Current practice patterns and gaps in guideline-concordant breast cancer survivorship care

Abstract

Purpose Breast cancer-specific survivorship care guidelines for the more than 3.8 million survivors in the U.S. are available, but implementation in clinical practice remains challenging. We examined current practice patterns and factors associated with guideline-concordant survivorship care among oncologists. Methods A national sample of medical oncologists, recruited using two databases, participated in a survey focused on practice patterns for breast cancer survivorship care. A “survivorship care composite score” was calculated for each respondent based on provision of services recommended in the survivorship guidelines. Descriptive statistics and multivariable linear regression analyses examined associations between physician and practice characteristics and composite scores. Results The survey was completed by 217 medical oncologists, with an overall response rate of 17.9% and eligibility rate of 56.9% for those who responded. Oncologists reported high engagement in evaluation of disease recurrence (78%). Performed less frequently were the provision of survivorship care plans (46%), assessment of psychosocial long-term and late effects (34%), and screening for subsequent cancers (34%). Lack of survivorship care training (p = 0.038) and not routinely informing patients about potential late effects (p = 0.003) were significantly associated with poorer survivorship care composite scores. Conclusions Despite the availability of disease-specific survivorship care guidelines, adherence to their recommendations in clinical practice is suboptimal. Survey results identified key gaps in survivorship care for breast cancer survivors, particularly related to subsequent primary cancers and psychosocial long-term and late effects. Implications for Cancer Survivors Improving the delivery of comprehensive survivorship care for the growing population of breast cancer survivors is a high priority. Disease-specific clinical guidelines for cancer survivorship provide valuable recommendations, but innovative strategies are needed to integrate them into the care of long-term breast cancer survivors.

A mixed method study of medical oncologists’ perceived barriers and motivators to addressing long-term effects in breast cancer survivors

“…Our findings reflect the dominant model of survivorship care, in which oncology specialists continue to follow their patients for years to decades after initial treatments, with no transition of care to other providers or settings [6,22]. As previously reported [17], most oncologists in this study described being the sole clinician (62%) providing follow-up care, while others collaborated with an oncology advanced practice provider (APP) in their practice (16%). Only 10% of participants reported access to a dedicated survivorship clinician (MD or NP).…”

“…This is a secondary analysis of survey data from the Medical Oncologist Survivorship Study (MOSS), conducted from October 2018 to April 2020 at the University of California, Los Angeles (UCLA) [ 17 ]. The purpose of this analysis was to examine oncologist-reported barriers and motivators to addressing physical and psychosocial long-term effects using a mixed-methods approach.…”

“…Survey content was informed by findings from prior qualitative research with medical oncologists and breast cancer survivors [8], and available clinical guidelines on survivorship care broadly, breast cancer-specific survivorship care, and specific cancer-related symptoms [10][11][12][13][14][15][18][19][20]. Eligible participants were U.S. medical oncologists who treat breast cancer patients, and were recruited using commercial and research databases from a professional society (ASCO), as described elsewhere [17]. Informed consent was obtained from all study participants.…”

Cancer survivor late-effects, chronic health problems after cancer treatment: what’s the evidence from population and registry data and where are the gaps?

“…A recent survey of medical oncologists in the United States found that only 46% provided survivorship care plans for women with breast cancer, 34% assessed for emotional distress and only 34% screened for additional cancers. Reasons listed were a lack of disease-specific training, lack of understanding of survivorship issues and that women were not routinely informed about potential late effects after treatment [36]. This study explored the medical roles, but there is also a need to consider the referral and access to the broader multi-professional team to address the wide range of problems that occur in cancer survivors.…”

Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer

“…This study can inform the implementation of survivorship care pathways in other centers.However, a comprehensive approach that serves all survivorship domains is insufficiently delivered in clinical practice. 13,14 This may be related to implementation challenges such as lack of health care professional awareness and training and prioritization of survivorship, organizational barriers including the need for dedicated time slots in clinics to allow for multidisciplinary assessment and management…”