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Improving the delivery of team-based survivorship care after primary breast cancer treatment through a multi-level intervention: a pilot randomized controlled trial

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Abstract

Purpose

We developed and tested a multi-level intervention, ConnectedCancerCare (CCC), which includes a tailored website and appointment reminder system for women with early-stage breast cancer and a provider summary letter sent to their medical oncologist and primary care provider to improve the delivery of team-based survivorship care.

Methods

We conducted a pilot randomized controlled trial to establish the feasibility and acceptability of CCC. Women diagnosed with stages 0–II breast cancer within one year of completing primary treatment were randomized to CCC (intervention) or a static online survivorship care plan (control). Participants completed baseline and 3-month follow-up surveys online. Post-trial interviews with 5 PCPs, 6 oncology providers, and 8 intervention patients were conducted.

Results

Of the 160 eligible women invited to participate, 66 completed the baseline survey and were randomized (41%) and 54 completed a follow-up survey (83%). Participants in the intervention arm found the CCC content to be acceptable, with 82% reporting it was easy to use and 86% reporting they would recommend it to other patients. Women randomized to CCC (vs. control) more often reported scheduling a PCP follow-up visit (64% vs. 42%), communicating with their PCP about provider roles (67% vs. 18%), and higher mean team-based cancer care knowledge scores (3.7 vs. 3.4).

Conclusion

Deploying CCC in medical oncology practices was feasible, and the intervention content was acceptable. CCC shows promise for improving patient knowledge and patient–provider communication about provider roles in team-based cancer care and encouraging patients to engage with their PCP early in the survivorship period.

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References

  1. Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, Belin TR (2006) Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer 106:751–758. https://doi.org/10.1002/cncr.21671

    Article  PubMed  Google Scholar 

  2. National Academy of Medicine (2006) From Cancer Patient to Cancer Survivor: Lost in Transition. In: Press TNA (ed), Washington

  3. Fu MR (2014) Breast cancer-related lymphedema: symptoms, diagnosis, risk reduction, and management. World J Clin Oncol 5:241–247. https://doi.org/10.5306/wjco.v5.i3.241

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pachman DR, Barton DL, Swetz KM, Loprinzi CL (2012) Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain. J Clin Oncol 30:3687–3696. https://doi.org/10.1200/JCO.2012.41.7238

    Article  PubMed  Google Scholar 

  5. National Academy of Medicine (2013) Delivering High Quality Cancer Care: Charting a New Course for a System in Crisis. In: Levit LA BE, Nass SJ, and Ganz PA (ed) National Academy of Medicine

  6. Emery JD, Jefford M, King M, Hayne D, Martin A, Doorey J, Hyatt A, Habgood E, Lim T, Hawks C, Pirotta M, Trevena L, Schofield P (2017) ProCare trial: a phase II randomized controlled trial of shared care for follow-up of men with prostate cancer. BJU Int 119:381–389. https://doi.org/10.1111/bju.13593

    Article  PubMed  Google Scholar 

  7. Grunfeld E, Levine MN, Julian JA, Coyle D, Szechtman B, Mirsky D, Verma S, Dent S, Sawka C, Pritchard KI, Ginsburg D, Wood M, Whelan T (2006) Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care. J Clin Oncol: Off J Am Soc Clin Oncol 24:848–855. https://doi.org/10.1200/JCO.2005.03.2235

    Article  Google Scholar 

  8. Mittman N (2018) Evaluating the impact of survivorship models on health system resources and costs. J Clin Oncol. https://doi.org/10.1200/JCO.2018.36.7_suppl.1

    Article  Google Scholar 

  9. NHS Improving Quality (2019) Stratified Cancer Pathways: redesigning services for those living with or beyond cancer. In

  10. Earle CC (2006) Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol: Off J Am Soc Clin Oncol 24:5112–5116. https://doi.org/10.1200/jco.2006.06.5284

    Article  Google Scholar 

  11. Faul LA, Luta G, Sheppard V, Isaacs C, Cohen HJ, Muss HB, Yung R, Clapp JD, Winer E, Hudis C, Tallarico M, Wang J, Barry WT, Mandelblatt JS (2014) Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901. J Cancer Survivorship: Res Pract. https://doi.org/10.1007/s11764-014-0371-5

    Article  Google Scholar 

  12. Forsythe LP, Parry C, Alfano CM, Kent EE, Leach CR, Haggstrom DA, Ganz PA, Aziz N, Rowland JH (2013) Use of survivorship care plans in the United States: associations with survivorship care. J Natl Cancer Inst 105:1579–1587. https://doi.org/10.1093/jnci/djt258

    Article  PubMed  PubMed Central  Google Scholar 

  13. Grunfeld E, Julian JA, Pond G, Maunsell E, Coyle D, Folkes A, Joy AA, Provencher L, Rayson D, Rheaume DE, Porter GA, Paszat LF, Pritchard KI, Robidoux A, Smith S, Sussman J, Dent S, Sisler J, Wiernikowski J, Levine MN (2011) Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. J Clin Oncol: Off J Am Soc Clin Oncol 29:4755–4762. https://doi.org/10.1200/jco.2011.36.8373

    Article  Google Scholar 

  14. Jacobsen PB, Derosa AP, Henderson TO, Mayer D, Moskowitz CS, Paskett ED, Rowland JH (2018) Impact of cancer survivorship care plans (SCPs) on health outcomes and health care delivery: a systematic review. Am Soc Clin Oncol 36:2. https://doi.org/10.1200/JCO.2018.36.7_suppl.2

    Article  Google Scholar 

  15. Jacobsen PB, DeRosa AP, Henderson TO, Mayer DK, Moskowitz CS, Paskett ED, Rowland JH (2018) Systematic review of the impact of cancer survivorship care plans on health outcomes and health care delivery. J Clin Oncol 36:2088–2100

    Article  Google Scholar 

  16. Sprague BL, Dittus KL, Pace CM, Dulko D, Pollack LA, Hawkins NA, Geller BM (2013) Patient satisfaction with breast and colorectal cancer survivorship care plans. Clin J Oncol Nurs 17:266–272. https://doi.org/10.1188/13.cjon.17-03ap

    Article  PubMed  PubMed Central  Google Scholar 

  17. Radhakrishnan A, Chandler McLeod M, Hamilton AS, Ward KC, Katz SJ, Hawley ST, Wallner LP (2019) Preferences for physician roles in follow-up care during survivorship: do patients, primary care providers, and oncologists agree? J Gen Intern Med 34:184–186. https://doi.org/10.1007/s11606-018-4690-5

    Article  PubMed  Google Scholar 

  18. Radhakrishnan A, Li Y, Furgal AKC, Hamilton AS, Ward KC, Jagsi R, Katz SJ, Hawley ST, Wallner LP (2019) Provider involvement in care during initial cancer treatment and patient preferences for provider roles after initial treatment. J Oncol Pract 15:e328–e337. https://doi.org/10.1200/JOP.18.00497

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wallner LP, Abrahamse P, Uppal JK, Friese CR, Hamilton AS, Ward KC, Katz SJ, Hawley ST (2016) Involvement of primary care physicians in the decision making and care of patients with breast cancer. J Clin Oncol 34(33):3969–3975. https://doi.org/10.1200/JCO.2016.67.8896

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wallner LP, Li Y, Furgal AKC, Friese CR, Hamilton AS, Ward KC, Jagsi R, Katz SJ, Hawley ST (2017) Patient preferences for primary care provider roles in breast cancer survivorship care. J Clin Oncol 35:2942–2948. https://doi.org/10.1200/JCO.2017.73.1307

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wallner LP, Li Y, McLeod MC, Gargaro J, Kurian AW, Jagsi R, Radhakrishnan A, Hamilton AS, Ward KC, Hawley ST, Katz SJ (2019) Primary care provider-reported involvement in breast cancer treatment decisions. Cancer 125:1815–1822. https://doi.org/10.1002/cncr.31998

    Article  PubMed  Google Scholar 

  22. Dybå T, Dingsøyr T (2008) Empirical studies of agile software development: a systematic review. Inf Softw Technol 50:833–859

    Article  Google Scholar 

  23. Larman C (2004) Agile and iterative development: a manager’s guide. Addison-Wesley Professional

    Google Scholar 

  24. Meso P, Jain R (2006) Agile software development: adaptive systems principles and best practices. Inf Syst Manag 23:19–30

    Article  Google Scholar 

  25. Hawley ST, Li Y, An LC, Resnicow K, Janz NK, Sabel MS, Ward KC, Fagerlin A, Morrow M, Jagsi R, Hofer TP, Katz SJ (2018) Improving breast cancer surgical treatment decision making: the icandecide randomized clinical trial. J Clin Oncol: Off J Am Soc Clin Oncol 36:659–666. https://doi.org/10.1200/JCO.2017.74.8442

    Article  Google Scholar 

  26. Bodenheimer T, Wagner EH, Grumbach K (2002) Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA 288:1909–1914

    Article  Google Scholar 

  27. Nekhlyudov L, Mollica MA, Jacobsen PB, Mayer DK, Shulman LN, Geiger AM (2019) Developing a quality of cancer survivorship care framework: implications for clinical care, research and policy. J Natl Cancer Inst 111(11):1120–1130. https://doi.org/10.1093/jnci/djz089

    Article  PubMed  PubMed Central  Google Scholar 

  28. National Comprehensive Cancer Network (2018) NCCN Clinical Practice Guidelines in Oncology Survivorship. National Comprehensive Cancer Network Inc., Pennsylvania

    Google Scholar 

  29. Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA (2016) American cancer society/american society of clinical oncology breast cancer survivorship care guideline. J Clin Oncol 34(6):611–635. https://doi.org/10.1200/jco.2015.64.3809

    Article  CAS  PubMed  Google Scholar 

  30. American Society of Clinical Oncology (2018) Survivorship Compendium. American Society of Clinical Oncology, Alexandria

    Google Scholar 

  31. Dillman DA (2007) Mail and internet surveys: the tailored design method. Wiley

    Google Scholar 

  32. Palmer SC, Stricker CT, Panzer SL, Arvey SA, Baker KS, Casillas J, Ganz PA, McCabe MS, Nekhlyudov L, Overholser L, Partridge AH, Risendal B, Rosenstein DL, Syrjala KL, Jacobs LA (2015) outcomes and satisfaction after delivery of a breast cancer survivorship care plan: results of a multicenter trial. J Oncol Pract 11:e222–e229. https://doi.org/10.1200/jop.2014.001404

    Article  PubMed  PubMed Central  Google Scholar 

  33. Klabunde CN, Han PK, Earle CC, Smith T, Ayanian JZ, Lee R, Ambs A, Rowland JH, Potosky AL (2013) Physician roles in the cancer-related follow-up care of cancer survivors. Fam Med 45:463–474

    PubMed  PubMed Central  Google Scholar 

  34. Potosky AL, Han PK, Rowland J, Klabunde CN, Smith T, Aziz N, Earle C, Ayanian JZ, Ganz PA, Stefanek M (2011) Differences between primary care physicians’ and oncologists’ knowledge, attitudes and practices regarding the care of cancer survivors. J Gen Intern Med 26:1403–1410. https://doi.org/10.1007/s11606-011-1808-4

    Article  PubMed  PubMed Central  Google Scholar 

  35. Wensing M (2017) The tailored implementation in chronic diseases (TICD) project: introduction and main findings. Implement Sci 12:5. https://doi.org/10.1186/s13012-016-0536-x

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wensing M, Huntink E, van Lieshout J, Godycki-Cwirko M, Kowalczyk A, Jager C, Steinhauser J, Aakhus E, Flottorp S, Eccles M, Baker R (2014) Tailored implementation of evidence-based practice for patients with chronic diseases. PLoS ONE 9:e101981. https://doi.org/10.1371/journal.pone.0101981

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Hershman DL, Greenlee H, Awad D, Kalinsky K, Maurer M, Kranwinkel G, Brafman L, Jayasena R, Tsai W-Y, Neugut AI (2013) Randomized controlled trial of a clinic-based survivorship intervention following adjuvant therapy in breast cancer survivors. Breast Cancer Res Treat 138:795–806

    Article  CAS  Google Scholar 

  38. Meneses KD, McNees P, Loerzel VW, Su X, Zhang Y, Hassey LA (2007) Transition from treatment to survivorship: effects of a psychoeducational intervention on quality of life in breast cancer survivors. Oncol Nurs Soc 34:1007–1016

    Google Scholar 

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Funding

This study was funded by the National Cancer Institute K07 CA201052. Research reported in this publication was also supported by the NCI under award number P30 CA46592 and through the use of the following Cancer Center Shared Resources: Health Communications, Biostatistics. Dr. Mullins received research support from the National Cancer Institute institutional training Grant T32-CA-236621.

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Authors and Affiliations

  1. Division of General Medicine, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 409E, Ann Arbor, MI, 48109-2800, USA

    Lauren P. Wallner, Archana Radhakrishnan, Lawrence C. An, John Z. Ayanian, Steven Katz & Sarah T. Hawley

  2. Department of Epidemiology, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 409E, Ann Arbor, MI, 48109-2800, USA

    Lauren P. Wallner

  3. Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA

    Lauren P. Wallner, Paul Abrahamse, Archana Radhakrishnan, Megan A. Mullins, Lawrence C. An, Jennifer J. Griggs, Anne F. Schott, Steven Katz & Sarah T. Hawley

  4. Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA

    Joan G. Gargaro & Sarah T. Hawley

  5. Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Jennifer J. Griggs & Anne F. Schott

  6. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA

    Lauren P. Wallner, Archana Radhakrishnan, Lawrence C. An, Jennifer J. Griggs, John Z. Ayanian, Anne E. Sales, Steven Katz & Sarah T. Hawley

  7. Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, MI, USA

    Anne E. Sales

  8. Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA

    Jennifer J. Griggs, John Z. Ayanian, Steven Katz & Sarah T. Hawley

Authors
  1. Lauren P. Wallner
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  2. Paul Abrahamse
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  3. Joan G. Gargaro
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  4. Archana Radhakrishnan
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  5. Megan A. Mullins
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  6. Lawrence C. An
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  7. Jennifer J. Griggs
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  8. Anne F. Schott
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  9. John Z. Ayanian
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  10. Anne E. Sales
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  11. Steven Katz
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  12. Sarah T. Hawley
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Corresponding author

Correspondence to Lauren P. Wallner.

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University of Michigan IRBMED March 2019.

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Wallner, L.P., Abrahamse, P., Gargaro, J.G. et al. Improving the delivery of team-based survivorship care after primary breast cancer treatment through a multi-level intervention: a pilot randomized controlled trial. Breast Cancer Res Treat 189, 81–92 (2021). https://doi.org/10.1007/s10549-021-06257-w

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