Duke University Medical Center, Durham, NC
Kelly Westbrook Mitchell , Kevin Houck , Gretchen Genevieve Kimmick , Kathy J. Trotter , Jeffrey M. Peppercorn
Background: The optimal method for delivery of care to over 2 million breast cancer survivors in the U.S. remains unclear, with multiple models currently in practice. This study involved a patient-centered investigation of experiences and preferences for breast cancer survivorship care. Methods: We conducted a single-institution, cross-sectional, self-administered survey of needs, experiences, and interests following initial breast cancer care at an academic multidisciplinary breast clinic. For 4 weeks, all patients presenting for routine oncology care were provided a survey at appointment check-in. Analysis is descriptive, with chi square testing used to evaluate demographic correlates of response. Results: 612 surveys were distributed, with a response rate of 66.8%. Median age of respondents was 56 (range 26-93); 71% were white, and 18% identified themselves as black. Over 55% had a college degree. Regarding ongoing care, 63% preferred to see a cancer specialist at least annually, and 30% wanted access to a cancer specialist as needed. Less than 15% preferred referral to a local practice, and less than 15% favored follow-up care from a specialized cancer survivorship clinic. Regarding visit content, over 90% felt assessment for disease recurrence was a priority on follow-up. A majority were interested in emotional and psychological support (52%). Nearly 40% of patients felt that assistance with non-cancer related health issues was very important in oncology clinic follow-up, but only 25% wanted a cancer specialist to provide general medical care. 42% reported receiving a summary of their cancer treatment. 37% reported receiving awritten plan or list of recommendations regarding care needed as a cancer survivor. White patients were less likely than non-white patients to receive a treatment summary (p < 0.02) or a care plan (p<0.005). Age and education were not correlated with receipt of these materials. Conclusions: Patients’ experiences and preferences regarding long-term management of breast cancer are varied. Many patients desire ongoing follow-up with their primary oncology team. Further evaluation of patients’ goals, needs, and an evidence-based approach to follow-up care is needed to guide optimal program design.
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