Proactive Care Pathway May Support Breast Cancer Survivor Needs

"Our study can serve as a model for cancer centers wishing to build and implement survivorship programs tailored to their availability and resources. It provides an example of how to apply team medicine and implementation science to deliver comprehensive care for survivors," according to lead study author Maria Alice Franzoi, MD.

A proactive survivorship care pathway was found to be helpful in supporting the needs of breast cancer survivors, according to findings from a pilot implementation study published in JCO Oncology Practice.

Among 321 patients who were eligible and given a personalized survivorship plan, 30% were present at Transition Day—consisting of survivorship seminars and tailored consultations for supportive care referrals. A total of 126 patients received a pathway experience survey, of whom 61.1% responded. Moreover, 70.1% of patients received a personalized survivorship care plan (SCP), and 51.9% were present during Transition Day. Additionally, 59.7% of patients accessed a mobile app designed to deliver personalized education and self-management advice.

Overall, 33.8% of patients who responded to the survey also made use of the resources available with Transition Day and the mobile app, 96.1% of whom reported being completely or very satisfied with the pathway. Of 54 patients who received the SCP, 81.5% agreed or completely agreed that it was easy to read and understand, and 64.8% agreed that it was useful. Of 40 patients who attended Transition Day, 92.5% agreed or completely agreed that it was easy to understand, 90.0% agreed that it was useful, and 62.5% were okay with the length of the seminar. Among 46 of those who used the mobile app, 73.9% agreed or completely agreed that the app was easy to understand, and 65.2% agreed that it was useful.

Of the small population of patients who considered the survivorship pathway components to be not useful, 3 were patients who used the SCP, 2 were those who used the mobile app, and 1 attended Transition Day. Additionally, 9.1% of patients reported that they did not receive an invitation to attend Transition Day, and 23.4% did not receive information on how to use the mobile app.

“This first pilot experience revealed a promising acceptability and feasibility of the pathway in a patient, provider, and organization level,” lead study author Maria Alice Franzoi, MD, stated in a written comment to CancerNetwork^®.

“Based on this study, the pathway is now being refined, including automated data collection from electronic medical records for pre-filling of survivorship care plan; a virtual version of the Transition Day for patients who cannot attend in person as well as incorporation of remote monitoring and self-management modules in the mobile application; [and] coordination of care with primary care for nutritional counselling, physical activity and psychosocial support close to home.”

Franzoi is a medical oncologist and researcher in the Cancer Survivorship Group, INSERM Unit 981 at Gustave Roussy Cancer Centre in Villejuif, France.

Investigators of this pilot implementation study assessed intervention with a survivorship care pathway that included the work of a multidisciplinary team including but not limited to breast medical oncologists, patient representatives, radiation oncologists, and gynecologists. The study was funded by a Conquer Cancer – Breast Cancer Research Foundation Career Development Award for Diversity and Inclusion, supported by the Breast Cancer Research Foundation. The pathway was comprised of 4 elements: the SCP, Transition Day, the mobile app, and symptom management decision aids for physicians focused on supportive care needs.

Investigators proposed the survivorship care pathway for use in a real-world setting among patients with stage I to III breast cancer who previously received primary therapy. Patients were educated about the pathway and invited to participate via their treating oncologist at the end of their treatment visit, an email invitation, and written information inside the SCP document.

The study’s primary outcome was patient-perceived satisfaction with the pathway. Investigators defined pathway progression criteria as a minimum of 70% of patients reporting that they were very or completely satisfied after completing the entire pathway.

Although the study wasn’t based in the United States, Franzoi indicated that the model may serve to manage several challenges that survivors of breast cancer may experience globally, including in the United States. This includes physical symptoms such as fatigue, pain, insomnia, and sexual dysfunction, as well as emotional distress and fear of recurrence. While survivorship care models exist, implementing these programs can be a challenge due to their multidisciplinary nature and the amount of resources for necessary operation, she said.

“Our study can serve as a model for cancer centers wishing to build and implement survivorship programs tailored to their availability and resources,” Franzoi explained. “It provides an example of how to apply team medicine and implementation science to deliver comprehensive care for survivors. Additionally, digital health can greatly facilitate the delivery of certain supportive care interventions if digital literacy programs are also available for patients with less access and exposure to digital devices.”

Through free-text responses, some patients reported the feeling of having their needs addressed, the feeling of not being abandoned, and satisfaction with the care team. Moreover, some patients reported a need for improvement in intervention delivery and the need for continuous care.

A total of 27 oncologists who were involved in breast cancer were given a physician pathway experience survey, 14 of whom responded. The majority of physicians who responded (92.8%) agreed or completely agreed on the usefulness of the SCP. Moreover, 85.7% reported agreement or complete agreement regarding the importance/use of decision aids, 92.8% for the themes explored during Transition Day, and 85.7% for the mobile app’s contents. Overall, 78.6% of physicians agreed that the entire pathway had a positive impact in clinics.

Thirteen of 17 members in the study’s Multidisciplinary Implementation Team responded to the survey, 84.6% of whom expected to continue their activities in the pathway, and 61.5% expressed interest in being involved in more pathway-related activities. Additionally, 46.1% of responders reported an increased workload and disturbance of their general routine.

Franzoi indicated that there are plans to further assess the pathway, and even add to it.

“A prospective cohort will be launched at the end of 2023 to collect longitudinal patient reported outcomes, including quality of life [QOL] and symptom burden, of patients who participated in this pathway,” she said.

“In parallel, we are also piloting another component of the pathway which is the stratification of supportive care services since diagnosis based on individual risk of QOL deterioration. This pilot will start in Q1 2024 and includes communicating the risk of individual long-term toxicities since diagnosis to patients and delivering tailored supportive care according to modifiable risk factors detected. Implementation metrics will also be collected including reach, effectiveness, adoption, implementation barriers and maintenance. We hope that results from these 2 cohort studies will inform and help fund a larger wide scale implementation.”

Reference

Franzoi MA, Degousée L, Martin E, et al. Implementing a PROACTive care pathway to empower and support survivors of breast cancer. JCO Oncol Pract. 2023;19(6):353-361. doi:10.1200/OP.23.00016