The voice of the breast cancer survivor: Implementation of survivorship needs assessment in an integrated health system.

Authors

null

Nayha Tahir

Department of Hematology/Oncology, The Permanente Medical Group, San Francisco, CA

Nayha Tahir, Jenny Wei, Constanza Zamani, Heather Kurz, Nancy Goler, Claudia DeYoung, Samantha Siegel, Aida Shirazi, Christine B. Weldon, Julia R. Trosman, Niharika Dixit, Raymond Liu

Organizations

Department of Hematology/Oncology, The Permanente Medical Group, San Francisco, CA, Department of Medicine, Kaiser Permanente San Francisco, San Francisco, CA, Department of Obstetrics and Gynecology, The Permanente Medical Group, Vallejo, CA, Department of Internal Medicine, The Permanente Medical Group, South Sacramento, CA, The Permanente Medical Group, Sacramento, CA, Department of Graduate Medical Education, Kaiser San Francisco, San Francisco, CA, Center for Business Models in Healthcare, Glencoe, IL, Division of Hematology Oncology, Department of Medicine, University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA

Research Funding

No funding received
None.

Background: The population of breast cancer survivors in the US has reached 3.8 million in 2022, underscoring the importance of understanding survivor needs. To address whether assessment of patient needs is feasible and leads to actionable findings, we implemented a breast cancer survivor needs assessment with standardized documentation of actions taken in the electronic medical record. Methods: An adapted NCCN evaluation tool (Coleman Tool) was used in survivorship visits to assess the feasibility of needs assessment from January 2022 to June 2022 as part of a quality improvement project. The assessment was done either electronically via secure health portal prior to the visit or in person at the time of the visit. Patient, tumor, treatment characteristics as well as needs identified, and actions taken were abstracted from the electronic medical record. Fisher’s exact test used for comparisons. Results: Patients were ethnically diverse (43% White, 39% Asian, 13% Hispanic, African American 4%), English speaking (82%), and employed (50.5%). The median time from cancer diagnosis to needs assessment was 884 days. Most of the patients had Stage 1A (38.2%), were ER (91.7%) and PR (77.8%) positive and HER2 negative (73.7%). The majority underwent lumpectomy (66.4%), had radiation therapy (67.7%) and hormonal therapy (81.6%). Only 32.3% received chemotherapy. Most patients received some form of needs assessment (202 of 217, 94.0%), with 59 (29.2%) receiving pre-appointment electronic assessments with a 42.4% response rate. Major domains of needs reported by patients and actions taken are mentioned below in the table. Both pre and at visit assessments noted a high degree of treatment and physical needs that lead to subsequent actions (p value of 1.00 and 0.04 respectively). Conclusions: An adapted NCCN Needs Assessment Tool (Coleman Tool) is a practical and feasible method of assessing breast cancer survivors’ needs. The assessment can be done pre or at visit and can lead to actions which improve survivorship care.

Specific actions taken, by domain and type of assessment.

Domains and Actions TakenPre-Visit (n, %) At visit (n, %) P value
Psychosocial (n=48) 11 (44.0%) 37 (20.9%) 0.02*
Referral Therapist 4 5
Follow-up Existing Therapist 1 8
General Support 7 24
Medication 0 1
Financial (n=10) 3 (12.0%) 7 (4.0%) 0.11
Referral to Social Work 1 1
Discussion/work letter 2 6
Nutrition (n=40) 11 (44.0%) 29 (16.4%) <0.01*
Referral 8 9
Lifestyle Changes 3 20
Treatment (n=158) 20 (80.0%) 138 (78.2%) 1.00
Education 19 135
Referral/new med 2 10
Physical (n=130) 21 (84.0%) 109 (61.6%) 0.04*
New Referral 7 25
Follow-up 7 36
Med Addition / Changes 5 33
Education/lifestyle/reassurance 8 37
Lifestyle (n=38) 8 (32.0%) 30 (16.9%) 0.10
Referral 2 4
Education/lifestyle/reassurance 6 28

*Statistically significant.

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Abstract Details

Meeting

2023 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Quality, Safety, and Implementation Science,Cost, Value, and Policy,Patient Experience,Survivorship

Sub Track

Communication and Transitions

Citation

JCO Oncol Pract 19, 2023 (suppl 11; abstr 488)

DOI

10.1200/OP.2023.19.11_suppl.488

Abstract #

488

Poster Bd #

L14

Abstract Disclosures

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