Survivorship Symposium 2016: Study Finds Personalized Survivorship Care Plans Improve Health Outcomes in Low-Income Breast Cancer Survivors

Key Points

  • Low-income breast cancer survivors who received tailored survivorship care plans, which included personalized breast cancer treatment summaries and a list of resources, such as patient support groups, and one-on-one counseling reported a nearly 10% greater adherence to survivorship care recommendations than those receiving usual medical care.
  • Breast cancer knowledge about survivorship issues and confidence in the ability to interact with the physician were associated with greater adherence to recommended care. Conversely, women who had no usual source of health care, including primary care provider, were less likely to receive the recommended care.
  • The combination of having a survivorship care plan and one-on-one counseling may be the key the improved survivor outcome.

Although the Institute of Medicine recommends the implementation of treatment summaries and survivorship care plans as a mechanism to improve ongoing clinical and coordination of oncology care and to address the immediate post-treatment and long-term effects of cancer therapy, empirical evidence has not been accrued to support their utilization. Now, a randomized study by Maly et al of low-income women with breast cancer has found that women who received tailored survivorship care plans, which included personalized breast cancer treatment summaries and a list of resources, such as patient support groups, and one-on-one counseling reported a nearly 10% greater adherence to survivorship care recommendations than those receiving usual medical care.

The study (Abstract 1) results were presented at the 2016 Cancer Survivorship Symposium, cosponsored by ASCO, the American College of Physicians, and the American Academy of Family Physicians, January 15 to 16 in San Francisco, California.

Study Methodology

The researchers randomly assigned 212 low-income women with stage 0 to III breast cancer to either a survivorship care intervention or usual care. The women were 10 to 24 months post diagnosis and at least 1-month post definitive treatment from two Los Angeles County public hospitals. One hundred and seven women were assigned to the intervention group and 105 women received usual care. The women in the intervention group completed a questionnaire assessing their needs and concerns, such as hot flashes, memory problems, weight gain, and sexual dysfunction. Based on their responses, the researchers provided recommendations for further care.

A survivorship care nurse drafted personalized survivorship care plans, which were provided to the patients and their physician of record (oncologist, surgeon, primary care physician). In addition to recommendations for further care, the plans included personalized breast cancer treatment summaries and a list of resources, such as patient support groups.

All survivors in the intervention group also received an hour-long one-on-one counseling session with the survivorship care nurse. Through role-play, the women were coached on how to ask their physicians to implement the survivorship care recommendations.

Mixed-effect regression modeling was performed to investigate potential predictors for breast cancer survivor adherence to recommended survivorship care.

Study Findings

At 12 months, the researchers found that the patients in the intervention group reported 9.5% greater adherence to survivorship care recommendations than patients in the usual care group. Patient adherence rates were 51.1% and 60.6% in the control and intervention groups, respectively. Breast cancer survivors in the experimental group reported greater adherence to recommended breast cancer survivorship care than the control group (estimate = 8.35, P = .006). Both patient self-efficacy in interacting with physicians and breast cancer knowledge were positively associated with greater adherence (estimate = 1.07, P = .019; estimate = 0.39, P = .003). Having no usual source of care was a barrier to adherence) estimate = 8.78, P = .42).

Empowering Survivors

During a press conference announcing the study’s findings, Merry-Jennifer Markham, MD, FACP, a spokesperson for ASCO and the moderator of the press conference said, “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 where to improve patient outcomes. This study nicely demonstrates that when a personalized survivorship care plan is provided in conjunction with one-on-one counseling about the care plan, adherence to the plan’s recommendations is higher. I think it is the combination of 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 outcome.”

This study was funded by the National Cancer Institute. For full disclosures of the study authors, view the study abstract.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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