Oncology Nurses Build A Successful Survivorship Program For Patients With Recurrent Breast Cancer

A survivorship program can increase quality of life (QoL) for patients living with recurrent breast cancer who are currently facing many unmet needs, according to study findings presented during the European Society of Medical Oncology 2019 Congress.

The unique challenges faced by the roughly 150,000 women who are living with recurrent breast cancer include lack of curative treatment, limited supportive care resources and changes in relationships. To help address these needs, a team that included researchers and oncology nurses from the Helen F. Graham Cancer Center and Research Institute in Newark, Delaware, created and implemented a survivorship program.

Addressing Unmet Needs

This type of program is needed because cancer recurrence information is not as plentiful as other vital treatment information, according to the researchers. In addition, recurrence data is not required to be submitted to various national tumor registries and any recurrent related data is only submitted to the Surveillance, Epidemiology, and End Results (SEER) Program once a year, according to lead study author Darcy Burbage, DNP, RN, AOCN.

“My hope is that recurrence rates will be added to tracking requirements as more individuals are living longer with cancers that have recurred due to advances in symptom management and available treatment options,” Burbage said in an interview with Oncology Nursing News®.

Forty patients, who ranged from ages 36 to 77, were accepted into the Healthy Outcomes for Positivity and Encouragement (H.O.P.E.) program and aided through the coaching process.

“The acronym takes into account that healthy outcomes are defined by the patient, positivity can be found in learning new ways to manage concerns and encouragement is the premise for this program as patients living with recurrent breast cancer will be provided additional support through this program,” she said.

The name H.O.P.E. was chosen, Burbage explained, because some patients expressed concern over the term “survivor” as a label for them. Some patients felt like they didn’t feel like a survivor because their cancer had returned.

Although Burbage accepts the definition of survivorship from the National Coalition of Cancer Survivorship, which states “from the time of diagnosis through the balance of life, a person who has been diagnosed with cancer is a survivor,” she also recognizes that oncology nurses have to provide individualized care to each patient. A cornerstone of how Burbage and fellow researchers implemented the program.

Methods and Findings

Patients were first given the Functional Assessment of Cancer Therapy-Breast (FACT-B) self-report instrument to measure QoL. Based on the top 3 concerns identified in the FACT-B survey, a personalized individual coaching intervention was created using evidence-based interventions to help address the patient’s QoL.

The researchers then waited 2 weeks to follow up with patients and had them retake the FACT-B survey to determine if QoL changed with the help of the tailored intervention. Findings showed that there was a statistically significant increase overall in the QoL reported in the post-intervention survey. Participants showed improvement in their physical, social and emotional well-being, functionality, and patient satisfaction. In addition, 29% of participants contacted the study coordinators for further information and support after the project ended.

Although the program was largely successful, the researchers acknowledged that unknown factors outside of the program’s control could have affected patient responses, such as a small sample size made up of mostly Caucasian women who were college-educated.

However, the findings were encouraging enough for Burbage who hopes to see the program expand to more patients as it grows to handle more referrals.

“Although individuals living with recurrent breast cancer are a heterogeneous population, they share similar unmet needs and those of us who work with this unique patient population can easily implement this program into their practice setting,” Burbage said. “In my clinical practice, having the support of the breast cancer multidisciplinary team was key to patient referrals.”

Reference:

Burbage D, Duffy N, Johnson E.J., et al. Implementing a Cancer Survivorship Program or Individuals with Recurrent Breast Cancer. Presented at 2019 ESMO Congress; September 27-October 2, 2019; Barcelona, Spain.