuing medical education events and online resources.