Navigating Breast Cancer Survivorship: Sustaining the Good News

Ann McCue, RN, BSN, OCN®

Robert Fisher, MD

Forty years after the declaration of war on cancer, one of the most profound shifts in cancer care today is a new focus on treating those living beyond cancer, as well as those living with cancer.¹ We celebrate the news that there are more than 2.6 million people in the United States who have a history of breast cancer, yet are alive today.² Oncology professionals, including nurse navigators, must address the specific needs of breast cancer survivors as their numbers continue to grow. In order for the oncology care community to sustain excellent outcomes for these survivors, there are several important questions to consider:

Will medical oncologists continue to provide long-term breast cancer follow-up care?

A recent survey found that 91% of breast cancer patients expect their oncologists to direct their follow-up care. Over the past two years, the American College of Surgeons and the Institute of Medicine have released reports that predict a severe shortage of medical oncologists (MOs) and other oncology-related healthcare personnel over the next 10-20 years.³ The expected shortage and ongoing changes to insurance reimbursement models are two factors that may accelerate the transition of breast cancer follow-up care from oncology specialists to primary care providers (PCPs). It is imperative that PCPs receive the support and education they need in order to provide safe and effective care during this transition.

Are primary care physicians ready to treat breast cancer survivors?

A nationwide study of barriers between PCPs and MOs revealed several clear themes. Cosponsored by the National Cancer Institute and the American Cancer Society, the Survey of Physician Attitudes Regarding the Care of Cancer Survivors was returned by 1072 PCPs and 1130 MOs providing care to breast and colon cancer survivors, a 57% response rate.⁴ PCPs were more likely than MOs to report ordering tests or treatments primarily as malpractice protection, being concerned about missing care, and lacking adequate training to manage patient problems. MOs were more likely than PCPs to report concerns about duplicated care. They also exhibited less confidence in PCPs’ skills to manage breast cancer than the PCPs did themselves. These results highlight the need for greater PCP support and training in breast cancer followup care, and the need for oncologists to promote and support that care by providing thorough treatment summaries and survivorship care plans.

How will breast cancer follow-up care be supported?

National standards are being discussed but are far from being finalized, so it is vital that evidence-based information about breast cancer follow-up care best practices is available to all stakeholders. In the fall of 2011, medical oncologist Robert Fisher, MD, formed a nonprofit organization to accomplish this very goal, as expressed in its mission statement: “The Pink Ribbon Survivors Network exists with the dual purpose of serving the needs of breast cancer survivors and the needs of health care professionals that care for breast cancer survivors.”⁵ The website offers a comprehensive online library that provides information for three primary groups: PCPs, survivors, and oncology professionals, including oncology nurse navigators (ONNs). These groups are all represented on the board.

Living Beyond Breast Cancer

In September 2011, the LIVESTRONG organization sponsored a meeting in Washington, DC, that brought together 150 community leaders, cancer experts, cancer survivors, and their advocates to identify the essential elements of survivorship care delivery. One of the five elements that received unanimous consensus was having a “strategy which addresses care coordination with primary care physicians and primary oncologists.”⁶ As plans evolve to provide support for breast cancer survivors throughout their lives, oncology nurse navigators must stay informed about the process and know how to access resources that will help make this goal a reality.

References

1. MD Anderson Cancer Center. Stages of Cancer Survivorship. MD Anderson Cancer Center website. http://www.mdanderson.org/patient-and-cancerinformation/cancer-information/cancer-topics/survivorship/stages-ofcancer-survivorship/index.html. Accessed January 2, 2011.
2. American Cancer Society. What are the key statistics about breast cancer? ACR website. http://goo.gl/ucpmb. Updated June 11, 2012. Accessed Aug. 8, 2012.
3. Debono D. Coping With the Oncology Workforce Shortage: Transitioning Oncology Follow-Up Care to Primary Care Providers. J Oncol Pract. 2010;6(4)203-205.
4. Potosky AL, Han PKJ, Rowland J, et al. Differences Between Primary Care Physicians’ and Oncologists’ Knowledge, Attitudes and Practices Regarding the Care of Cancer Survivors. J Gen Intern Med. 2011; 26(12);1403-1410.
5. Pink Ribbon Survivors Network. Our Mission. Pink Ribbon Survivors Network website. http://goo.gl/1fwfW. Accessed January 2, 2012.
6. Rechis R, Beckjord EB, Arvey SR, et al. The Essential Elements of Survivorship Care: A Livestrong Brief. Livestrong website. https://livestrong.org/pdfs/3-0/EssentialElementsBrief. Published December 2011. Accessed January 3, 2011.