Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Melinda Irwin

Second Advisor

Tara Sanft

Abstract

Despite the Institute of Medicines recommendation that all cancer survivors be provided with a survivorship care plan (SCP) at the end of their treatment, very few cancer centers have a mechanism for doing so. One of the major obstacles for providing breast cancer patients SCPs is that breast cancer treatments are complex, occur over a variable length of time, and are provided by many different providers, thus it is difficult to determine when and who should provide SCPs to patients. However, the majority of patients diagnosed with stage I-III will receive surgery and will continue to follow up with their surgeon for several years following their active treatment phase. The purpose of this study was first to determine if it is feasible to identify women for SCPs at their postoperative visit and track them prospectively throughout their treatment. The secondary aim of this study was to determine if participant's knowledge about their diagnosis, treatment, and risk for long term side effects improved after receiving their SCP .

75 English-speaking women over the age of 18 with stage I-III breast cancer were enrolled at their postoperative appointment. The participants' treatment progress was tracked through the electronic medical record; the treatment information was abstracted from the records and used to create treatment summaries. Once treatment was completed, participants received the SCP during one of their scheduled follow-up appointments. Knowledge of tumor, treatments, potential side effects, and screening recommendations were assessed before receiving the SCP and again two months later. Accuracy of responses at baseline and follow up were compared using the McNemar test.

Accrual occurred during 42 clinic days between April 2011 and February 2012. Of the patients who met the eligibility requirements 100% agreed to participate and we were able to complete 100% of the SCPs regardless of where participants received their treatments. Finally the surgical department was the only common department among all our participants. We found that participants were more accurate in reporting details about their tumor, treatments, screening recommendations, and potential side effects at follow up than they were at baseline for most measures but the only statistically significant changes were in identifying their stage (p = 0.0016), receiving 5-Fluorouracil during chemotherapy (p= 0.0196), and having an increased risk of leukemia (p = 0.0348).

Women recently diagnosed with breast cancer are interested in receiving survivorship care plans after treatment, as demonstrated by 100% accrual rate of eligible patients approached in the postoperative visit. The postoperative visit in a surgical clinic may provide the starting point for tracking a patient through treatment. Additionally SCPs appear to improve patient knowledge in several important areas including basic and specific treatment details, as well as screening recommendations and potential side effects.

Comments

This is an Open Access Thesis.

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