Breast cancer survivorship care plans: what are they covering and how well do they align with national guidelines?

Youngjee Choi, Katherine C. Smith, Aishwarya Shukla, Amanda L. Blackford, Antonio C. Wolff, Elissa Thorner, Kimberly S. Peairs, Walid El Ayass, Patricia Njoku, Katie Papathakis, Carol D. Riley, Nelli Zafman, Fariba Asrari, Melissa Camp, Jean L. Wright, Nancy J. Mayonado, Sharon M. White, Claire F. Snyder

Research output: Contribution to journalArticle

Abstract

Purpose: Survivorship care plans (SCPs) provide key information about cancer treatment history and follow-up recommendations. We describe the completeness of breast cancer SCPs and evaluate guideline concordance of follow-up recommendations. Methods: We analyzed 149 breast cancer SCPs from two sites, abstracting demographics, cancer/treatment details, surveillance plans, and health promotion advice. SCP recommendations and provided information were compared to American Cancer Society/American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines. Results: SCP information provided in > 90% of the plans included patient age; relevant providers; cancer stage; treatment details; and physical exam, mammogram, and health promotion recommendations. SCP components completed less frequently included post-treatment symptoms/side effects (67%). All SCPs at the community site were uniform but had the potential for oversurveillance if visits occurred every 3 months in years 1–2 or every 6 months in years 3–5 with multiple cancer providers. The academic site recommended three predominant patterns of follow-up: (1) primary care provider every 6–12 months; (2) cancer team every 3–6 months (year 1), every 6–12 months (years 4–5); and (3) alternating oncology providers every 3–6 months (years 1–2) then every 6 months. Compared to guidelines, these patterns recommend under- and oversurveillance at various times. Mammography recommendations showed guideline concordance (annual) for 84%, oversurveillance for 10%, and were incomplete for 6%. SCPs of only 12/79 (15%) women on aromatase inhibitors recommended guideline-concordant bone density testing. Conclusions: SCP content is more complete for demographic and treatment summary information but has follow-up recommendation gaps. Efforts to improve follow-up recommendations are needed.

Original languageEnglish (US)
JournalBreast Cancer Research and Treatment
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Survival Rate
Guidelines
Breast Neoplasms
Neoplasms
Health Promotion
Demography
Therapeutics
Aromatase Inhibitors
Mammography
Bone Density
Primary Health Care
History

Keywords

  • Breast cancer
  • Cancer survivorship
  • Guideline concordance
  • Survivorship care plan

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Breast cancer survivorship care plans : what are they covering and how well do they align with national guidelines? / Choi, Youngjee; Smith, Katherine C.; Shukla, Aishwarya; Blackford, Amanda L.; Wolff, Antonio C.; Thorner, Elissa; Peairs, Kimberly S.; El Ayass, Walid; Njoku, Patricia; Papathakis, Katie; Riley, Carol D.; Zafman, Nelli; Asrari, Fariba; Camp, Melissa; Wright, Jean L.; Mayonado, Nancy J.; White, Sharon M.; Snyder, Claire F.

In: Breast Cancer Research and Treatment, 01.01.2019.

Research output: Contribution to journalArticle

Choi, Youngjee ; Smith, Katherine C. ; Shukla, Aishwarya ; Blackford, Amanda L. ; Wolff, Antonio C. ; Thorner, Elissa ; Peairs, Kimberly S. ; El Ayass, Walid ; Njoku, Patricia ; Papathakis, Katie ; Riley, Carol D. ; Zafman, Nelli ; Asrari, Fariba ; Camp, Melissa ; Wright, Jean L. ; Mayonado, Nancy J. ; White, Sharon M. ; Snyder, Claire F. / Breast cancer survivorship care plans : what are they covering and how well do they align with national guidelines?. In: Breast Cancer Research and Treatment. 2019.
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title = "Breast cancer survivorship care plans: what are they covering and how well do they align with national guidelines?",
abstract = "Purpose: Survivorship care plans (SCPs) provide key information about cancer treatment history and follow-up recommendations. We describe the completeness of breast cancer SCPs and evaluate guideline concordance of follow-up recommendations. Methods: We analyzed 149 breast cancer SCPs from two sites, abstracting demographics, cancer/treatment details, surveillance plans, and health promotion advice. SCP recommendations and provided information were compared to American Cancer Society/American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines. Results: SCP information provided in > 90{\%} of the plans included patient age; relevant providers; cancer stage; treatment details; and physical exam, mammogram, and health promotion recommendations. SCP components completed less frequently included post-treatment symptoms/side effects (67{\%}). All SCPs at the community site were uniform but had the potential for oversurveillance if visits occurred every 3 months in years 1–2 or every 6 months in years 3–5 with multiple cancer providers. The academic site recommended three predominant patterns of follow-up: (1) primary care provider every 6–12 months; (2) cancer team every 3–6 months (year 1), every 6–12 months (years 4–5); and (3) alternating oncology providers every 3–6 months (years 1–2) then every 6 months. Compared to guidelines, these patterns recommend under- and oversurveillance at various times. Mammography recommendations showed guideline concordance (annual) for 84{\%}, oversurveillance for 10{\%}, and were incomplete for 6{\%}. SCPs of only 12/79 (15{\%}) women on aromatase inhibitors recommended guideline-concordant bone density testing. Conclusions: SCP content is more complete for demographic and treatment summary information but has follow-up recommendation gaps. Efforts to improve follow-up recommendations are needed.",
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author = "Youngjee Choi and Smith, {Katherine C.} and Aishwarya Shukla and Blackford, {Amanda L.} and Wolff, {Antonio C.} and Elissa Thorner and Peairs, {Kimberly S.} and {El Ayass}, Walid and Patricia Njoku and Katie Papathakis and Riley, {Carol D.} and Nelli Zafman and Fariba Asrari and Melissa Camp and Wright, {Jean L.} and Mayonado, {Nancy J.} and White, {Sharon M.} and Snyder, {Claire F.}",
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T2 - what are they covering and how well do they align with national guidelines?

AU - Choi, Youngjee

AU - Smith, Katherine C.

AU - Shukla, Aishwarya

AU - Blackford, Amanda L.

AU - Wolff, Antonio C.

AU - Thorner, Elissa

AU - Peairs, Kimberly S.

AU - El Ayass, Walid

AU - Njoku, Patricia

AU - Papathakis, Katie

AU - Riley, Carol D.

AU - Zafman, Nelli

AU - Asrari, Fariba

AU - Camp, Melissa

AU - Wright, Jean L.

AU - Mayonado, Nancy J.

AU - White, Sharon M.

AU - Snyder, Claire F.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Survivorship care plans (SCPs) provide key information about cancer treatment history and follow-up recommendations. We describe the completeness of breast cancer SCPs and evaluate guideline concordance of follow-up recommendations. Methods: We analyzed 149 breast cancer SCPs from two sites, abstracting demographics, cancer/treatment details, surveillance plans, and health promotion advice. SCP recommendations and provided information were compared to American Cancer Society/American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines. Results: SCP information provided in > 90% of the plans included patient age; relevant providers; cancer stage; treatment details; and physical exam, mammogram, and health promotion recommendations. SCP components completed less frequently included post-treatment symptoms/side effects (67%). All SCPs at the community site were uniform but had the potential for oversurveillance if visits occurred every 3 months in years 1–2 or every 6 months in years 3–5 with multiple cancer providers. The academic site recommended three predominant patterns of follow-up: (1) primary care provider every 6–12 months; (2) cancer team every 3–6 months (year 1), every 6–12 months (years 4–5); and (3) alternating oncology providers every 3–6 months (years 1–2) then every 6 months. Compared to guidelines, these patterns recommend under- and oversurveillance at various times. Mammography recommendations showed guideline concordance (annual) for 84%, oversurveillance for 10%, and were incomplete for 6%. SCPs of only 12/79 (15%) women on aromatase inhibitors recommended guideline-concordant bone density testing. Conclusions: SCP content is more complete for demographic and treatment summary information but has follow-up recommendation gaps. Efforts to improve follow-up recommendations are needed.

AB - Purpose: Survivorship care plans (SCPs) provide key information about cancer treatment history and follow-up recommendations. We describe the completeness of breast cancer SCPs and evaluate guideline concordance of follow-up recommendations. Methods: We analyzed 149 breast cancer SCPs from two sites, abstracting demographics, cancer/treatment details, surveillance plans, and health promotion advice. SCP recommendations and provided information were compared to American Cancer Society/American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines. Results: SCP information provided in > 90% of the plans included patient age; relevant providers; cancer stage; treatment details; and physical exam, mammogram, and health promotion recommendations. SCP components completed less frequently included post-treatment symptoms/side effects (67%). All SCPs at the community site were uniform but had the potential for oversurveillance if visits occurred every 3 months in years 1–2 or every 6 months in years 3–5 with multiple cancer providers. The academic site recommended three predominant patterns of follow-up: (1) primary care provider every 6–12 months; (2) cancer team every 3–6 months (year 1), every 6–12 months (years 4–5); and (3) alternating oncology providers every 3–6 months (years 1–2) then every 6 months. Compared to guidelines, these patterns recommend under- and oversurveillance at various times. Mammography recommendations showed guideline concordance (annual) for 84%, oversurveillance for 10%, and were incomplete for 6%. SCPs of only 12/79 (15%) women on aromatase inhibitors recommended guideline-concordant bone density testing. Conclusions: SCP content is more complete for demographic and treatment summary information but has follow-up recommendation gaps. Efforts to improve follow-up recommendations are needed.

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KW - Guideline concordance

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