1. Susman, Ed

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SAN FRANCISCO-Younger cancer patients and those who may consider themselves financially secure appear to be the type of person who needs focused intervention in the form of cancer survivorship care plans, researchers suggested at the inaugural ASCO Cancer Survivorship Symposium (Abstract 8).

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"This is a phase of life issue," said Elizabeth Kvale, MD, Director of the Supportive Care and Survivorship Program and Associate Professor of Medicine at the University of Alabama at Birmingham.


"When you are a younger person, you have competing life priorities and cancer survivorship doesn't fit in very well," she told OT in discussing her poster presentation. "For some, it doesn't fit in at all as to where you thought you were going to be in your life trajectory."


After analyzing responses from a cohort of breast cancer survivors, Kvale and colleagues reported that baseline characteristics including younger age, lower perceived finance adequacy, higher medical comorbidity, burden of depression, and anxious/preoccupation coping were significantly associated with greater self-reported health change (P < 0.05).


Additionally, higher levels of cancer symptom severity, fatigue, lower social functioning, and mental health status at baseline were significantly correlated with greater improvement on depressive symptoms (P < 0.05). Race, education, health literacy level, and cancer stage were not associated with improved outcomes, Kvale said.


What those findings indicate is that, "while survivorship care planning is an important step to improving care for cancer survivors, it is likely that some cancer survivors need a robust intervention to support self-management of survivorship issues," the researchers reported.


The POSTCARE intervention (Patient-Owned Survivorship Transition Care for Activated, EmpoweREd Survivors) demonstrates a positive impact on quality of life, depression, and self-efficacy, Kvale said.


"Our preliminary findings suggest that patients with younger age and higher perceived financial, emotional, and cancer symptom burdens may benefit from a focused survivorship care plan intervention to a greater extent than patients without these characteristics," she said. "There have been a lot of survivorship care plans that don't show a difference, but this is a different way of doing it. The focus is on the process rather than the plan. The survivor gets to prioritize.


"Appropriate targeting of survivorship care planning interventions to patient need is essential, but little evidence exists to support systematic triaging according to survivor needs," she said. Therefore, the researchers sought to examine how patient characteristics predict response to POSTCARE.


Study Specifics

In the parent study, researchers enrolled 79 recent breast cancer survivors. They randomized 40 women to receive the POSTCARE intervention and 39 women were assigned to usual care. Kvale said 75 participants completed post-intervention assessments at 3-month follow-up.


POSTCARE is a single coaching encounter utilizing motivational interviewing techniques to engage patients in the development of a patient-owned survivorship care plan that incorporates health goals and strategies related to surveillance, symptom management, and health behavior, Kvale explained. The survivorship coaching intervention was delivered by Master's-level mental health professionals who completed motivational interviewing trainings.


The steps involved in the intervention include:

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* rapport building and survivorship narration elicitation;


* a review of the treatment summary;


* identification of personalized health goals along with strategies to achieve those goals;


* identification of a health care team and a primary care provider;


* identification of red flags;


* review of medication and exploration of hormonal therapy adherence; and


* review of care transition self-management checklist and completion of the survivorship care plan.



The researchers conducted their data analyses using SPSS (Version 22) and SAS (Version 9.4) programs. Descriptive analyses were performed to assess demographic and treatment characteristics. Linear regression and mixed effect models were conducted to examine the effect of POSTCARE intervention on care coordination, health-related quality of life, and depression. Bivariate correlations were conducted to examine patient characteristics associated with response to the intervention.


Kvale said further work in creating beneficial survivorship care plans should build on errors to define targeting strategies to identify cancer survivors who will benefit from robust survivorship transition support.