Personalized Survivorship Care Plans Key for Low-Income Breast Cancer Survivors

New research has found that low-income breast cancer survivors are more likely to adhere to recommended survivorship care if they receive counseling along with a treatment summary and survivorship care plan (TSSP).

Rose C. Maly, MD

New research has found that low-income breast cancer survivors are more likely to adhere to recommended survivorship care if they receive counseling along with a treatment summary and survivorship care plan (TSSP).

This National Cancer Institute—funded study marks the first to show that survivorship care plans can lead to improved outcomes.

“Physicians and survivors believe that survivorship care plans are crucial to the ongoing health and wellness of cancer survivors, but there’s no standard best way to implement these plans in order to improve patient outcomes,” said Merry-Jennifer Markham, ASCO Expert and moderator of the presscast held in advance of the 2016 Cancer Survivorship Symposium where the findings were announced.

The inaugural symposium is being held in San Francisco from January 15-16 and marks a collaborative effort of the American Society of Clinical Oncology, the American Academy of Family Physicians, and the American College of Physicians,

“This study nicely demonstrates that when a personalized survivorship care plan is provided in conjunction with one-on-one counseling about that care plan, adherence to the plan’s recommendations is higher.”

For the study, reported by lead author Rose C. Maly, MD, 212 breast cancer survivors diagnosed with stage 0-III disease were randomized to the control or intervention group. Survivors were recruited and randomized 10 to 24 months after their diagnosis and at least 1 month after their last definitive treatment. All study participants came from two Los Angeles County public hospitals.

The intervention group (107 patients) first completed a questionnaire regarding their needs and concerns about survivorship. Among the issues addressed were hot flashes, memory problems, weight gain, and sexual dysfunction.

A survivorship nurse then drafted a TSSP and mailed it with a cover letter to the survivor’s healthcare providers (including the oncologist, surgeon, and primary care physician). The TSSP included recommendations for further care, treatment summaries, and external resources (such as patient support groups).

Survivors in the intervention group also received an hour-long counseling session in which they were coached on how to communicate with their physicians to carry out the care recommendations. The control group (105 patients) received usual medical care only.

All patients on the study received quarterly adherence surveys and completed a follow-up interview 12 months after intervention.

At 12 months, patients in the intervention group reported a 9.5% higher adherence to recommended survivorship care (60.6% compared with 51.1%). According to the adjusted mixed-effects regression model for patient adherence, recommended survivorship care adherence was slightly different — it was an estimated 8.35% higher in the intervention group.

In addition to the intervention group, having a usual source of care (8.78% higher), knowledge of survivorship issues (1.07%) and perceived efficacy in patient—physician interactions (0.39%) were all associated with greater adherence to survivorship care recommendations.

“Low-income women tend to have less access to high-quality healthcare, along with unique needs and concerns,” said Maly, an associate professor of family medicine at the University of California in Los Angeles, California (UCLA). “This personalized intervention would be of greatest benefit to this vulnerable group, and it could be adapted for use with other types of cancer.”

Further, physician implementation of recommended survivorship care was 64.6 percent in the intervention group and 52.6 percent in the control group.

“I think it’s the combination — the survivorship care plan and the one-on-one counseling, which both engages and empowers the survivor — that may be the key to improved survivor outcomes,” Markham says.