Roxanne Nelson, BN, RN

January 13, 2016

Low-income breast cancer survivors are more likely to adhere to recommended care if they receive counseling and a tailored survivorship care plan, according to a new study.

For women who received these interventions, at 12 months, reported adherence to survivorship care recommendations was approximately 9.5% greater than for those who received usual care.

"Physicians of patients in the intervention group were also more likely to implement recommended survivorship care than physicians of participants in the control group," said lead author Rose C. Maly, MD, MSPH, associate professor of family medicine at the University of California, Los Angeles. She discussed the findings during a press briefing held ahead of the upcoming Cancer Survivorship Symposium in San Francisco.

The Institute of Medicine has recommended the implementation of treatment summaries and survivorship care plans (TSSPs), explained Dr Maly. "The objective is to improve ongoing clinical care and coordination of care of cancer survivors and to address the immediate posttreatment and long-term effects of cancer treatment, including the ongoing psychosocial burden of a cancer diagnosis."

But despite this, there have been no empirical data from randomized, controlled trials to support the utilization of survivorship care plans, she said.

Low-income women in particular may be in special need of enabling and enhanced communication on the use of TSSPs during the transition from breast cancer patient to breast cancer survivor, because these patients tend to have less access to high-quality healthcare, she commented.

Their study was conducted in 212 low-income women with stage 0-III breast cancer who were 10-24 months post diagnosis and were at least 1 month post definitive treatment. They were randomly assigned to receive a survivorship care intervention (n = 107) or usual care (n = 105).

The intervention group received usual care plus a 1-hour in-person counseling session with a survivorship care nurse, who then drafted individualized treatment summaries and survivorship care plans. These were then sent to the provider.

All participants underwent a telephone-based baseline interview before receiving the intervention and a follow-up interview 12 months post intervention.

Both overall implementation of and adherence to the survivorship care plan were better in the intervention group. Physician implementation was 52.6% in the control group vs 64.6% in the intervention arm (P = .015).

Likewise, patient adherence was 51.1% in the control group vs 60.6% in the intervention group (P = .045). Several factors appeared to be associated with better health outcomes. For example, patient self-efficacy when interacting with physicians (estimate = 1.07; P = .019) and personal knowledge of breast cancer (estimate = .039; P = .003) were positively associated with greater adherence.

Conversely, the lack of a usual source of care was a barrier to adherence (estimate = 8.78; P = 0.42).

"Over time and after controlling for potentially confounding factors, the intervention group still showed greater adherence to this model," said Dr Maly.

Commenting on the study, Merry-Jennifer Markham, MD, associate professor of medicine at the University of Florida, Gainesville, noted that "physicians and survivors believe that survivorship care plans are crucial to the ongoing health and wellness of cancer survivors, but there is no standard best way to implement these plans and thus improve patient outcomes.

"This study nicely demonstrates that when a personalized survivorship care plan is provided, in conjunction with one-on-one counseling, adherence to that plan is higher," said Dr Markham, who moderated the briefing. "It is the combination of the survivorship care plan with counseling that empowers the survivor and which may be the key to improved outcomes."

The study was funded by the National Cancer Institute. Dr Maly and Dr Markham have disclosed no relevant financial relationships. Coauthor Patricia A. Ganz, MD, has consulted for several pharmaceutical companies.

Cancer Survivorship Symposium (CSS) Advancing Care and Research: Abstract 1. Presented January 15, 2016.


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