Filling the Gap for Early-Stage Breast Cancer Follow-Up: An Overview for Primary Care Providers

2016 ◽  
Vol 61 (2) ◽  
pp. 166-176 ◽  
Author(s):  
Stacy Bond-Bero
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Early Stage ◽  
Primary Care Providers ◽  
Early Stage Breast Cancer ◽  
Care Providers

Primary care providers propensity to order non-recommended surveillance testing after curative breast cancer treatment.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 52-52
Author(s):  
Lauren P. Wallner ◽  
Paul Abrahamse ◽  
Archana Radhakrishnan ◽  
Ann S. Hamilton ◽  
Kevin C. Ward ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Patients ◽  
Early Stage ◽  
Primary Care Providers ◽  
Early Stage Breast Cancer ◽  
Ca 125 ◽  
Care Providers ◽  
Breast Cancer Patients ◽  
High Propensity

52 Background: Team-based cancer care models promote primary care providers taking on a larger role in survivorship care. However, little is known about PCP attitudes toward and propensity to order non-recommended surveillance testing. Methods: A stratified random sample of PCPs identified by early-stage breast cancer patients diagnosed in 2013-15 who participated in iCanCare Study (Georgia and Los Angeles SEER registries) were surveyed about their experiences caring for cancer patients (N = 519, 58% response rate). PCPs were asked in a clinical vignette whether they would order non-recommended bone scans, other imaging (i.e. PET) or tumor marker testing (i.e. CA-125) in an asymptomatic, early-stage breast cancer survivor. A composite score was created by averaging their responses to the individual items, and categorized by tertiles into low, selective and high propensity to order non-recommended testing. PCP confidence in their knowledge about appropriate testing was also measured (5 pt. Likert-type scale; not all all-very confident) and compared with propensity to order. Multivariable, weighted, multinomial logistic regression was used to then evaluate PCP-reported factors associated with high and selective propensity to order non-recommended testing (vs. low). Results: In this sample, 32% of PCPs had a low propensity, 40% selective, and 28% a high propensity to order non-recommended surveillance tests. Of the 80% of PCPs who reported they were confident in their knowledge about appropriate testing, 27% had a high propensity to order. PCPs practicing in staff-model HMOs were less likely to have a high or selective propensity to order (vs. low) when compared to PCPs in private practice. (high aOR: 0.4, 95%CI: 0.2-0.7; selective aOR: 0.3, 95%CI: 0.2-0.6). Conclusions: Over a quarter of PCPs had a high propensity to order non-recommended surveillance testing for early-stage breast cancer patients, yet the majority reported they were confident in their knowledge about appropriate surveillance testing. Efforts to increase PCP knowledge about the specifics of breast cancer surveillance may be warranted to reduce the overuse of non-recommended testing during survivorship.

scholarly journals Discharge to Primary Care for Survivorship Follow-Up: How Are Patients With Early-Stage Breast Cancer Faring?

2015 ◽  
Vol 13 (6) ◽  
pp. 762-771 ◽  
Author(s):  
Cindy Railton ◽  
Sasha Lupichuk ◽  
Jennifer McCormick ◽  
Lihong Zhong ◽  
Jenny Jaeeun Ko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Early Stage ◽  
Early Stage Breast Cancer

scholarly journals What do primary care providers think about implementing breast cancer survivorship care?

2018 ◽  
Vol 25 (3) ◽  
pp. 196 ◽  
Author(s):  
M. Luctkar-Flude ◽  
A. Aiken ◽  
M.A. McColl ◽  
J. Tranmer
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Early Stage ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Survivorship Care ◽  
Care Providers ◽  
Structured Interviews ◽  
Educational Preparation ◽  
Care Guidelines

Purpose As cancer centres move forward with earlier discharge of stable survivors of early-stage breast cancer (bca) to primary care follow-up, it is important to address known knowledge and practice gaps among primary care providers (pcps). In the present qualitative descriptive study, we examined the practice context that influences implementation of existing clinical practice guidelines for providing such care. The purpose was to determine the challenges, strengths, and opportunities related to implementing comprehensive evidence-based bca survivorship care guidelines by pcps in southeastern Ontario.Methods Semi-structured interviews were conducted with 19 pcps: 10 physicians and 9 nurse practitioners.Results Thematic analysis revealed 6 themes within the broad categories of knowledge, attitudes, and resources. Participants highlighted 3 major challenges related to providing bca survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden. They also described 3 major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles.Conclusions We identified several important challenges to implementation of comprehensive evidence-based survivorship care for bca survivors, as well as several strengths and opportunities that could be built upon to address those challenges. Findings from our research could inform targeted knowledge translation interventions to provide support and education for pcps and bca survivors.

Breast Cancer Follow-Up: Strategies for Successful Collaboration between Cancer Care Specialists and Primary Care Providers

2010 ◽  
Vol 6 (6) ◽  
pp. 452-463
Author(s):  
Mary Ann Zalewski ◽  
Susan Beikman ◽  
Shannon Ferrari ◽  
Kathleen Slavish ◽  
Margaret Rosenzweig
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Successful Collaboration

scholarly journals Use of physician services during the survivorship phase: a multi-province study of women diagnosed with breast cancer

2017 ◽  
Vol 24 (2) ◽  
pp. 81 ◽  
Author(s):  
C. Kendell ◽  
K.M. Decker ◽  
P.A. Groome ◽  
M.L. McBride ◽  
L. Jiang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
British Columbia ◽  
Nova Scotia ◽  
Cancer Survivors ◽  
Primary Care Providers ◽  
Care Providers ◽  
Follow Up Care ◽  
The Mean

Introduction Oncologists have traditionally been responsible for providing routine follow-up care for cancer survivors; in recent years, however, primary care providers (pcps) are taking a greater role in care during the follow-up period. In the present study, we used a longitudinal multi-province retrospective cohort study to examine how primary care and specialist care intersect in the delivery of breast cancer follow-up care.Methods Various databases (registry, clinical, and administrative) were linked in each of four provinces: British Columbia, Manitoba, Ontario, and Nova Scotia. Population-based cohorts of breast cancer survivors were identified in each province. Physician visits were identified using billings or claims data and were classified as visits to primary care (total, breast cancer–specific, and other), oncology (medical oncology, radiation oncology, and surgery), and other specialties. The mean numbers of visits by physician type and specialty, or by combinations thereof, were examined. The mean numbers of visits for each follow-up year were also examined by physician type.Results The results showed that many women (>64%) in each province received care from both primary care and oncology providers during the follow-up period. The mean number of breast cancer–specific visits to primary care and visits to oncology declined with each follow-up year. Interprovincial variations were observed, with greater surgeon follow-up in Nova Scotia and greater primary care follow-up in British Columbia. Provincial differences could reflect variations in policies and recommendations, relevant initiatives, and resources or infrastructure to support pcp-led follow-up care.Conclusions Optimizing the role of pcps in breast cancer follow-up care might require strategies to change attitudes about pcp-led follow-up and to better support pcps in providing survivorship care.

Transition of breast cancer (BC) survivors to primary care: Results of a Cancer Care Ontario (CCO) pilot project.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 58-58 ◽  
Author(s):  
Jonathan Sussman ◽  
Maria Grant
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Providers ◽  
Care Process ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Providers ◽  
Transition Clinic ◽  
Prospective Longitudinal

58 Background: Emerging evidence indicates that the transition of well breast cancer survivors to primary care is safe and effective. Methods: Prospective longitudinal cohort study across 14 health regions in Ontario, Canada. Each region received $100 000 (CAN) to develop and implement a sustainable new model of survivorship care for BC survivors that involved transition from medical oncology-led practice. Each region had a designated lead, and support from primary care. Funding could be used to develop any aspect of the model including personnel support, development of communication materials and outcome measurement. A minimal dataset reporting requirement included a description of the program, documentation of transitioned BC survivors as well as standardized patient and provider experience feedback once transition completed. Results: All 14 health regions in Ontario participated and all developed a survivorship care plan and patient educational materials. The models developed included direct transition to primary care in 6 regions, a nurse-led transition clinic in 4 and a GP-led transition clinic in 4. To date, 3,418 BC survivors have transitioned. Of 676 BC respondents to date, 83% felt there was a clear plan for follow up and 87% felt adequately prepared for transition. Feedback from primary care providers demonstrated that many feel informed about intent of transition and understand their role in on-going follow-up care. Process outcomes such as re-referral back to cancer center and adherence to follow-up guidelines are currently underway. Conclusions: The wide scale transition of appropriate BC survivors to a primary setting appears feasible with high acceptability by patients and providers.

An evaluation of the breast cancer Well Follow-up Care Initiative using administrative databases: A new model of analysis.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 1-1
Author(s):  
Nicole Mittmann ◽  
Craig Earle ◽  
Hasmik Beglaryan ◽  
Ning Liu ◽  
Julie Gilbert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Health System ◽  
Primary Care Providers ◽  
Administrative Databases ◽  
Care Providers ◽  
Significant Difference ◽  
Follow Up Care ◽  
System Resources

1 Background: Cancer Care Ontario (CCO) implemented the Well Follow-up Care Initiative (WFCI) to transition low-risk breast cancer (BC) survivors from oncologist to primary care providers. The objective of this work was to compare both the health system resources utilized and their associated costs, among women in the WFCI (cases) and women who were not transitioned (controls). Methods: Cases were linked to provincial administrative databases and matched to a control group based on year of diagnosis, cancer stage, age, comorbidity, income, geographic area of residence, and prior health system use. Health system resource utilization (physician, hospitalization, diagnostics, medication, and homecare) was ascertained per group. The annual mean and median costs (CAD 2014) per patient were determined. Annualized incremental costs between cases and controls were estimated using generalized estimating equations, accounting for matched pairs. Results: Results are based on 2,324 cases and 2,324 controls (mean age 64.4 and 64.9 years, respectively). During an average of 2.5 years of follow-up since the transition date, there were significant differences between the two groups for mean annual visits per patient with a medical oncologist (0.4 vs. 1.3, p<0.001) and radiation oncologist (0.2 vs. 0.4, p<0.001). There was no significant difference in mean annual family physician visits per patient (7.4 vs. 7.9, p=0.082). The intervention group had fewer inpatient hospitalizations (75.6% vs. 79.9%) and cancer clinic visits (84.9% vs. 94.0%). While there was a higher number of mammograms for cases compared to controls, other diagnostic tests (bone scan, CT, MRI, ultrasound, and x-rays) were done less frequently. The model was associated with a 39.3% reduction in mean annual costs ($6,575 among cases and $10,832 among controls) and a 22.1% reduction in median annual costs ($2,261 among cases and $2,903 among controls). Conclusions: Transitioning BC survivors to primary care was associated with fewer health system resources and had a lower annual mean cost per patient than women who were not transitioned.

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