Breast Cancer Follow-Up Care Recommendations: Considerations for a Growing Survivorship Population

Follow-up Care

To wrap up the session, Dr Melisko discussed the growing and evolving field of survivorship and follow-up care for women with breast cancer. Currently, survivorship care comprises about one-third of overall breast cancer expenditures, totaling about $8.9 billion in 2014.⁸

As the number of breast cancer survivors, and cancer survivors overall, increases, the health care system must work to establish models of care for transferring the care of these patients from oncologists to primary care physicians or other “physician extenders.” Part of that transition must include evolving follow-up care to be based on patients’ individual disease and risk. 

“If you look at the current guidelines from the National Comprehesive Cancer Network (NCCN) or the American Society of Clinical Oncology (ASCO), they bunch all of breast cancer together, but the biology of breast cancer can be very different,” Dr Melisko said. “Some patients have a high risk of recurrence early but if they make it to 5 years the risk drops dramatically, others have a slow, persistent risk.”

This risk level can help to dictate the level of involvement from primary care physicians. For example, primary care physicians can assume a major role in shared survivorship care of women with low-risk starting 1 to 2 years after a patient has finished treatment; whereas, for women at moderate risk of recurrence, the primary care physician would not assume a major role until closer to 5 years post-treatment. 

Additionally, research should begin to make steps toward looking at different strategies for follow-up care. 

“There needs to be studies to see how people fair in terms of quality of life if we had more interventions that mandated people to see nutritionists, or engaging in exercise programs, or seeing psychologists,” Dr Melisko concluded. “In addition, we should be looking at whether there are subsets of very high-risk patients that would benefit, in terms of better outcomes, from more frequent follow-up.”

References

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2. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. SEER Stat Fact Sheets: Female Breast Cancer. https://seer.cancer.gov/statfacts/html/breast.html. Accessed December 20, 2016.

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5. Chlewboski RT, Blackburn GL, Thomson CA, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition study. J Natl Cancer Inst. 2006;98(24):1767-1776.

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7. Harrigan M, Cartmel B, Loftfield E, et al. Loss counseling on body composition and circulating biomarkers in women treated for breast cancer: The Lifestyle, Exercise, and Nutrition (LEAN) study. J Clin Oncol. 2016:34(7):669-676.

8. Mariotto AB, Yabroff KR, Shao Y, et al. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103(2):117-128.