Study of Survivorship Care Plans and Outcomes in Underserved Breast Cancer Survivors
| Status: | Completed |
|---|---|
| Conditions: | Breast Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 21 - Any |
| Updated: | 4/21/2016 |
| Start Date: | August 2012 |
| End Date: | July 2015 |
Survivorship Plans and Outcomes in Underserved Breast Cancer Survivors RCT
Improvements in early detection and successful treatment of breast cancer have lead to a
steady rise in the number of breast cancer (BC) survivors. With so many individuals living
for extended periods after diagnosis, the Institute of Medicine (IOM) recommends the
implementation of treatment summaries and survivorship care plans (TSSPs) as a mechanism to
improve ongoing clinical and coordination of care, and to address the immediate
post-treatment and long-term effects of cancer treatment, including the ongoing psychosocial
burden of a cancer diagnosis. The need for TSSPs has also been strongly advocated by the
American Society of Clinical Oncology's Quality Oncology Practice Initiative and TSSPs have
been included in the recently introduced Comprehensive Cancer Improvement Act (H.R. 1844).
This will be one of the first randomized controlled trials to test the efficacy of TSSPs.
The investigators will recruit 500 low income, medically underserved women from two county
public hospitals, LAC+USC Medical Center and Harbor-UCLA Medical Center, 10-24 months after
breast cancer diagnosis for participation in a randomized controlled trial (RCT) designed to
test the efficacy of TSSPs. The investigators will randomize these women into one of two
groups: 1) a control condition of usual medical care and 2) an experimental condition of the
control condition + a tailored TSSP + 1 face-to-face nurse counseling session, with all
cancer specialists and primary care physicians of record also receiving the TSSP and a cover
letter suggesting how they can be clinically utilized.
The investigators specific aims are to assess and compare between experimental and control
groups the following primary outcomes at one year post-intervention: 1) discussion and
implementation of recommended breast cancer survivorship care, including surveillance and
the evaluation and management of BC treatment-related symptoms, 2) patient satisfaction with
survivorship communication and care, 3) pertinent aspects of health-related quality of life,
and further, to then 4) assess the cost-consequences of the experimental intervention. This
study will provide a unique opportunity to assess the efficacy of TSSPs in a low-income,
underserved population of BC survivors known to be at high risk for poorer long-term
outcomes, including in mental health, quality of life, recurrence and mortality, and will
therefore allow us to demonstrate the greatest possible benefit of such an intervention.
steady rise in the number of breast cancer (BC) survivors. With so many individuals living
for extended periods after diagnosis, the Institute of Medicine (IOM) recommends the
implementation of treatment summaries and survivorship care plans (TSSPs) as a mechanism to
improve ongoing clinical and coordination of care, and to address the immediate
post-treatment and long-term effects of cancer treatment, including the ongoing psychosocial
burden of a cancer diagnosis. The need for TSSPs has also been strongly advocated by the
American Society of Clinical Oncology's Quality Oncology Practice Initiative and TSSPs have
been included in the recently introduced Comprehensive Cancer Improvement Act (H.R. 1844).
This will be one of the first randomized controlled trials to test the efficacy of TSSPs.
The investigators will recruit 500 low income, medically underserved women from two county
public hospitals, LAC+USC Medical Center and Harbor-UCLA Medical Center, 10-24 months after
breast cancer diagnosis for participation in a randomized controlled trial (RCT) designed to
test the efficacy of TSSPs. The investigators will randomize these women into one of two
groups: 1) a control condition of usual medical care and 2) an experimental condition of the
control condition + a tailored TSSP + 1 face-to-face nurse counseling session, with all
cancer specialists and primary care physicians of record also receiving the TSSP and a cover
letter suggesting how they can be clinically utilized.
The investigators specific aims are to assess and compare between experimental and control
groups the following primary outcomes at one year post-intervention: 1) discussion and
implementation of recommended breast cancer survivorship care, including surveillance and
the evaluation and management of BC treatment-related symptoms, 2) patient satisfaction with
survivorship communication and care, 3) pertinent aspects of health-related quality of life,
and further, to then 4) assess the cost-consequences of the experimental intervention. This
study will provide a unique opportunity to assess the efficacy of TSSPs in a low-income,
underserved population of BC survivors known to be at high risk for poorer long-term
outcomes, including in mental health, quality of life, recurrence and mortality, and will
therefore allow us to demonstrate the greatest possible benefit of such an intervention.
According to the National Cancer Institute (NCI), there are over 11 million cancer survivors
in the United States. Among survivors, breast cancer (BC) is the most common, with BC
survivors accounting for 23% (approximately 2.5 million). A 2006 report by the Institute of
Medicine (IOM), From Cancer Patient to Cancer Survivor: Lost in Transition, provided a
comprehensive assessment of the health needs of cancer survivors including a recommendation
for the implementation of treatment summaries and survivorship care plans (TSSPs) to promote
coordinated care for cancer survivors and to address the immediate post-treatment and
long-term effects of cancer treatment including the ongoing psychosocial burden of a cancer
diagnosis, as well as the potential for later sequelae of treatment. Because of the ever
increasing number of BC survivors, the fact that 98% of patients with local stage and 84% of
patients with regional stage survive for at least 5 years after diagnosis, and the
multimodal nature of BC treatment, providing a mechanism that summarizes, monitors and
coordinates BC follow-up care and treatment is essential. The use of TSSPs has also been
strongly advocated by the American Society of Clinical Oncology's (ASCO) - Quality Oncology
Practice Initiative and TSSPs have been included in the recently introduced Comprehensive
Cancer Improvement Act of 2009 (H.R. 1844). Further, it is apparent that patients themselves
strongly desire written follow-up plans after treatment is ended. The IOM recommended that
research should be undertaken to evaluate the impact and costs of such plans. To our
knowledge, however, no randomized controlled trials of TSSPs or evaluations of their
cost-effectiveness have been conducted in a low-income, medically underserved population.
In the proposed study, we will recruit 500 low income, medically underserved women from two
county public hospitals, Los Angeles County + University of Southern California Medical
Center (LAC+USC Medical Center) and Harbor-UCLA Medical Center, 10-24 months after breast
cancer diagnosis for participation in a randomized control trial (RCT) designed to test the
efficacy of TSSPs. The intervention will be delivered after collection of pre-intervention
(baseline) measures. We will consent and randomize these women into one of two groups: 1) a
control condition of usual medical care and 2) an experimental condition of usual medical
care + tailored materials which includes the TSSP + 1 face-to-face nurse counseling session,
with all cancer specialist and primary care physicians of record also receiving the TSSP and
a cover letter suggesting how it is to be clinically utilized. The study will provide a
unique opportunity to assess the feasibility and clinical utility of a tailored treatment
summary and survivorship care plan in a vulnerable population of BC survivors known to be at
high risk for poorer long-term outcomes, including in mental health, quality of life, BC
recurrence and mortality, and will therefore allow us to obtain the greatest possible effect
size of such an intervention.
We will conduct a randomized controlled trial to test the efficacy of Treatment Summaries
and Survivorship Care Plans and accompanying nurse counseling. The TSSP will consist of 4
sections: 1) the breast cancer treatment summary and 2) a cognitively appropriate
survivorship care plan including recommendations for follow-up breast cancer care for both
the patient and the physician, 3) a special section targeted towards the physician, and 4) a
list of local and national patient resources.
Those women who consent to participate will have pre-intervention measures collected (i.e.,
the baseline interview) and will be randomized to either the usual care condition or the
experimental condition. Individuals in the experimental group will participate in a
face-to-face session with a trained, bilingual nurse to review the contents of the TSSP.
Follow-up measures on all participants will be collected at 12-months after delivery of the
intervention. We will evaluate receipt of recommended breast cancer survivorship care,
patient self-efficacy and satisfaction with communication with providers, health related
quality of life, and cost-effectiveness of the intervention. In addition, all participants
in the control group will receive a written copy of their individualized TSSP at the
completion of the study.
in the United States. Among survivors, breast cancer (BC) is the most common, with BC
survivors accounting for 23% (approximately 2.5 million). A 2006 report by the Institute of
Medicine (IOM), From Cancer Patient to Cancer Survivor: Lost in Transition, provided a
comprehensive assessment of the health needs of cancer survivors including a recommendation
for the implementation of treatment summaries and survivorship care plans (TSSPs) to promote
coordinated care for cancer survivors and to address the immediate post-treatment and
long-term effects of cancer treatment including the ongoing psychosocial burden of a cancer
diagnosis, as well as the potential for later sequelae of treatment. Because of the ever
increasing number of BC survivors, the fact that 98% of patients with local stage and 84% of
patients with regional stage survive for at least 5 years after diagnosis, and the
multimodal nature of BC treatment, providing a mechanism that summarizes, monitors and
coordinates BC follow-up care and treatment is essential. The use of TSSPs has also been
strongly advocated by the American Society of Clinical Oncology's (ASCO) - Quality Oncology
Practice Initiative and TSSPs have been included in the recently introduced Comprehensive
Cancer Improvement Act of 2009 (H.R. 1844). Further, it is apparent that patients themselves
strongly desire written follow-up plans after treatment is ended. The IOM recommended that
research should be undertaken to evaluate the impact and costs of such plans. To our
knowledge, however, no randomized controlled trials of TSSPs or evaluations of their
cost-effectiveness have been conducted in a low-income, medically underserved population.
In the proposed study, we will recruit 500 low income, medically underserved women from two
county public hospitals, Los Angeles County + University of Southern California Medical
Center (LAC+USC Medical Center) and Harbor-UCLA Medical Center, 10-24 months after breast
cancer diagnosis for participation in a randomized control trial (RCT) designed to test the
efficacy of TSSPs. The intervention will be delivered after collection of pre-intervention
(baseline) measures. We will consent and randomize these women into one of two groups: 1) a
control condition of usual medical care and 2) an experimental condition of usual medical
care + tailored materials which includes the TSSP + 1 face-to-face nurse counseling session,
with all cancer specialist and primary care physicians of record also receiving the TSSP and
a cover letter suggesting how it is to be clinically utilized. The study will provide a
unique opportunity to assess the feasibility and clinical utility of a tailored treatment
summary and survivorship care plan in a vulnerable population of BC survivors known to be at
high risk for poorer long-term outcomes, including in mental health, quality of life, BC
recurrence and mortality, and will therefore allow us to obtain the greatest possible effect
size of such an intervention.
We will conduct a randomized controlled trial to test the efficacy of Treatment Summaries
and Survivorship Care Plans and accompanying nurse counseling. The TSSP will consist of 4
sections: 1) the breast cancer treatment summary and 2) a cognitively appropriate
survivorship care plan including recommendations for follow-up breast cancer care for both
the patient and the physician, 3) a special section targeted towards the physician, and 4) a
list of local and national patient resources.
Those women who consent to participate will have pre-intervention measures collected (i.e.,
the baseline interview) and will be randomized to either the usual care condition or the
experimental condition. Individuals in the experimental group will participate in a
face-to-face session with a trained, bilingual nurse to review the contents of the TSSP.
Follow-up measures on all participants will be collected at 12-months after delivery of the
intervention. We will evaluate receipt of recommended breast cancer survivorship care,
patient self-efficacy and satisfaction with communication with providers, health related
quality of life, and cost-effectiveness of the intervention. In addition, all participants
in the control group will receive a written copy of their individualized TSSP at the
completion of the study.
Inclusion Criteria:
- Female
- 21 years of age or older
- English- or Spanish-speaking
- Diagnosis of ductal carcinoma in situ (DCIS) or Stage I, II, or III BC for the first
time
- 10-24 months post-diagnosis
- At least 1 month post-chemotherapy completion
Exclusion Criteria:
- Previous cancer except non-melanomatous skin cancers or in situ non-breast cancers
- Pregnant and lactating women
- Patients receiving parenteral anti-cancer therapy, except trastuzumab
- Clinically apparent cognitive or psychiatric impairment
- Participation in another research study
- Current treatment for another cancer
- Male
- Residing outside of Los Angeles County
- Too ill to participate
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