Breast cancer survivor’s perspectives on the role different providers play in follow-up care

Abstract

Importance: Significant variation in the number and types of oncologists that provide breast cancer follow-up exists. However, there is limited understanding regarding breast cancer survivors’ preferences for who provides their follow-up. Our objective was to explore breast cancer survivors’ perspectives on the goals of breast cancer follow-up, the preferred role for primary care providers, and the perceived roles of different types of oncologists during follow-up. Methods: A convenience sample of stage 0-III breast cancer survivors was identified and in-depth one-on-one interviews conducted. Data were analyzed using inductive content analysis. Results: Survivors cited a strong preference for oncology-based follow-up within the first five years after diagnosis, driven by their need for reassurance that cancer had not recurred. Survivors also thought that their primary care provider needed to be involved. Survivors assumed that oncology follow-up was directed by a standard protocol that included streamlining the follow-up team. Survivors recognized that patients with more complex cancers or challenging treatment courses may require more intensive follow-up and deviate from the standard protocol. Most survivors were comfortable deferring decisions regarding who participated in follow-up to the oncology team. Conclusions: Most patients think a streamlined approach to oncology-based breast cancer follow-up already occurs, driven by a standard protocol. Use of a standard protocol to provide guidance for which types of oncology providers should participate in breast cancer follow-up will streamline care and represents a significant opportunity to reduce unnecessary variation. This approach is especially critical given patients’ strong preferences for oncology-based follow-up.

Association between nonadherence to cardiovascular risk factor medications after breast cancer diagnosis and incidence of cardiac events

“…The majority of patients prefer their PCPs to manage chronic comorbid conditions, but in a population‐based study of >2000 women with stages 0 to II BC, approximately 20% of patients preferred their oncologists to manage general preventive and comorbidity care compared with their PCPs . This may be related to patients' preference for oncology‐focused care within the first years after diagnosis, when patients are most concerned about disease recurrence . Other barriers to PCP participation in BC survivorship include lack of coordinated care, fragmented provider‐to‐provider communication, and changes to the care team as a result of postdiagnosis insurance plan changes or changes regarding the acceptance of insurance plans by physicians .…”

“…20 This may be related to patients' preference for oncologyfocused care within the first years after diagnosis, when patients are most concerned about disease recurrence. [21][22][23] Other barriers to PCP participation in BC survivorship include lack of coordinated care, fragmented provider-to-provider communication, and changes to the care team as a result of postdiagnosis insurance plan changes or changes regarding the acceptance of insurance plans by physicians. [21][22][23][24][25] To our knowledge to date, interventions to enhance communication between oncology specialists and PCPs have not proven to be successful.…”

“…[21][22][23] Other barriers to PCP participation in BC survivorship include lack of coordinated care, fragmented provider-to-provider communication, and changes to the care team as a result of postdiagnosis insurance plan changes or changes regarding the acceptance of insurance plans by physicians. [21][22][23][24][25] To our knowledge to date, interventions to enhance communication between oncology specialists and PCPs have not proven to be successful. 26 The association between PCP follow-up care and adherence to chronic noncancer medications is unknown, and future research is necessary to improve interdisciplinary care delivery as well as comorbidity management between oncology specialists and PCPs in this population, which…”

Follow‐up after breast cancer: Variations, best practices, and opportunities for improvement according to health care professionals

“…HCPs in this study indicated perspectives on the frequency of aftercare widely ranging from leaving the responsibility for organisation of aftercare with the patients as much as possible to providing a structured program with planned care moments, to make sure that all patients receive sufficient aftercare. Additionally, HCPs involved in aftercare varied considerably in disciplines and coordination of care, possibly due to a lack of standard protocols as seen in other studies (Neuman et al, 2017;Tucholka et al, 2018). One way to streamline care and to reduce inefficiency is to appoint a case manager that has an overview of the care process and acts as a contact person for patients.…”

“…The Dutch Breast Cancer Association (BVN) provided input for the study design and patient representatives were present at two interviews. A considerable amount of information about the needs and preferences of patients in breast cancer follow‐up is already present in literature (Berendsen et al, 2016 ; Brandenbarg et al, 2017 ; Feiten et al, 2016 ; Kwast et al, 2013 ; Lubberding et al, 2015 ; Onuma et al, 2019 ; Tucholka et al, 2018 ; van Hezewijk et al, 2011 ).…”