Conference Coverage

Breast cancer survivors need a comprehensive care plan, says doctor



Many of the persistent problems that breast cancer survivors experience after treatment are not part of the conversation with oncologists during treatment, said Patricia A. Ganz, MD, during a presentation at the European Society for Medical Oncology Breast Cancer annual congress.

Several studies suggest that many breast cancer patients are not well prepared to move forward after a breast cancer diagnosis and subsequent treatments, continued Dr. Ganz, who works at the UCLA Jonsson Comprehensive Cancer Center, Los Angeles.

Meeting the survivorship needs of breast cancer patients requires addressing both their physical and psychosocial needs, Dr. Ganz said. She explained how to achieve that, but first pointed to research elaborating on what's missing from some breast cancer survivors' care and barriers to these patients having their variety of health-related needs met.

In a 2021 study published in the Journal of Cancer Survivorship, Dr. Ganz and colleagues conducted a survey of approximately 200 medical oncologists in the United States. They determined that less than 50% provide survivorship care plans to patients at the end of treatment or communicate with patients’ other physicians about follow-up care.

In a secondary analysis of data from the same survey published in 2022 in Breast Cancer Research and Treatment, Dr. Ganz and colleagues examined medical oncologists’ perceived barriers to addressing both physical and psychosocial long-term effects in breast cancer survivors. For both, lack of time was the greatest perceived barrier, cited by nearly two-thirds of oncologists. Other barriers to addressing physical effects included lack of evidence-based, effective interventions, lack of clinical algorithms to guide care, and ambiguity regarding professional responsibility at the end of treatment. Other top barriers to addressing psychosocial issues included lack of mental health providers, lack of psychosocial resources, and lack of clinician knowledge and skills.

Data from additional studies suggest that, overall, cancer patients with greater physical burdens, such as more complex and lengthy treatment regimens, also have greater psychosocial needs, Dr. Ganz noted. Plus, approximately 15%-20% of cancer survivors have ongoing anxiety and depressive symptoms.

Shift to primary care

As more breast cancer and other cancer patients survive for longer periods, more care will likely occur in general medical settings, Dr. Ganz said. Issues to be addressed will include the potential increased risk of comorbid conditions for these survivors, and whether survivorship interventions earlier in the disease trajectory will impact survivorship. For cancer patients who achieve remission after treatment, the first 5 years after a diagnosis involves treatment and short-term surveillance for late effects. Beyond 5 years, care for cancer survivors mainly involves primary care and management of any comorbid conditions, as well as surveillance for late effects and recurrences, and awareness of new research.

A patient consultation early in the process after diagnosis is the start of a continuum of care, Dr. Ganz said. A patient consultation should address symptoms related to initial treatments, such as neuropathy, pain, fatigue, and insomnia, as well as the psychological symptoms of anxiety and depression. An early consultation also should evaluate adherence to endocrine therapy and management of symptoms, if needed, with the larger goal of preparing patients for recovery and the transition to survivorship, and what to expect for long-term follow-up.


Recommended Reading

Anthracycline+taxane combo reduces BC recurrence more effectively than either drug alone
MDedge Hematology and Oncology
Better lifestyle index scores associated with improved mortality and disease recurrence in high-risk BC
MDedge Hematology and Oncology
Postmastectomy implants did not increase risk for squamous cell carcinoma in BC patients
MDedge Hematology and Oncology
HER2+ early BC: Extent of disease at diagnosis may predict risk for relapse even after pCR
MDedge Hematology and Oncology
125I seed placement before neoadjuvant chemotherapy good marking method for metastatic lymph nodes in BC
MDedge Hematology and Oncology
Anlotinib-chemotherapy combo shows good efficacy and safety in metastatic TNBC
MDedge Hematology and Oncology
Are family members of early-onset BC patients at risk for discordant early-onset cancers?
MDedge Hematology and Oncology
Breast cancer survivors face increased risk for sexual dysfunction
MDedge Hematology and Oncology
Reproductive tract infections associated with lower risk and better prognosis in breast cancer
MDedge Hematology and Oncology
PARP inhibitors and breast cancer: Questions remain about wider use
MDedge Hematology and Oncology