Transitioning from Cancer Patient to Survivor: Implementing a Breast Cancer Survivorship Care Plan

BACKGROUND: Advancements in early detection, research, and treatment have led to increased breast cancer survival. Survivorship begins with diagnosis and continues throughout the lifetime. Anxiety is a common occurrence during the transition from active therapy to surveillance, especially in young females under the age of 45. Evidence supports the use of standardized cancer survivorship care plans (SCPs) to reduce anxiety. Reducing anxiety improves patient-reported outcomes, cancer incidence, and mortality.

LOCAL PROBLEM: This practice improvement project was conducted in an East Tennessee community oncology clinic. The clinic had no standardized process for survivorship care planning. The project's purpose was to implement standardized SCPs for breast cancer survivors under the age of 45, with aims to refer 75% to survivorship care and reduce anxiety by 25%.

METHODS: The Evidence-based Practice Improvement (EBPI) model provided the framework for project implementation. Plan-Do-Study-Act (PDSA) cycles were utilized to test the practice change. Referral rates and anxiety symptoms were measured to evaluate progress toward the aims.

INTERVENTIONS: Breast cancer patients under age 45 who had completed active therapy were referred to a nurse practitioner for survivorship care planning. Standardized SCPs were formulated at the initial meeting. Anxiety symptoms were measured before implementing the SCP and one month after using the generalized anxiety (GAD-7) tool.

RESULTS: 100% of eligible patients were appropriately referred for survivorship care planning, exceeding our project aim of 75%. The pre-intervention GAD-7 mean score was 9.33 (range 0-21). Post-SCP, the GAD-7 mean score was 8.67 (range 0-21), a 7.07% decrease.

CONCLUSIONS: Implementation of an evidence-based standardized SCP process was successful at this project site. While the anxiety reduction aim was not met, anxiety improved. Longer follow-up intervals may allow for better assessment and management of anxiety. The standardization and success of this project provides a foundation for sustainability and spread within the practice to include patients with all cancer types.