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Use of Survivorship Care Plans for Early Breast Cancer Pa ents

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Use of Survivorship Care Plans for Early Breast Cancer Pa ents Powered By Docstoc
					          Sarah
Pra'

Use
of
Survivorship
Care
Plans
for
Early
Breast

               Cancer
Pa8ents

 Use of Survivorship Care Plans
for Early Breast Cancer Patients:
    The Peter Mac Experience

          Sarah Pratt
   Breast Nurse Coordinator


                              2
               Summary
•  An overview of Breast Cancer
   Survivorship
•  Survivorship Care Plans (SCP)
•  Implementation of SCPs at Peter Mac
   (background, project aims, process and
   evaluation)
•  Useful resources and summary


                                      3
Breast cancer
is the third
most common
cancer in
Australia
(excluding non
melanoma skin cancers)




              4
1, 5 and 10
year survival
from breast
cancer is high




          5
5 year survival
     87%




   6
Survival rates are improving




                          7
Greatest
number of
cancer
survivors are
breast cancer
survivors




         8
Potential issues after completing
 treatments for (breast) cancer
•  Varied reactions to       •  Late and long-term effects
   finishing treatment          of treatment
                                 –  menopausal
•  Fear of recurrence                symptoms, loss of
•  Ongoing treatment side            fertility, osteoporosis,
                                     cognitive disturbance,
   effects                           weight changes,
•  Relationship issues               altered body image,
                                     sexual problems,
•  Work / financial issues           fatigue, heart
•  Impact on family                  problems, risk of
                                     second cancers
                             •  Distress, anxiety,
                                depression

                                                          9
     The US Institute of Medicine
            (IOM) report
•    From Cancer Patient
     to Cancer Survivor:
     Lost in Transition
•    Landmark report
•    Argued that the post
     treatment phase is a
     distinct phase that
     requires increased
     attention by
     clinicians             •  17 minute video on
                               YouTube at
                               www.youtube.com/watch?
                               v=7y0msS6KNAA

                                                  10
The US Institute of Medicine
          report
 Recommends four components of quality
 survivorship care
1.  prevention of recurrent and new cancers
2.  surveillance for cancer recurrence as well
    as for medical and psychosocial late effects
3.  strategies to deal with the broad
    consequences of cancer and its treatment
4.  coordination between specialists and
    primary care providers


                                              11
 Strategies to improve outcomes for
          cancer survivors

•  Information
  –  Survivorship care plans
•  Strategies to remain well
•  Regular surveillance
  –  Hospital, GP, nurses-led services
•  Supportive care

                                         12
       Survivorship care plans

•     A key component of optimal survivorship care
      is the use of a survivorship care plan (SCP)
•     The SCP is a summary of:
     –  Cancer diagnosis and treatments
     –  Plans for follow up
     –  Current medical, psychosocial, practical
          issues, and a plan for management
     –  Potential future issues and a plan for
          management
•     Ideally discussed with someone toward the
      end of potentially-curative treatment(s)

                                                 13
     Why do we need them?
•  Because patients can become ‘lost in
   transition’ (from cancer patient to cancer
   survivor)
•  Fragmented, poorly coordinated
   healthcare system
•  Patients need a coordinated plan for
   follow up and a plan to protect their health
•  Patients (and GPs) want to be informed
   and help ensure good survivorship
   outcomes
                                             14
•  The Breast Service is an integrated multidisciplinary service
   providing diagnosis and comprehensive treatment of patients
   with early breast cancer (EBC)
•  A clinical audit conducted in 2007 examined the follow-up care
   of 47 EBC patients who had completed active treatment
   between 2004-2006
•  It was found that:
    –  Although patients should have had a combined total of 285
       follow up appointments, they had a total of 422
    –  Up to 40% of review appointments could be avoided if
       patients followed an approved evidence-based treatment
       Protocol
    –  Communication with referring General Practitioners (GP)
       could be improved.
    –  Patient awareness about survivorship issues and lifestyle
       factors could be improved

                                                           15
•  To introduce an evidence-based End of Treatment (EoT)
   Protocol to establish appropriate follow-up for EBC patients

•  To provide the GP with a comprehensive summary of the
   patient’s journey including information on:
   –  The stage of disease, treatments completed, ongoing
      therapies and recommendations for appropriate follow-up
      and recommendations for the management of any potential
      future problems

•  To provide the GP with support with relation to follow up care

•  To improve the psychosocial care of Peter Mac patients

•  To reduce unnecessary appointments for patients during their 5
   year follow-up
                                                            16
•  Protocols for the best practice follow-up treatment of EBC
   patients were developed by the Breast Service & endorsed in
   2007
•  These relate to the follow up treatment for 6 patient sub-groups,
   depending on the type of treatment received
•  Patients finishing active treatment are identified as eligible for
   the project by the link nurses, Breast Service Secretary and
   Breast Care Nurse Coordinator according to the following
   criteria:
   –  EBC and no evidence of metastatic disease
   –  The patient must have had all their active treatment at Peter
      MacCallum or surgery at St Vincent’s Hospital with the rest of
      the treatment completed at Peter MacCallum
•  Patient information is collated into an individual follow-up plan
   based on the Protocols
                                                                17
•  This plan is prepared by the breast unit secretary,
   reviewed by the BCN and then presented at the weekly
   multidisciplinary team meeting to ensure that all
   information and appropriate recommendations are correct
•  This is endorsed by the patient’s Consultants before a
   copy is posted to the GP and placed in the patient’s
   medical record
•  At the first follow-up appointment, the Breast Care Nurse
   meets with the patient and provides them with a copy of
   their plan.
•  They also provide the patient with information and support
   about survivorship issues and with contact information in
   the event that any new symptoms/concerns occur
   between scheduled appointments
                                                      18
22
23
              Evaluation
1)  GP questionnaire 2008



2)  Patient questionnaire 2008 and 2009



3)  MDT evaluation 2009

                                     24
27
                  Project outcomes
•  The benefit to the patients and their GPs has been significant


    –  The clinical risk associated with patients falling through the gap has
       been reduced, optimising patient treatment outcomes


    –  Patients and their GP now know the follow-up plan for 5 years following
       active treatment


    –  Outpatient appointments involving all teams within the Breast Service
       have been coordinated and unnecessary appointments reduced
               Project outcomes
•  Verbal and survey feedback from patients has been very
   positive:
  - “I am very grateful for the new initiative and the care received at
      Peter Mac. This form gives me a clear idea of my follow up
      appointments for the next 5 years – I have an idea of what to
      expect"
  - “The document is extremely good. It is very clear and easy to find
      the required information”

•  Feedback from GPs has been very positive, encouraging
   primary care partnerships to grow and enabling GP’s to
   be more involved in patient follow-up care:
    - “concise, informative, excellent for myself coordinating pt care”
    - “very useful initiative, keep it going! Thanks”

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Useful resources




                   36
              Resources
Online survivorship care plan
http://www.livestrongcareplan.org/
University of Pennsylvania (Oncolink)

National Cancer Survivorship Initiative
  (NCSI)UK
http://www.improvement.nhs.uk/cancer/
  survivorship/
                                        37
Useful resources




                   38
39
          Acknowledgements

•  Members of the Peter Mac breast MDT
•  A/Professor Michael Jefford (medical
   oncologist)




     sarah.pratt@petermac.org
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