Follow-up care for breast cancer survivors: improving patient outcomes

Abstract

BackgroundAppropriate follow-up care is important for improving health outcomes in breast cancer survivors (BCSs) and requires determination of the optimum intensity of clinical examination and surveillance, assessment of models of follow-up care such as primary care-based follow-up, an understanding of the goals of follow-up care, and unique psychosocial aspects of care for these patients. The objective of this systematic review was to identify studies focusing on follow-up care in BCSs from the patient’s and physician’s perspective or from patterns of care and to integrate primary empirical evidence on the different aspects of follow-up care from these studies.MethodsA comprehensive literature review and evaluation was conducted for all relevant publications in English from January 1, 1990 to December 31, 2013 using electronic databases. Studies were included in the final review if they focused on BCS’s preferences and perceptions, physician’s perceptions, patterns of care, and effectiveness of follow-up care.ResultsA total of 47 studies assessing the different aspects of follow-up care were included in the review, with a majority of studies (n=13) evaluating the pattern of follow-up care in BCSs, followed by studies focusing on BCS’s perceptions (n=9) and preferences (n=9). Most of the studies reported variations in recommended frequency, duration, and intensity of follow-up care as well as frequency of mammogram screening. In addition, variations were noted in patient preferences for type of health care provider (specialist versus non-specialist). Further, BCSs perceived a lack of psychosocial support and information for management of side effects.ConclusionThe studies reviewed, conducted in a range of settings, reflect variations in different aspects of follow-up care. Further, this review also provides useful insight into the unique concerns and needs of BCSs for follow-up care. Thus, clinicians and decision-makers need to understand BCS’s preferences in providing appropriate follow-up care tailored specifically for each patient.

The Transition Experience to Breast Cancer Survivorship

“…22,37 There is one population-based cohort study with a median follow-up time of 6.6 years that reported stable or improved QOL in the 6 to 18 month post-treatment phase, which resulted in an absolute survival advantage of 4.9% for BCS. 11 This study suggests that interventions that promote self-management, which have been shown to improve QOL outcomes, offer the potential to improve the quality and quantity of survival for BCS.…”

“…4,12,[22][23][24]27 Fear of recurrence represents existential concerns, uncertainty related to prognosis, and perceived morbidity associated with advanced disease. Anxiety is closely related to fear of recurrence and follow-up surveillance visits but lack of adequate knowledge to manage symptoms, uncertainty about the predicted recovery trajectory, and information and access to resources will increase a woman's anxiety levels.…”

“…Information is essential 30,34 but to empower BCS to improve health outcomes 22 we must consider tailoring information to the individual and providing strategies to integrate the information into effective coping and healthy lifestyle behaviors. 21,28,37,38 Self-management has been proposed as a model of cancer care.…”

“…19,21 The expectations for health care providers in survivorship care have been delineated, but to improve health and QOL outcomes for survivors, it is equally important to engage, inform, and support BCS in the transitional survivorship work in the context of their everyday lives. 22,23 The purpose of this article is to review reported concerns and needs of BCS in the transitional phase of survivorship, from curative intent therapy, and describe approaches to quality patient-centered BCS care.…”

Protocol for Moving On: a randomized controlled trial to increase outcome expectations and exercise among breast cancer survivors

“…Patients are commonly provided written information; however, the extent to which they read and find the information useful is rarely assessed. Due to the continuously increasing demands of breast cancer survivorship care (I. Chopra & Chopra, ), it is necessary to test low‐cost, simple methods of disseminating information to patients.…”