Physician implementation, patient adherence enhanced by counseling plus tailored survivorship care plan in breast cancer survivors

By Liz Meszaros, MDLinx
Published April 19, 2017

Key Takeaways

Among low-income breast cancer survivors, physicians are more likely to recommend and implement survivorship care for survivors who are also undergoing counseling and a tailored survivorship care plan (TSSPs), and women who received these interventions after treatment for breast cancer had an approximately 12.2% greater implementation of survivorship care recommendations than those who did not, according to results from a recent study published online in the Journal of Clinical Oncology.

“The results are very exciting as they clearly demonstrate that the combination of a survivorship care plan with counseling can empower low-income women as they transition from breast cancer patient to breast cancer survivor,” said co-author Patricia Ganz, MD, director of Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA.

Among a low-income population of breast cancer survivors, Dr. Ganz and colleagues sought to evaluate the effects of treatment summaries and survivorship care plans coupled with a nurse counseling session, primarily on physician implementation of, and secondarily on, patient adherence to recommended survivorship care.

For their randomized controlled trial, they included 212 low-income survivors with stage 0 to III breast cancer (average age: 53 years; 72.6% Latina) from two Los Angeles County public hospitals. Survivorship care was comprised of a 1-hour nurse counseling session plus provision of individualized treatment summaries and survivorship care plans to patients and their health care providers from December 2012 to July 2014.

Patients who received the intervention were also asked to write down their three most important questions, and were encouraged to make an appointment with the physician most involved with her cancer care to discuss the TSSP, as well as to take a copy of the TSSP to future visits with other providers.

In all, 107 survivors received this experimental intervention, while 105 received usual care. Researchers used multiple linear regression analyses to determine the effects the intervention had on physician implementation of, and patient adherence to, the recommended survivorship care.

In women who received the intervention, patient adherence to recommended follow-up care was higher than in those who received only usual care (55.7% vs 48.7%, respectively). Furthermore, in the intervention group, physician implementation was also higher than in the usual care group (60.8% vs 48.6%). Subjects receiving the intervention had greater physician implementation of recommended breast cancer survivorship care, including treatment of depression and hot flashes, compared with those who did not (adjusted difference: 16 ± 5.3; P=0.003).

Researchers also found that baseline satisfaction with care and information was positively associated with physician implementation (coefficient: 5.2 ± 2.2; P=0.02), and that being married or partnered (-11.8 ± 4.0; P=0.004) and age (-0.5 plus minus 0.2; P=0.28) were negatively associated with patient adherence.

Dr. Ganz and colleagues also found that this intervention was especially effective in the Latina population, for whom the TSSPs were provided in Spanish when appropriate. A full 97.1% of Latinas reported that the TSSPs improved communication with their doctors, compared with 73.7% of non-Latinas.

According to lead author Rose C. Maly, MD, also a Jonsson Cancer Center member, “One of the most important findings of this study is that women should not be afraid to ask their doctor to pay attention to their chief concerns. When women are empowered to better understand and talk about their survivorship needs, it is directly and positively related to physician implementation of their recommended care.”

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