Study Identifies Important Benefits of Cancer Survivorship Programs

Charles Bankhead

October 2014, Vol 5 , No 8 - Breast Cancer

San Francisco, CA—Patients with breast cancer who attended survivorship clinics demonstrated improved compliance with follow-up visits, increased use of supportive services, and felt their concerns were better addressed, according to the results of a cancer center’s patient survey reported by Leah L. Dietrich, MD, an oncologist at Gundersen Health System, La Crosse, WI, at the 2014 Breast Cancer Symposium.

The survivorship clinic attendees were significantly more likely to have a medical history and physical examination every 3 to 6 months (P = .004) and regular gynecologic evaluations among users of tamoxifen (P = .003), as recommended by the National Comprehensive Cancer Network (NCCN). Overall, the quality-of-life scores did not differ significantly between the 65 attendees and 52 nonattendees.

“Significant differences in quality of life may be found in larger sample sizes, but not in our current study,” Dr Dietrich and colleagues concluded in a poster presentation. “We are doing well with many aspects of survivor care, regardless of whether patients are attending survivorship clinics.”

They added, “We can improve on some core aspects of our survivorship clinic, such as improving our patients’ recollection and understanding of their treatment summaries and care plans.”

The landmark Institute of Medicine report, “From Cancer Patient to Cancer Survivor: Lost in Transition,” provided the impetus for the development of survivorship programs at many hospitals and clinics. However, few studies have examined the impact of these programs on cancer survivorship.

The Gundersen Center for Cancer and Blood Disorders implemented a survivorship clinic in 2011. Dr Dietrich and colleagues conducted an evaluation of the program and the patients served by it.

The investigators identified 192 women with newly diagnosed stage I to III breast cancer between January 2010 and December 2012 who received all their cancer care at Gundersen Health System. After matching patients who attended the survivorship clinic with those who did not, the evaluation included 117 patients.

The clinic attendees and nonattendees differed only with respect to the frequency of lymph node involvement (24% among attendees and 11% among nonattendees; P = .01).

The attendees were 50% more likely than nonattendees to recall having received a written treatment summary (63% vs 42%, respectively), but a similar proportion of both groups said they knew who to call with questions (96%-100%) and said their primary care providers were well informed by cancer care providers (76%-83%).

All 65 of the clinic attendees adhered to the NCCN recommendations regarding follow-up history and physical examinations, whereas 46 (88%) followed the recommendations. In addition, 11 of the 12 (92%) clinical attendees underwent the recommended evaluations of tamoxifen and gynecologic status compared with 4 of the 16 (25%) nonattendees.

The clinic attendees felt that their concerns were more adequately addressed across all of the domains that were assessed (physical, emotional, practical, spiritual, risk of recurrence, fear of recurrence, and long-term side effects). The only differences that attained statistical significance (P <.05) were practical concerns (work, finances, household activities, etc) and long-term side effects.

Dr Dietrich concluded that “many of these measures can be used to help us improve our care of cancer survivors and for other institutions to measure quality and effectiveness of their programs.”