Abstract
Purpose
This study aims to explore and examine experiences and perceptions of follow-up care (medical and psychosocial) after active treatment for breast cancer among women living outside major Australian cities.
Method
Twenty-five semi-structured telephone interviews were conducted. Participants also completed a brief questionnaire to collect demographic, diagnosis, and treatment information. Interviews were audio-recorded, transcribed, independently coded, and then thematically analysed.
Results
Themes that emerged from the interviews centred on patient experiences and perceptions of follow-up service provision and provider interactions related to medical, psychosocial, and lifestyle (e.g., diet, physical activity) care. Many women perceived a marked decline in the quality and duration of follow-up consultations with clinicians in comparison to their initial treatment experiences. Several women experienced considerable overlap in follow-up care when multiple providers were involved resulting in ‘unnecessary’ time and travel costs. Generally, women experienced limited availability of medical providers in rural areas, resulting in a lack of continuity in care, exacerbated by limited communication and coordination between treating health professionals. Lastly, women perceived a lack of available psychosocial support and resources for rural breast cancer survivors in their areas.
Conclusions
Breast cancer survivors living outside major Australian cities have limited access to medical follow-up care, and psychosocial and lifestyle support programmes. There is a need for greater co-ordination of care between health professionals to improve communication and reduce patient and medical system burden. Finding solutions (such as eHealth options) could help to alleviate these barriers and improve follow-up care for rural breast cancer survivors.
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References
Australian Institute of Health and Welfare, National Breast and Ovarian Cancer Centre (2009) Breast cancer in Australia: An overview 2009. AIHW, Canberra
Australian Institute of Health and Welfare, Australasian Association of Cancer Registries (2008) Cancer in Australia: an overview, 2008. AIHW, Canberra
Australian Institute of Health and Welfare & Cancer Australia, Australasian Association of Cancer Registries (2008) Cancer survival and prevalence in Australia: Cancers diagnosed from 1982 to 2004. AIHW, Canberra
National Breast Cancer Centre (2001) Clinical practice guidelines for the management of early breast cancer. National Health and Medical Research Council, Canberra
Lash TL, Silliman RA (2002) Long-term follow-up of upper body function among breast cancer survivors. Breast J 8:28–33
Vinokur AD, Threatt BA, Vinokur-Kaplan D, Satariano WA (1990) The process of recovery from breast cancer for younger and older patients. Changes during the first year. Cancer 65:1242–1254
Escalante CP (2003) Treatment of cancer-related fatigue: An update. Support Care Cancer 11:79–83
Stasi R, Abriani L, Beccaglia P, Terzoli E, Amadori S (2003) Cancer-related fatigue: Evolving concepts in evaluation and treatment. Cancer 98:1786–1801
Collins LG, Nash R, Round T, Newman B (2004) Perceptions of upper-body problems during recovery from breast cancer treatment. Support Care Cancer 12:106–113
Hewitt ME, Bamundo A, Day R, Harvey C (2007) Perspectives on post-treatment cancer care: Qualitative research with survivors, nurses, and physicians. J Clin Oncol 25:2270–2273
Hewitt M, Greenfield S, Stovall E (2006) From cancer patient to cancer survival: Lost in transition. National Academies Press, Washington, DC
Ganz PA, Kwan L, Stanton AL et al (2004) Quality of life at the end of primary treatment of breast cancer: First results from the moving beyond cancer randomized trial. J Natl Cancer Inst 96:376–387
Stanton AL (2006) Psychosocial concerns and interventions for cancer survivors. J Clin Oncol 24:5132–5137
Stanton AL, Ganz PA, Kwan L et al (2005) Outcomes from the Moving Beyond Cancer psychoeducational, randomized, controlled trial with breast cancer patients. J Clin Oncol 23:6009–6018
Bettencourt BA, Schlegel RJ, Talley AE, Molix LA (2007) The breast cancer experience of rural women: A literature review. Psychooncology 16:875–887
Gray RE, James P, Manthorne J, Gould J, Fitch MI (2004) A consultation with Canadian rural women with breast cancer. Health Expect 7:40–50
Wilson SE, Andersen MR, Meischke H (2000) Meeting the needs of rural breast cancer cancer survivors: What still needs to be done? J Womens Health Gend Based Med 9:667–677
Australian Bureau of Statistics. Australian Standard Geographical Classification, 2001 (No. 1216.0). Canberra: Australian Bureau of Statistics, 2001.
Clavarino AM, Lowe JB, Carmont S-A, Balanda K (2002) The needs of cancer patients and their families from rural and remote areas of Queensland. Aust J Rural Health 10:188–195
Girgis A, Boyes A, Sanson-Fisher RW, Burrows S (2000) Perceived needs of women diagnosed with breast cancer: Rural versus urban location. Aust N Z J Public Health 24:166–173
McGrath P, Patterson C, Yates P et al (1999) A study of postdiagnosis breast cancer concerns for women living in rural and remote Queensland. Part II: Support issues. Aust J Rural Health 7:43–52
Sanson-Fisher R, Girgis A, Boyes A et al (2000) The unmet supportive care needs of patients with cancer. Supportive Care Review Group. Cancer 88:226–237
Strauss A, Corbin J (1990) Basics of qualitative research: grounded theory procedures and techniques. Sage Publications, California
Davis C, Williams P, Redman S, White K, King E (2003) Assessing the practical and psychosocial needs of rural women with early breast cancer in Australia. Soc Work Health Care 36:25–36
Hodgkinson K, Butow P, Hunt GE et al (2007) Breast cancer survivors' supportive care needs 2–10 years after diagnosis. Support Care Cancer 15:515–523
Raupach JC, Hiller JE (2002) Information and support for women following the primary treatment of breast cancer. Health Expect 5:289–301
Brennan ME, Butow P, Spillane AJ, Boyle FM (2010). Survivorship care after breast cancer: follow-up practices of Australian health professionals and attitudes to a survivorship care plan. Asia Pac J Clin Oncol 6:116–125
Gulliford M, Naithani S, Morgan M (2006) What is 'continuity of care'? J Health Serv Res Policy 11:248–250
Eley RM, Rogers-Clark C, Murray K (2008) The value of a breast care nurse in supporting rural and remote cancer patients in Queensland. Cancer Nursing 31:E10–18
Ganz PA (2006) Monitoring the physical health of cancer survivors: a survivorship-focused medical history. J Clin Oncol 24:5105–5111
Oeffinger K, McCabe M (2006) Models for delivering survivorship care. J Clin Oncol 24:5117–5124
Acknowledgements
Dr. S Lawler had full access to all data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. This study was funded a Queensland Health Core Research Infrastructure Grant and NHMRC Program Grant funding (#301200). E Eakin is funded by a NHMRC Senior Research Fellowship (#511001). J Adams is funded by a PHCRED Research Fellowship, Department of Health and Ageing. The project funding body had no role in the design and conduct of the study, data extraction or analyses, in the writing of the manuscript, or the review and approval of the manuscript for publication. We thank the participants from across Australia, the Breast Cancer Network of Australia in supporting this study, and the entire project team. There are no conflicts of interest.
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Lawler, S., Spathonis, K., Masters, J. et al. Follow-up care after breast cancer treatment: experiences and perceptions of service provision and provider interactions in rural Australian women. Support Care Cancer 19, 1975–1982 (2011). https://doi.org/10.1007/s00520-010-1041-4
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DOI: https://doi.org/10.1007/s00520-010-1041-4