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Personalized survivorship plans improve outcomes among low-income breast cancer survivors
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Low-income survivors of breast cancer who received tailored survivorship care plans had a higher adherence to recommended survivorship care, according to the results of a randomized controlled trial presented at the Cancer Survivorship Symposium.
Several key factors — including the survivors’ knowledge of breast cancer, their confidence interacting with medical professionals and whether they had a usual source of health care — appeared associated with better health outcomes.
“Low-income women tend to have less access to high-quality health care, along with unique needs and concerns,” Rose C. Maly, MD, MSPH, associate professor of family medicine at University of California, Los Angeles, said in a press release. “This personalized intervention would be of the greatest benefit to this vulnerable group, and it could be adapted for us with other types of cancer.”
Despite recommendations from the Institute of Medicine for the implementation of treatment summaries and survivorship care plans, little research has been conducted to support its utilization, according to study background.
Maly and colleagues conducted a randomized controlled trial to assess the effect of personalized survivorship care plans vs. standard of care in women with breast cancer.
The study included data from 212 low-income survivors of breast cancer recruited 10 months to 24 months after diagnosis of stage 0 to stage III disease. All study participants received at least 1 month of care after definitive treatment.
The researchers randomly assigned 107 women to an experimental intervention that consisted of counseling sessions with a survivorship care nurse plus individualized treatment summaries and survivorship care plans. The other 105 women received usual care.
Prior to intervention, women submitted to a baseline telephone interview, with a follow-up interview scheduled for 12 months after the intervention or usual care.
According to Maly, survivors assigned to the experimental intervention reported greater adherence to the recommended survivorship care plan than women in the control arm (estimate = 8.35; P = .005).
Patient self-efficacy when interacting with physicians (estimate = 1.07; P = .019) and personal knowledge of breast cancer (estimate = .039; P = .003) appeared associated with greater adherence.
The lack of a usual source of care — such as a regular primary care physician — appeared associated with poor adherence to survivorship care plans (estimate = 8.78).
“This is the first randomized controlled trial of treatment summary and survivorship care plans to show improved clinical outcomes,” Maly said during a press conference. “Over time and after controlling for potentially confounding factors, the intervention group still showed greater adherence to this model.” – by Cameron Kelsall
Reference:
Maly RC, et al. Abstract 1. Presented at: Cancer Survivorship Symposium; Jan. 15-16, 2016; San Francisco.
Disclosure: The NCI provided funding for this study. One study researcher reports stock and/or ownership interests in Abbott Laboratories, GlaxoSmithKline, Johnson & Johnson, Merck, Novartis, Pfizer and Teva, as well as compensated relationships held by an immediate family member with InformedDNA, Intrinsic LifeSciences, Keryx, Merganser Biotech, Silarus Therapeutics and UpToDate. Maly and the other researchers report no relevant financial disclosures.
Perspective
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Merry-Jennifer Markham, MD, FACP
There are over 14.5 million cancer survivors in the U.S. alone, and that number is expected to increase up to 19 million by 2024. 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. It is the combination of the survivorship care plan with counseling that empowers the survivor and which may be the key to improved outcomes.
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