According to national estimates, breast cancer ranks as the most common non-cutaneous malignancy among women, representing four in 10 female cancer survivors in the United States. The 5-year survival rate after breast cancer treatment is almost 85% for all stages, according to studies. More than 245,000 women will be newly diagnosed with invasive breast cancer this year, and an estimated 2.8 million breast cancer survivors are alive in the U.S. Considering the likelihood of long-term survival among these patients, it is important to address the unique post-treatment needs of these women so that clinicians can provide quality healthcare.
A Helpful Document
Recently, the American Cancer Society (ACS) and the American Society of Clinical Oncology (ASCO) issued breast cancer survivorship care guidelines. Published in the Journal of Clinical Oncology and in CA: A Journal for Clinicians, the guidelines were developed to enhance the quality of clinical follow-up care for patients who have completed active treatment for breast cancer. The ACS/ASCO guideline expert panel looked at more than 1,000 scientific articles and studies and included 237 as the evidence base. Recommendations provided in the guideline are based on current evidence in the literature and expert consensus opinion.
“It’s important that physicians are aware of this document so that they can use it as a tool in patient care,” says Corinne R. Leach, PhD, MS, MPH, who chaired the guideline writing group. Since the document was released, ACS has developed both a digital application for the survivorship care guidelines for clinicians as well as an online patient self-management tool.
“The ACS/ASCO document builds on and goes beyond recommendations from previous guidelines by providing comprehensive, holistic recommendations that are specific to post-treatment breast cancer clinical care,” explains Dr. Leach. She adds that this information is especially important because many survivors will continue to be at risk for disease recurrence and complications from their breast cancer treatment.
The ACS/ASCO guidelines offer recommendations on the coordination of care to improve quality of care as well as the development of survivorship care plans. “Survivorship care planning is critical for enhancing communication with patients and allocating responsibilities for who should manage different components of future care,” Dr. Leach says. “Ideally, plans should be developed with survivors to identify and prioritize goals for survivorship care. This information can ensure that patients understand their individual risks and recognize the importance of recommended tests, procedures, and supportive care strategies.”
Dr. Leach notes that the promotion of healthy behaviors and lifestyle can also empower patients to take an active role in their health (Table). “Optimizing wellness is critical to enhancing quality of care,” she says. “This requires that survivorship care be coordinated with treating cancer specialists as well as other healthcare providers.” Physicians are recommended to consider each patient’s individual risk profile and preferences of care so that they can address physical and psychosocial effects of the disease.
In many cases, breast cancer survivors who have received treatment may have other chronic conditions. These patients are a challenging group to manage because it is difficult to account for all of the possible permutations when developing specific recommendations for care. The ACS/ASCO guidelines provide comprehensive tables based on specific types of treatment that patients may receive, including surgery, radiation, targeted therapy, and/or chemotherapy, among others. “These tables provide information on potential long-term and late effects that may emerge among breast cancer survivors due to each type of treatment,” says Dr. Leach. “The digital app also provides this information, making it readily accessible on their Apple smartphone device.”
The guidelines note that more data are needed to improve quality of care among breast cancer survivors. “We need better evidence to support strategies for enhancing the coordination of care among healthcare providers who manage this patient population,” Dr. Leach says. “It’s critical that we improve the clarification of roles for all clinicians who work with cancer survivors.”
According to Dr. Leach, more research is also needed on the assessment and management of body image issues, lymphedema, sexual concerns, and bone and musculoskeletal impairments among survivors. “These issues are common among breast cancer survivors, but we lack strong evidence on how best to manage them,” she says. “We also need better data on caring for symptoms associated with breast cancer treatments, such as fatigue, pain, and mental health. The hope is that future research will address these issues so that we can further enhance the quality of care among breast cancer survivors and perhaps increase survival rates.”
According to the ACS/ASCO guidelines, many patients have limited access to medical care, and additional efforts may be required to address health disparities. Patients with cancer who are members of racial and ethnic minorities suffer disproportionately from comorbidities, experience more substantial obstacles to receiving care, are more likely to be uninsured, and are at greater risk of receiving poor-quality care than other Americans. Awareness of these disparities—as well as recognizing potential issues with access to care—are paramount to delivering the highest level of cancer care, according to the guidelines.
Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guidelines. J Clin Onc. 2016; 34:611-635. Available at: http://ascopubs.org/doi/full/10.1200/JCO.2015.64.3809.
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Cowens-Alvarado R, Sharpe K, Pratt-Chapman M, et al. Advancing survivorship care through the National Cancer Survivorship Resource Center: developing American Cancer Society guidelines for primary care providers. CA Cancer J Clin. 2013;63:147-150.
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. 2013;31:961-965.