Randomized phase 2 trial of a coordinated breast cancer follow‐up care program. Issue 22 (26th July 2016)

• Record Type: Journal Article
• Authors: Ruddy, Kathryn J.; Guo, Hao; Baker, Emily L.; Goldstein, Matthew J.; Mullaney, Erin E.; Shulman, Lawrence N.; Partridge, Ann H.
• Is Part Of: Cancer. Volume 122:Issue 22(2016)
• Page Start: 3546
• Page End: 3554
• Publication Date: 2016-07-26
• Subjects: breast neoplasms -- continuity of patient care -- delivery of health care -- patient care planning -- program effectiveness; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.30206
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: Previous research has demonstrated that cancer survivors often fail to receive recommended care and also undergo unnecessary care; this reduces care quality and increases costs. METHODS: This phase 2 trial randomized 100 stage 0 to IIIa breast cancer patients who had primary care providers within a large Massachusetts‐based hospital network (with accessible online records) to either coordinated follow‐up care (CC), which entailed a tailored survivorship care plan (SCP) and patient navigator calls every 3 months, or standard care (SC), which did not include an SCP or patient navigation, for 1 year after the completion of their last chemotherapy, surgery, or radiation treatment. The primary endpoint was the frequency of redundant examinations (>1 breast/chest wall examination per patient within any 30‐day period in the absence of a new breast or chest wall complaint) over the year of follow‐up. The total number of non–plastic surgery visits in the year of follow‐up was a secondary endpoint. RESULTS: Two patients (both on CC) were ineligible, and 2 patients (1 per arm) had a recurrence or died during follow‐up; this left 96 for analysis (47 in the CC arm and 49 in the SC arm). Twenty‐two of the 47 CC patients (47%; 95% confidence interval, 32%‐62%) and 19 of the 49 SC patients (39%; 95% confidence interval, 25%‐54%) had 1 or more redundant breast/chest wall examinations during the year. The median number of non–plastic surgery visits was 12 for CC patients and 8 for SC patients. CONCLUSIONS: Early‐stage breast cancer patients visit health care providers very frequently during their first year of follow‐up and often receive unnecessary breast/chest wall examinations. An SCP and patient navigator calls did not reduce this surrogate for redundant care. Cancer 2016;122:3546–3554 . © 2016 American Cancer Society Abstract : Although there is a need for better coordination of care for breast cancer survivors, a paper survivorship care plan, combined with repeated telephone‐based contact with a patient navigator, has not been found to reduce redundant care in a randomized trial. Future efforts may be more successful if Web‐ or text‐based communication tools are used.