Integrating a prospective surveillance model for rehabilitation into breast cancer survivorship care

George Mason University, Center for Study of Chronic Illness and Disability, Fairfax, Virginia 22030, USA.
Cancer (Impact Factor: 4.89). 04/2012; 118(8 Suppl):2201-6. DOI: 10.1002/cncr.27472
Source: PubMed


At some point during or after treatment, breast cancer may be considered a chronic illness, presenting many choices for managing the disease, its adverse treatment-related effects, other medical comorbidities as well as the biobehavioral burden of having a life-threatening disease, even for individuals with potentially curable breast cancer. Health care models, such as the chronic care model, the medical home, and the shared care model, provide a context for building survivorship health care models. Goals and characteristics of recently proposed shared care models for cancer survivorship health care delivery closely align with the goals and concepts of the prospective surveillance model (PSM) proposed elsewhere in this supplement to the journal Cancer. Given these similarities, along with the growth and expansion of survivorship care models and impending mandates for delivery, there is merit to considering how implementation of the PSM can be integrated with models of survivorship care delivery. The PSM model will likely face many similar challenges and barriers that have impeded widespread dissemination of other survivorship models of care. There exist opportunities to integrate lessons learned as well as to align efforts to achieve greater impact on the shared goal of improving health outcomes for breast cancer survivors.

Download full-text


Available from: Nicole L Stout, Oct 08, 2014
  • Source
    • "This accounts for about 12% of all new cancer cases and 25% of all cancers that affect women.1 Furthermore, breast cancer survival has increased significantly due to improvement in diagnosis and treatment programs; women diagnosed with early, node-negative breast cancer now have a 5-year survival of 95%–98%, especially in developed countries.3,4 The significant progress made in prolonging survival after breast cancer treatment has presented new challenges to health care professionals (HCPs) and patients.5 Breast cancer is a long-lasting illness as it presents various post-treatment issues pertaining to cancer and its related treatments, including short- and long-term side effects, comorbidities, and emotional issues (fear of recurrence, late episodes of depression) as well as risk of cancer recurrence.6 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Appropriate follow-up care is important for improving health outcomes in breast cancer survivors (BCSs) and requires determination of the optimum intensity of clinical examination and surveillance, assessment of models of follow-up care such as primary care-based follow-up, an understanding of the goals of follow-up care, and unique psychosocial aspects of care for these patients. The objective of this systematic review was to identify studies focusing on follow-up care in BCSs from the patient's and physician's perspective or from patterns of care and to integrate primary empirical evidence on the different aspects of follow-up care from these studies. Methods: A comprehensive literature review and evaluation was conducted for all relevant publications in English from January 1, 1990 to December 31, 2013 using electronic databases. Studies were included in the final review if they focused on BCS’s preferences and perceptions, physician's perceptions, patterns of care, and effectiveness of follow-up care. Results: A total of 47 studies assessing the different aspects of follow-up care were included in the review, with a majority of studies (n=13) evaluating the pattern of follow-up care in BCSs, followed by studies focusing on BCS's perceptions (n=9) and preferences (n=9). Most of the studies reported variations in recommended frequency, duration, and intensity of follow-up care as well as frequency of mammogram screening. In addition, variations were noted in patient preferences for type of health care provider (specialist versus non-specialist). Further, BCSs perceived a lack of psychosocial support and information for management of side effects. Conclusion: The studies reviewed, conducted in a range of settings, reflect variations in different aspects of follow-up care. Further, this review also provides useful insight into the unique concerns and needs of BCSs for follow-up care. Thus, clinicians and decision-makers need to understand BCS’s preferences in providing appropriate follow-up care tailored specifically for each patient.
    Patient Related Outcome Measures 08/2014; 5:71-85. DOI:10.2147/PROM.S49586
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The authors report on a February 2011 roundtable meeting and introduce a series of articles addressing a prospective evaluation approach for the physical rehabilitation of breast cancer survivors. They issue a call to action to include rehabilitation assessment, rehabilitation interventions, and exercise in survivorship care.
    Cancer 04/2012; 118(8 Suppl):2187-90. DOI:10.1002/cncr.27471 · 4.89 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The current model of care for individuals with breast cancer focuses on treatment of the disease, followed by ongoing surveillance to detect recurrence. This approach lacks attention to patients' physical and functional well-being. Breast cancer treatment sequelae can lead to physical impairments and functional limitations. Common impairments include pain, fatigue, upper-extremity dysfunction, lymphedema, weakness, joint arthralgia, neuropathy, weight gain, cardiovascular effects, and osteoporosis. Evidence supports prospective surveillance for early identification and treatment as a means to prevent or mitigate many of these concerns. This article proposes a prospective surveillance model for physical rehabilitation and exercise that can be integrated with disease treatment to create a more comprehensive approach to survivorship health care. The goals of the model are to promote surveillance for common physical impairments and functional limitations associated with breast cancer treatment; to provide education to facilitate early identification of impairments; to introduce rehabilitation and exercise intervention when physical impairments are identified; and to promote and support physical activity and exercise behaviors through the trajectory of disease treatment and survivorship. The model is the result of a multidisciplinary meeting of research and clinical experts in breast cancer survivorship and representatives of relevant professional and advocacy organizations. The proposed model identifies time points during breast cancer care for assessment of and education about physical impairments. Ultimately, implementation of the model may influence incidence and severity of breast cancer treatment-related physical impairments. As such, the model seeks to optimize function during and after treatment and positively influence a growing survivorship community.
    Cancer 04/2012; 118(8 Suppl):2191-200. DOI:10.1002/cncr.27476 · 4.89 Impact Factor
Show more