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Supportive Care in Cancer

, Volume 26, Issue 6, pp 2015–2022 | Cite as

Breast cancer survivor’s perspectives on the role different providers play in follow-up care

  • J. L. Tucholka
  • N. Jacobson
  • N. M. Steffens
  • J. R. Schumacher
  • A. J. Tevaarwerk
  • B. Anderson
  • L. G. Wilke
  • C. C. Greenberg
  • Heather B. NeumanEmail author
Original Article
  • 245 Downloads

Abstract

Importance

Significant variation in the number and types of oncologists that provide breast cancer follow-up exists. However, there is limited understanding regarding breast cancer survivors’ preferences for who provides their follow-up. Our objective was to explore breast cancer survivors’ perspectives on the goals of breast cancer follow-up, the preferred role for primary care providers, and the perceived roles of different types of oncologists during follow-up.

Methods

A convenience sample of stage 0–III breast cancer survivors was identified and in-depth one-on-one interviews conducted. Data were analyzed using inductive content analysis.

Results

Survivors cited a strong preference for oncology-based follow-up within the first 5 years after diagnosis, driven by their need for reassurance that cancer had not recurred. Survivors also thought that their primary care provider needed to be involved. Survivors assumed that oncology follow-up was directed by a standard protocol that included streamlining the follow-up team. Survivors recognized that patients with more complex cancers or challenging treatment courses may require more intensive follow-up and deviate from the standard protocol. Most survivors were comfortable deferring decisions regarding who participated in follow-up to the oncology team.

Conclusions

Most patients think a streamlined approach to oncology-based breast cancer follow-up already occurs, driven by a standard protocol. The use of a standard protocol to provide guidance for which types of oncology providers should participate in breast cancer follow-up will streamline care and represents a significant opportunity to reduce unnecessary variation. This approach is especially critical given patients’ strong preferences for oncology-based follow-up.

Keywords

Breast cancer Providers Follow-up care Survivorship Surveillance 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Howlader N NA, Krapcho M, Miller D, Bishop K, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA. SEER Cancer Statistics Review, 1975–2013. Bethesda, MD.: National Cancer Institute; 2016:http://seer.cancer.gov/csr/1975_2013/, based on November 2015 SEER data submission, posted to the SEER web site, April 2016
  2. 2.
    Khatcheressian JL, Hurley P, Bantug E, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. Mar 1 2013;31(7):961–965CrossRefGoogle Scholar
  3. 3.
    National Comprehensive Cancer Network. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Breast Cancer. 2016; v.1.2016:http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed February 22, 2016
  4. 4.
    Runowicz CD, Leach CR, Henry NL et al (2016) American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol: Off J Am Soc Clin Oncol 34(6):611–635CrossRefGoogle Scholar
  5. 5.
    Potosky AL, Han PK, Rowland J et al (2011) Differences between primary care physicians’ and oncologists’ knowledge, attitudes and practices regarding the care of cancer survivors. J Gen Intern Med 26(12):1403–1410.  https://doi.org/10.1007/s11606-011-1808-4 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kantsiper M, McDonald EL, Geller G, Shockney L, Snyder C, Wolff AC (2009) Transitioning to breast cancer survivorship: perspectives of patients, cancer specialists, and primary care providers. J Gen Intern Med 24(Suppl 2):S459–S466CrossRefGoogle Scholar
  7. 7.
    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(16):2270–2273CrossRefGoogle Scholar
  8. 8.
    Virgo KS, Lerro CC, Klabunde CN, Earle C, Ganz PA (2013) Barriers to breast and colorectal cancer survivorship care: perceptions of primary care physicians and medical oncologists in the United States. J Clin Oncol 31(18):2322–2336CrossRefGoogle Scholar
  9. 9.
    Klabunde CN, Han PK, Earle CC, Smith T, Ayanian JZ, Lee R, Ambs A, Rowland JH, Potosky a (2013) Physician roles in the cancer-related follow-up care of cancer survivors. Fam Med 45(7):463–474PubMedPubMedCentralGoogle Scholar
  10. 10.
    Bober SL, Recklitis CJ, Campbell EG et al (2009) Caring for cancer survivors: a survey of primary care physicians. Cancer 115(18 Suppl):4409–4418CrossRefGoogle Scholar
  11. 11.
    Dawes AJ, Hemmelgarn M, Nguyen DK et al (2015) Are primary care providers prepared to care for survivors of breast cancer in the safety net? Cancer 121(8):1249–1256CrossRefGoogle Scholar
  12. 12.
    Margenthaler JA, Allam E, Chen L, Virgo KS, Kulkarni UM, Patel AP, Johnson FE (Mar 2012) Surveillance of patients with breast cancer after curative-intent primary treatment: current practice patterns. J Oncol Pract 8(2):79–83.  https://doi.org/10.1200/JOP.2011.000289 CrossRefPubMedGoogle Scholar
  13. 13.
    Grunfeld E, Hodgson DC, Del Giudice ME, Moineddin R (Jul 2010) Population-based longitudinal study of follow-up care for breast cancer survivors. J Oncol Pract 6(4):174–181.  https://doi.org/10.1200/JOP.200009 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Neuman HB, Weiss JM, Schrag D, Ronk K, Havlena J, LoConte NK, Smith MA, Greenberg CC (Dec 2013) Patient demographic and tumor characteristics influencing oncologist follow-up frequency in older breast cancer survivors. Ann Surg Oncol 20(13):4128–4136.  https://doi.org/10.1245/s10434-013-3170-8 CrossRefPubMedGoogle Scholar
  15. 15.
    Neuman HB, Rathouz PJ, Winslow E, Weiss JM, LoConte NK, Lin CP, Wurm M, Smith MA, Schrag D, Greenberg CC (Oct 2016) Use of a novel statistical technique to examine the delivery of breast cancer follow-up care by different types of oncology providers. J Eval Clin Pract 22(5):737–744.  https://doi.org/10.1111/jep.12529 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ganz PA, Hahn EE, Petersen L, Melisko ME, Pierce JP, von Friederichs-Fitzwater M, Lane KT, Hiatt RA (Oct 2016) Quality of posttreatment care among breast cancer survivors in the University of California Athena Breast Health Network (Athena). Clin Breast Cancer 16(5):356–363.  https://doi.org/10.1016/j.clbc.2016.05.003 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Weaver KE, Aziz NM, Arora NK, Forsythe LP, Hamilton AS, Oakley-Girvan I, Keel G, Bellizzi KM, Rowland JH (Jul 2014) Follow-up care experiences and perceived quality of care among long-term survivors of breast, prostate, colorectal, and gynecologic cancers. J Oncol Practice / Am Soc Clin Oncol 10(4):e231–e239.  https://doi.org/10.1200/JOP.2013.001175 CrossRefGoogle Scholar
  18. 18.
    Neuman HB, Schumacher JR, Schneider DF, Winslow ER, Busch RA, Tucholka JL, Smith MA, Greenberg CC (Mar 2017) Variation in the types of providers participating in breast cancer follow-up care: a SEER-Medicare analysis. Ann Surg Oncol 24(3):683–691.  https://doi.org/10.1245/s10434-016-5611-7 CrossRefPubMedGoogle Scholar
  19. 19.
    Neuman HB, Steffens NM, Jacobson N, Tevaarwerk A, Anderson B, Wilke LG, Greenberg CC (Mar 2016) Oncologists’ perspectives of their roles and responsibilities during multi-disciplinary breast cancer follow-up. Ann Surg Oncol 23(3):708–714.  https://doi.org/10.1245/s10434-015-4904-6 CrossRefPubMedGoogle Scholar
  20. 20.
    Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G (Jan 2012) Patient preferences for shared decisions: a systematic review. Patient Educ Couns 86(1):9–18.  https://doi.org/10.1016/j.pec.2011.02.004 CrossRefPubMedGoogle Scholar
  21. 21.
    Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG (2004) Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol 22(15):3091–3098CrossRefGoogle Scholar
  22. 22.
    Katz SJ, Lantz PM, Janz NK et al (2005) Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol: Off J Am Soc Clin Oncol 23(24):5526–5533CrossRefGoogle Scholar
  23. 23.
    Opatt D, Morrow M, Hawley S, Schwartz K, Janz NK, Katz SJ (Sep 2007) Conflicts in decision-making for breast cancer surgery. Ann Surg Oncol 14(9):2463–2469.  https://doi.org/10.1245/s10434-007-9431-7 CrossRefPubMedGoogle Scholar
  24. 24.
    Temple WJ, Russell ML, Parsons LL et al (2006) Conservation surgery for breast cancer as the preferred choice: a prospective analysis. J Clin Oncol 24(21):3367–3373CrossRefGoogle Scholar
  25. 25.
    Murchie P, Norwood PF, Pietrucin-Materek M, Porteous T, Hannaford PC, Ryan M (2016) Determining cancer survivors’ preferences to inform new models of follow-up care. British J Cancer 115(12):1495–1503CrossRefGoogle Scholar
  26. 26.
    Hugh-Yeun K, Kumar D, Moghaddamjou A, Ruan JY, Cheung WY (2017) Young adult cancer survivors’ follow-up care expectations of oncologists and primary care physicians. J Cancer Survivorship : Res Pract 11(3):295–301.  https://doi.org/10.1007/s11764-016-0587-7 CrossRefGoogle Scholar
  27. 27.
    Chubak J, Aiello Bowles EJ, Tuzzio L, Ludman E, Rutter CM, Reid RJ, Wagner EH (Jun 2014) Perspectives of cancer survivors on the role of different healthcare providers in an integrated delivery system. J Cancer Surviv 8(2):229–238.  https://doi.org/10.1007/s11764-013-0335-1 CrossRefPubMedGoogle Scholar
  28. 28.
    Hudson SV, Miller SM, Hemler J, Ferrante JM, Lyle J, Oeffinger KC, DiPaola RS ’. Ann Fam Med Sep-Oct 2012;10(5):418–427, DOI:  https://doi.org/10.1370/afm.1379 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hudson SV, Ohman-Strickland PA, Bator A, O’Malley D, Gundersen D, Lee HS, Crabtree BF, Miller SM (2016) Breast and prostate cancer survivors’ experiences of patient-centered cancer follow-up care from primary care physicians and oncologists. J Cancer Survivorship : Res Pract 10(5):906–914.  https://doi.org/10.1007/s11764-016-0537-4 CrossRefGoogle Scholar
  30. 30.
    Patton MQ (2002) Qualitative research & evaluation methods. Sage Publications, Thousand Oaks, CAGoogle Scholar
  31. 31.
    Elo S, Kyngas H (Apr 2008) The qualitative content analysis process. J Adv Nurs 62(1):107–115.  https://doi.org/10.1111/j.1365-2648.2007.04569.x CrossRefPubMedGoogle Scholar
  32. 32.
    Hsieh HF, Shannon SE (Nov 2005) Three approaches to qualitative content analysis. Qual Health Res 15(9):1277–1288.  https://doi.org/10.1177/1049732305276687 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Miles MB, Huberman AM (1994) An expanded sourcebook: qualitative data analysis, 2ne edn. SAGE Publications, Inc., Thousand Oaks, CaliforniaGoogle Scholar
  34. 34.
    Mao JJ, Bowman MA, Stricker CT et al (2009) Delivery of survivorship care by primary care physicians: the perspective of breast cancer patients. J Clin Oncol 27(6):933–938CrossRefGoogle Scholar
  35. 35.
    Mayer EL, Gropper AB, Neville BA et al (2012) Breast cancer survivors’ perceptions of survivorship care options. J Clin Oncol 30(2):158–163CrossRefGoogle Scholar
  36. 36.
    Wallner LP, Abrahamse P, Uppal JK et al (2016) Involvement of primary care physicians in the decision making and care of patients with breast cancer. J Clin Oncol: Off J Am Soc Clin Oncol 34(33):3969–3975CrossRefGoogle Scholar
  37. 37.
    Cheung WY, Neville BA, Cameron DB, Cook EF, Earle CC (2009) Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol: Off J Am Soc Clin Oncol 27(15):2489–2495CrossRefGoogle Scholar
  38. 38.
    Oeffinger KC, Argenbright KE, Levitt GA, McCabe MS, Anderson PR, Berry E, Maher J, Merrill J, Wollins DS (2014) Models of cancer survivorship health care: moving forward. Am Soc Clin Oncol Educational book / ASCO American Society of Clinical Oncology Meeting 34:205–213.  https://doi.org/10.14694/EdBook_AM.2014.34.205 CrossRefGoogle Scholar
  39. 39.
    Oeffinger KC, McCabe MS Models for delivering survivorship care. J Clin Oncol: Off J Am Soc Clin Oncol, 2006 24(32):5117–5124CrossRefGoogle Scholar
  40. 40.
    Watson EK, Sugden EM, Rose PW (Jun 2010) Views of primary care physicians and oncologists on cancer follow-up initiatives in primary care: an online survey. J Cancer Surviv 4(2):159–166.  https://doi.org/10.1007/s11764-010-0117-y CrossRefPubMedGoogle Scholar
  41. 41.
    Yang W, Williams JH, Hogan PF, Bruinooge SS, Rodriguez GI, Kosty MP, Bajorin DF, Hanley A, Muchow A, McMillan N, Goldstein M (Jan 2014) Projected supply of and demand for oncologists and radiation oncologists through 2025: an aging, better-insured population will result in shortage. J Oncol Pract 10(1):39–45.  https://doi.org/10.1200/JOP.2013.001319 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • J. L. Tucholka
    • 1
  • N. Jacobson
    • 2
  • N. M. Steffens
    • 3
  • J. R. Schumacher
    • 1
  • A. J. Tevaarwerk
    • 4
    • 5
  • B. Anderson
    • 6
  • L. G. Wilke
    • 1
    • 4
  • C. C. Greenberg
    • 1
    • 4
  • Heather B. Neuman
    • 1
    • 4
    Email author
  1. 1.Wisconsin Surgical Outcomes Research Program, Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.School of Nursing, Institute for Clinical and Translational ResearchUniversity of Wisconsin-MadisonMadisonUSA
  3. 3.Denver Public HealthDenver Health and Hospital AuthorityDenverUSA
  4. 4.University of Wisconsin Carbone Cancer CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  5. 5.Department of Medicine, Division of Hematology and OncologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  6. 6.Department of Human OncologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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