Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901

Faul, Leigh Anne; Luta, George; Sheppard, Vanessa B.; Isaacs, Claudine; Cohen, Harvey Jay; Muss, Hyman B.; Yung, Rachel; Clapp, Jonathan D.; Winer, Eric P.; Hudis, Clifford A.; Tallarico, Michelle; Julhy, Wang,; Barry, William T.; Mandelblatt, Jeanne S.

doi:10.1007/s11764-014-0371-5

Cited by 37 publications

(39 citation statements)

References 54 publications

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“…[23][24][25] The increasing use of electronic medical records may also help facilitate electronic communication between PCPs and cancer providers and between these providers and patients via patient portals, but may also hinder more active discussions between providers and patients. These clinician-directed provisions do not address the issue of improving the communication and exchange of information about the cancer care between the PCP and the patient.…”

Section: Discussionmentioning

confidence: 99%

Involvement of Primary Care Physicians in the Decision Making and Care of Patients With Breast Cancer

Wallner

Abrahamse

Uppal

et al. 2016

JCO

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Collaborative care between cancer specialists and primary care providers (PCPs) may improve the delivery of high-quality cancer care. Yet, patient perspectives about how involved the PCPs were in their breast cancer care and treatment decisions remain unknown. Patients and MethodsA weighted random sample of women newly diagnosed with breast cancer in 2013 to 2014, as reported to the SEER registries in Los Angeles, California, and Georgia, were sent a survey approximately 6 months after diagnosis (N = 2,279, 71% response rate). The distributions of patientperceived PCP quality (six questions about PCP access and awareness of values) and the following three measures of patient-reported PCP involvement were assessed: how informed the respondent felt her PCP was about her breast cancer (engagement); how often the respondent talked with her PCP (communication); and how often the respondent felt the PCP participated in treatment decisions (participation). Adjusted mean scores of patient-reported satisfaction with and deliberation about the surgical treatment decision were then compared across levels of PCP engagement, communication, and participation using multivariable linear regression. ResultsThe majority of women in this sample perceived high PCP quality (63.6%), high PCP breast cancer engagement (66.2%), and high PCP communication (69.1%). More than a third of women (35.4%) reported that their PCP participated in their treatment decisions. Higher PCP engagement was associated with higher decision satisfaction when compared with low PCP engagement (adjusted P = .003). ConclusionPatient perceptions of PCP quality and PCP involvement in breast cancer care during treatment are high for most women, and PCPs often participate in breast cancer treatment decisions. However, PCP involvement did not lead to meaningful improvements in patients' appraisals of their decision making.

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Section: Discussionmentioning

confidence: 99%

Involvement of Primary Care Physicians in the Decision Making and Care of Patients With Breast Cancer

Wallner

Abrahamse

Uppal

et al. 2016

JCO

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“…Prior reports included earlier subsets of enrollees and/or shorter‐term follow‐up 24, 25, 26, 27. To the best of our knowledge, the current study is the first report using the final cohort and their complete follow‐up data.…”

Section: Methodsmentioning

confidence: 97%

Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Mandelblatt

Clapp

Luta

et al. 2016

Cancer

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138

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BACKGROUNDThe number of survivors of breast cancer aged ≥65 years (“older”) is growing, but to the authors' knowledge, little is known regarding the cognitive outcomes of these individuals.METHODSA cohort of cognitively intact older survivors with nonmetastatic, invasive breast cancer was recruited from 78 sites from 2004 through 2011; approximately 83.7% of the survivors (1280 survivors) completed baseline assessments. Follow‐up data were collected at 6 months and annually for up to 7 years (median, 4.1 years). Cognitive function was self‐reported using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30); scores ranged from 0 to 100, with a higher score indicating better function. Group‐based trajectory modeling determined trajectories; women were assigned to a trajectory group based on the highest predicted probability of membership. Multinomial logistic regression evaluated the association between receipt of chemotherapy (with or without hormonal treatment) and trajectory group.RESULTSSurvivors were aged 65 to 91 years; approximately 41% received chemotherapy. There were 3 cognitive trajectories: “maintained high” (42.3% of survivors); “phase shift” (50.1% of survivors), with scores slightly below but parallel to maintained high; and “accelerated decline” (7.6% of survivors), with the lowest baseline scores and greatest decline (from 71.7 [standard deviation, 19.8] to 58.3 [standard deviation, 21.9]). The adjusted odds of being in the accelerated decline group (vs the maintained high group) were 2.1 times higher (95% confidence interval, 1.3‐3.5) for survivors who received chemotherapy (with or without hormonal therapy) versus those treated with hormonal therapy alone. Greater comorbidity and frailty also were found to be associated with accelerated decline.CONCLUSIONSTrajectory group analysis demonstrated that the majority of older survivors maintained good long‐term self‐reported cognitive function, and that only a small subset who were exposed to chemotherapy manifested accelerated cognitive decline. Future research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline. Cancer 2016;122:3555–3563. © 2016 American Cancer Society

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“…Prior reports included earlier subsets of patients and/or shorter-term follow-up. 21,25-27 Eligible patients were 65 years or older, were diagnosed with primary invasive non-metastatic breast cancer, spoke English or Spanish, passed an entry cognitive screen using the Blessed Orientation, Memory and Concentration test, 28 and were within 20 weeks of definitive surgery.…”

Section: Methodsmentioning

confidence: 99%

Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance)

Mandelblatt

Cai

Luta

et al. 2017

Breast Cancer Res Treat

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Purpose Breast cancer patients aged 65+ (“older”) vary in frailty status. We tested whether a deficits accumulation frailty index predicted long-term mortality. Methods Older patients (n=1280) with non-metastatic, invasive breast cancer were recruited from 78 Alliance sites from 2004-2011, with follow-up to 2015. Frailty categories (robust, pre-frail, and frail) were based on 35 baseline illness and function items. Cox proportional hazards and competing risk models were used to calculate all-cause and breast cancer-specific mortality for up to 7-years, respectively. Potential covariates included demographic, psychosocial, and clinical factors, diagnosis year, and care setting. Results Patients were 65-91 years old. Most (76.6%) were robust; 18.3% were pre-frail, and 5.1% frail. Robust patients tended to receive more chemotherapy +/- hormonal therapy (vs. hormonal) than pre-frail or frail patients (45% vs. 37% and 36%, p=.06), and had the highest adherence to hormonal therapy. The adjusted hazard ratios for all-cause mortality (n=209 deaths) were 1.7 (95% CI 1.2-2.4) and 2.4 (95% CI 1.5-4.0) for pre-frail and frail vs. robust women, respectively, with an absolute mortality difference of 23.5%. The adjusted hazard of breast cancer death (n-99) was 3.1 (95% CI 1.6-5.8) times higher for frail vs. robust patients (absolute difference of 14%). Treatment differences didn't account for the relationships between frailty and mortality. Conclusions Most older breast cancer patients are robust and could consider chemotherapy where otherwise indicated. Patients who are frail or pre-frail have elevated long-term all-cause and breast-cancer mortality. Frailty indices could be useful for treatment decision-making and care planning with older patients.

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Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901

Cited by 37 publications

References 54 publications

Involvement of Primary Care Physicians in the Decision Making and Care of Patients With Breast Cancer

Involvement of Primary Care Physicians in the Decision Making and Care of Patients With Breast Cancer

Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance)

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