Patient-Centered, Team-Based Continuing Care After Breast Cancer Treatment: The ConnectedCancerCare Pilot Study
Phase: NA
Conditions: Early-stage Breast Cancer, Breast Cancer Female, Survivorship, Cancer Survivors, Transitional Care
Sponsor: University of Michigan Rogel Cancer Center

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UNIVERSITY OF MICHIGAN 
ROGEL CANCER CENTER 
HUM00115786 - UMCC 2018.016  
Patient-Centered, Team-Based Continuing Care After Breast Cancer Treatment: 
The ConnectedCancerCare Pilot Study 
Principal Investigator 
Lauren P. Wallner, PhD, MPH;  
Department of Internal Medicine, Division of General Medicine 
Co-Investigators 
Sarah T. Hawley, PhD; Department of Internal Medicine 
Steven J. Katz, MD, MPH; Department of Internal Medicine 
John Z. Ayanian, MD, MPPH; Institute for Healthcare Policy and Innovation, and 
Department of Internal Medicine 
Anne Sales, PhD, RN; School of Nursing 
Jennifer Griggs, MD, Department of Internal Medicine, Division of Hematology and 
Oncology 
Statisticians 
Yun Li, PhD; Department of Biostatistics, School of Public Health 
Trial Management Team 
Joan Gargaro, MPH; Department of Internal Medicine 
Study Drug: 
 ConnectedCancerCare Tool 
Initial version: 
1/18/2018 
This study is funded by a career development award from the National Cancer Institute 
(K07 CA201052).  
NCT03618017

 
 
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TABLE OF CONTENTS 
 
STUDY SCHEMA..................................................................................................3 
 
STUDY SUMMARY OR ABSTRACT ....................................................................4 
 
1.0 OBJECTIVES/SPECIFIC AIMS ....................................................................5 
2.0 BACKGROUND AND SIGNIFICANCE.........................................................6 
3.0 PRELIMINARY DATA...................................................................................8 
4.0 METHODS .................................................................................................. 10 
4.1 
Design ................................................................................................... 10 
4.2 
Subject Recruitment .............................................................................. 11 
4.3 
Subject Selection ................................................................................... 11 
4.4 
Intervention ............................................................................................ 11 
4.5 
Time and Events Table .......................................................................... 14 
5.0 MEASURES ................................................................................................ 14 
6.0 PROCEDURES ........................................................................................... 15 
6.1 
Data Management ................................................................................. 15 
7.0 DATA ANALYSIS ....................................................................................... 16 
7.1 
Analysis Plan ......................................................................................... 16 
7.2 
Power Calculations ................................................................................ 16 
8.0 PROTECTION OF HUMAN SUBJECTS .................................................... 16 
 
8.1  Adequacy of Protection Against Risks……………………………………17 
9.0 DATA AND SAFETY MONITORING .......................................................... 18 
10.0 ADVERSE EVENT REPORTING ................................................................ 18 
 
10.1  Pilot Test Safety and Reporting of Adverse Events………………….. 19 
12.0 REFERENCES ............................................................................................ 20 
13.0 APPENDIX (see uploaded supporting documents) 
 

 
 
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STUDY SCHEMA 
 
 
 
 
 

 
 
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STUDY ABSTRACT 
 
The population of aging cancer survivors and their related healthcare needs are rapidly growing 
in the United States, necessitating the delivery of high-quality, team-based, patient-centered 
survivorship care long term. However, the delivery of this continuing care after treatment is 
complex and involves an increasing number of providers, which often results in uncoordinated, 
fragmented and/or duplicated care as a result. Promoting team-based, patient-centered 
continuing care after treatment is currently limited by coordination and communication 
challenges among providers, a lack of evidence about patients’ preferences and expectations 
for their continuing care and few interventions to support the successful transition from primary 
treatment to survivorship. 
 
The goal of this project is to pilot test a personalized, web-based navigation tool to support the 
transition from cancer treatment to survivorship that promotes team-based care. Using breast 
cancer as a model, this study will pilot test a patient-focused website to improve the quality of 
continuing care after primary treatment, by promoting the participation of the primary care 
provider in this care. Completion of this pilot study will inform future versions of the tool, as well 
as the full evaluation of the tool in a multi-site randomized control trial, with the ultimate goal of 
promoting team-based care plans for breast cancer survivors and informing policies to improve 
the quality of ongoing continuing care for cancer patients overall. 
 
STUDY SUMMARY 
 
Title 
Patient-centered, team-based continuing care after breast cancer 
treatment: The ConnectedCancerCare Pilot Study 
Phase 
Pilot study 
Objectives 
Aim 1: To conduct a pilot evaluation to assess the feasibility and 
acceptability of a patient-centered, web-based navigation tool, 
ConnectedCancerCare, that supports the transition from breast 
cancer treatment to survivorship and promotes team-based 
survivorship care. 
          Aim 1A: To assess the feasibility of recruiting at least 60 
and up to 70 women with early-stage breast cancer who are 
completing primary treatment in the breast oncology clinic to the 
study. 
          Aim 2A: To assess the acceptability of the CCC website 
among the 30 women randomized to the CCC intervention group. 
 
Aim 2: To explore whether CCC influences patient and provider 
communication about team-based survivorship care, patient-
reported knowledge about team-based survivorship care and 
follow-up visit scheduling in primary care.   
 
Aim 3: To conduct debriefing interviews with participating patients 
and providers in the intervention group to inform the future 
evaluation and implementation of the tool.  
 
Study Design 
Pilot randomized control trial  
 
Eligibility Criteria 
1. Ability to voluntarily provide written IRB-approved informed 
consent and communicate satisfactorily with the investigator, to 
participate fully in the study, and comply with all its requirements.  
2. Women diagnosed with Stages 0-II breast cancer  

 
 
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3. Women who are receiving care from a medical oncologist 
4. Women who are completing their primary treatment for breast 
cancer and transitioning into survivorship  
 
Statistical Considerations 
As this is a pilot study, we will be primarily assessing whether the 
recruitment of at least 60 and up to 70 women is feasible, and 
whether the majority of participants (50%) report the tool is 
acceptable using descriptive statistics. We will assess differences 
in patient-reported outcomes between the intervention group and 
control group, but this is an exploratory analysis to guide future 
versions of the tool and our planned multi-site RCT. As such, a 
sample size of at least 60 women and up to 70 participants is 
sufficient to address our primary outcomes (see power calculation 
section).  
 
Number of Participants 
At least 60 and up to 70 women (30-35 intervention and 30-35 
control arm) 
Estimated Enrollment 
Period 
9 months 
Estimated Study Duration 
12 months 
 
1. Objectives/Specific Aims 
 
The population of cancer survivors is expected to grow to nearly 19 million by 2024. Breast 
cancer makes up the largest proportion of cancer survivors (3 million) and most of these 
patients are over the age of 60 (72%), have survived at least 5 years (89%), and have other 
medical comorbidities (42%). Nearly all breast cancer survivors will continue to deal with 
treatment-related issues such as pain, fatigue and lymphedema, and most will also face other 
comorbid health concerns as they age. This necessitates the delivery of high-quality, team-
based, patient-centered continuing care, defined as care that encompasses all aspects of care, 
not just that related to the breast. However, the quality of continuing care for breast cancer falls 
short of this goal due to: 1) a burden on patients to coordinate their own care, 2) an increasing 
number of providers involved in delivering care making coordination and communication more 
difficult, 3) increasing care fragmentation and duplication of services provided by primary care 
physicians (PCPs) and oncologists and, importantly, 4) a lack of evidence and interventions to 
support the successful transition from primary treatment to continuing care.   
 
The National Academy of Medicine’s report on the cancer delivery “system in crisis” calls for 
comprehensive, patient-centered, team-based continuing care models that promote cross-
specialty provider collaboration (particularly between PCPs and oncologists) and decrease 
patient burden. Yet, providing high quality, team-based care through the transition to 
survivorship remains a challenge. Although prior research has identified provider-level barriers 
to providing team-based care, patients’ knowledge of what encompasses continuing care is low, 
and little is known about patient preferences and expectations for who provides the various 
aspects of it. Informing patients about team-based continuing care and managing their related 
expectations is critical to improving care coordination, reducing fragmentation and inefficient use 
of services. While team-based care models offer promise for improving continuing cancer care, 
interventions that educate patients about continuing care needs and help them navigate the 
complexities of their cancer and comorbidity management are needed. Therefore, the goal of 
this study is to begin to address the existing gaps in the care of breast cancer survivors by 
building and evaluating an individualized, virtual navigation tool that promotes patient-centered, 
team-based, continuing care after breast cancer treatment. The specific aims of the study are as 
follows:  

 
 
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Aim 1: To conduct a pilot evaluation to assess the feasibility and acceptability of a 
patient-centered, web-based navigation tool, ConnectedCancerCare, that supports the 
transition from breast cancer treatment to survivorship and promotes team-based 
survivorship care. We will conduct a pilot randomized control trial of our prototype website 
ConnectedCancerCare, which is tailored to patient’s knowledge about survivorship care 
guidelines and their preferences for their oncologist and primary care providers’ roles in 
delivering their survivorship care. We will assess the feasibility of conducting a large-scale RCT 
in the future and the acceptability of CCC as outlined below in the following sub-aims:   
 
Aim 1A: To assess the feasibility of recruiting at least 60 and up to 70 women with 
early-stage breast cancer who are completing primary treatment in the breast oncology 
clinic to the study. We will randomize 30-35 women into the intervention group who will view 
the CCC website and 30-35 women into the control group, who will view an online care plan 
document. H1a: It will be feasible to deploy CCC in an academic breast clinic, as measured by 
the successful recruitment of at least 60 and up to 70 women (80%) into the study.   
 
Aim 1B: We will assess the acceptability of the CCC website among the 30-35 
women randomized to the CCC intervention group. H1b: CCC will demonstrate high 
usability among those who interact with it, as measured by patient-reported ratings of website 
usability (ease of use, time to completion, amount of information), usefulness, and whether they 
would recommend it to others.  
 
Aim 2: To explore whether CCC influences patient and provider communication about 
team-based survivorship care, patient-reported knowledge about team-based 
survivorship care and follow-up visit scheduling with primary care. H2a: Patients who view 
CCC will report greater knowledge about and better communication with their providers about 
team-based survivorship care when compared to the control group. H2b: A greater proportion of 
patients who viewed CCC will report scheduling a follow-up visit with their PCP within 3 months 
compared to those who viewed the control website. 
 
Aim 3: To conduct debriefing interviews with a sample of patients and their providers 
about their experiences with ConnectedCancerCare. We will debrief oncologists, PCPs and 
patients (in the intervention arm) about the usefulness of the tool and how to best implement it 
into practice. The results will then be used to further tailor and revise the tool and develop future 
evaluation plans, as well as guide post-evaluation implementation and ultimate incorporation 
into the electronic medical record.  
 
Impact: The findings from this pilot study will directly inform future versions of the CCC 
intervention and support conducting a full-scale, multi-site, randomized control trial to evaluate 
whether CCC improves team-based care delivery for breast cancer survivors (planned R01 
submission to NCI). More broadly, the findings from this study will also inform future 
survivorship care delivery strategies and will help guide interventions to improve the delivery 
and quality of survivorship care, both in breast cancer and other cancers.  
 
2. Background and Significance 
 
The growing number of aging cancer survivors face major challenges because their 
medical care is especially complex. The population of cancer survivors is expected to 
approach 19 million by 2024.hawley1,2 Breast cancer makes up the largest proportion of 
survivors (3 million), the majority of which are over the age of 60 (72%) and have survived at 
least 5 years (89%).1 Nearly all breast cancer survivors will continue to deal with treatment-

 
 
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related issues such as pain, fatigue and lymphedema.3-5 They will also face increasing comorbid 
health concerns as they age, as 42% have at least one comorbidity,6 and on average are seeing 
5-16 different doctors.7 This obligates the delivery of high-quality, team-based, patient-centered 
and comprehensive care.  
 
As a result of concerns regarding the quality of cancer care and the rising costs associated with 
its delivery in the United States, The National Academy of Medicine’s (Academy, formerly IOM) 
released a report in 2013 highlighting the cancer delivery “system in crisis” and calling for 
comprehensive, patient-centered, team-based continuing care models that promote cross-
specialty provider collaboration and decrease patient burden.2 The report highlights the explicit 
goal of providing team-based care to cancer survivors in which members of the cancer team 
coordinate with primary care to implement care plans and deliver efficient and patient-centered 
care. Further supporting team-based care models are provisions for patient-centered medical 
homes and Accountable Care Organizations in the Affordable Care Act, which promote and 
incentivize a collaborative model of care.8 These provisions support oncology providers 
partnering with primary care and geriatric providers in new ways and integrating primary care 
into cancer care delivery throughout the continuum of disease.9 In addition, one of the 
conceptual goals of survivorship care plans (SCPs) is to promote collaboration and 
communication between the providers involved in delivering this care.10 However, despite high 
satisfaction among patients, receipt of care plans has been limited,11,12 and when evaluated, 
SCPs were not found to improve care coordination and quality.13 Nor have these plans 
eliminated the patients’ confusion around the coordination of team-based continuing care and 
which provider is delivering it.14 It is possible that the reason that SCPs have not been 
successful to date is in part driven by the fact that they are not patient-centered enough, and 
aren’t promoting team-based care as they were intended to do conceptually. Despite these 
challenges, SCPs have wide support including recommendations from the Academy and the 
American College of Surgeons Commission on Cancer (ACSCoC). As such, the use of SCPs is 
starting to be required for ACSCoC cancer program accreditation.15 
 
Despite these recommendations, policy provisions and the creation of SCPs, it remains 
very challenging to provide high-quality, patient-centered, team-based care through the 
transition to survivorship. The often chaotic delivery of cancer care is in part driven by the 
increasing number of providers involved in delivering the care, the increasing number of 
comorbid conditions the patients are managing as they age and the burden put on patients to 
coordinate their ongoing care, often with little support or guidance. Workforce shortages further 
complicate these issues, as significant shortages in both oncology and primary care physicians 
are expected by 2020.16 As patients go through care transitions, such as transitioning from 
primary treatment to continuing care, they are at increased risk of experiencing fragmented or 
duplicated care such as repeated or missed clinic visits, lab and imagining tests.17 Because of 
these challenges, continuing to provide cancer care without successfully sharing care between 
specialties such that communication and coordination are improved is not sustainable, and puts 
the patient at high risk of poor quality outcomes.2   
 
The success of these care models is dependent on understanding the factors that 
promote or inhibit them. Previous research suggests that primary care physicians (PCPs) and 
oncologists differ in their knowledge, attitudes and practices as it relates to continuing care.18,19 
Findings from the Survey of Physician Attitudes Regarding the Care of Cancer Survivors Study 
(SPARCCS) suggest the majority of oncologists prefer an oncology dominant model of care 
whereas PCPs prefer a PCP/shared care model.19 Also, clinicians from both specialties are 
uncertain about what roles they should play in delivering continuing care, which may lead to 
duplication or omission of important medical services.19 While previous studies have identified 
provider-level barriers to implementing team-based continuing care, there remains a large gap 
in our understanding about what patients perceive, understand and expect about it. This inhibits 

 
 
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our ability to successfully engage and inform them about their ongoing care needs and 
sufficiently support them as they complete primary treatment.   
 
To successfully promote team-based continuing care models that are truly patient-
centered, we must partner with patients in managing their survivorship care. This requires 
providing patients with patient-centered, reliable information that helps them to navigate the 
transition to survivorship and centrally participate in managing their care going forward. Yet, we 
know very little about patients’ preferences and expectations with regard to their continuing care 
after treatment, particularly as it relates to the role of the PCP. Focus group data suggests that 
patients feel that their care is in part their responsibility, are open to having PCPs manage 
aspects of it, but report hesitation and uncertainty about the role that PCPs play in delivering 
this care.20 As a result, many survivors report that they continue to receive care and 
reassurance from their cancer specialist rather than their PCP.20 Assessment of patients’ 
attitudes, beliefs and knowledge about team-based continuing care in population-based 
samples does not currently exist despite qualitative findings that suggest that they may be 
important barriers to best practices. This lack of understanding hinders our ability to design 
patient-centered interventions that promote team-based care and improve continuing care 
quality and coordination. While team-based care models offer promise for improving continuing 
care, without an understanding of the factors that promote or inhibit them, and the preferences 
and expectations of those involved, these models will not be effective and our ability to design 
interventions to promote team-based care will be limited.  
 
Therefore, the goal of this study is to conduct a pilot evaluation an individualized, virtual 
navigation tool that promotes patient-centered, team-based, continuing care after breast 
cancer treatment. The study objectives address the large gaps in the evidence and the need to 
develop interventions to improve the quality of collaborative care after cancer treatment. Breast 
cancer is an excellent model for this work, as the transition from treatment to survivorship is 
particularly complex with patients remaining on protracted adjuvant therapies. In addition, the 
findings from this study will also be applicable to other cancer survivors as they transition to 
survivorship.  
 
3. Preliminary Data 
 
There are untapped opportunities for PCPs to take on a larger role in survivorship care. 
Our previous findings in the iCanCare Study suggest that PCPs are more involved in care 
during cancer treatment than previously understood. Most women with early-stage breast 
cancer reported high primary care quality (as measured by access and relationship with the 
PCP) during their initial cancer treatment. In addition, the majority reported seeing their current 
PCP for more than 2 years, and that their PCPs were engaged in and informed about the 
cancer care they were receiving during treatment. However, almost a quarter of women 
reported low PCP engagement in and communication about the cancer care during treatment, 
despite reporting high primary care quality. While our findings suggest PCPs are quite engaged 
in cancer care during treatment, another recent study from Canada suggests that patient 
contacts with their PCPs decreased over time in survivorship and were lowest in the adjuvant 
treatment phase.21 Prior work from our group also suggests that PCP involvement may be lower 
later in survivorship, as only a quarter of women with early-stage breast cancer reported they 
were followed by a PCP 4 years after diagnosis.22  
 
There is a need to clarify provider roles during survivorship. Because prior cancer care 
delivery research has focused on characterizing utilization in survivorship, it remains unknown 
what aspects of care PCPs are handling vs. what aspects oncologists are handling in 
survivorship. This has led a lack of clarity regarding provider roles in survivorship care. As a 
result, current guidelines fall short of clearly delineating which specialty should handle the 

 
 
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various aspects of care. This has led to confusion among both patients and providers.23 Our 
prior work in the iCanCare Study supports this, as the majority of women with early-stage breast 
cancer preferred their oncologists handle multiple aspects of their survivorship care that PCPs 
typically deliver (e.g. screening for other cancers and comorbidity management).24  
 
In addition, this ongoing lack of clarity about provider roles in survivorship may result in 
clinicians providing care outside the scope of their specialty. Our preliminary oncologist data 
from iCanCare suggests that this may be the case, as most medical oncologists reported often 
having problems in avoiding duplication of care with PCPs as well as coordinating care for 
existing or new comorbidities. Importantly, over one third of oncologists reported problems even 
determining whether they or the PCP should provide general preventive care. Others have 
reported similar findings, specifically with respect to oncologists providing the majority of 
survivorship care.25 Therefore, oncologists may not only continue to dominate surveillance 
services and cancer-related follow-up, they may also be delivering aspects of care that PCPs or 
other specialists typically deliver.  
 
Significant disparities exist in the quality of breast cancer care. Our research group, the 
Cancer Surveillance and Outcomes Research Team (CanSORT), has extensive experience in 
conducting population-based studies of diverse cancer patients, their caregivers and clinicians 
focused on examining disparities in the quality of cancer treatment and outcomes. This work 
has directly informed multiple patient-level interventions focused on improving the quality of 
cancer care.26 Our prior research has also demonstrated important sociodemographic 
disparities in the breast cancer treatment decision-making process27-29 and outcomes after 
treatment,22 including financial toxicity,30-32 worry about recurrence33 and quality of life34 years 
after initial treatment, notably among black and Latina women.35-37 Our population-based 
research directly informs our intervention research and has led to the development and 
successful evaluation of a multi-site randomized control trial of a patient decision aid for breast 
cancer treatment, led by Dr. Wallner’s mentor, Dr. Sarah Hawley. The ConnectedCancerCare 
pilot study will be modeled after the pilot approach used to support this study, which ultimately 
led to the successful recruitment of over 500 patients across multiple clinic sites across the US 
for the full-scale RCT.38  
 
Beta Testing. Usability testing of an early version of the ConnectedCancerCare website was 
conducted with early stage breast cancer patients (n= 4; age range: 33-50 years) who had 
recently completed active treatment and were in continuing/survivorship care. Patients were 
identified via outreach with the Breast Cancer Advocacy Committee at UM Rogel Cancer 
Center. Participants met with a team of developers and designers in the Center for Health 
Communications Research (CHCR) to go through the website and think out loud about the 
navigation, flow, usability and drafts of the content. While viewing the beta website on a laptop 
computer, patients were asked about the ease of navigation and functionality of the site; clarity 
of links to sections; expectations and satisfaction with information under specific sections; the 
value of a “to-do” vs. checklist; knowledge of medical team members’ roles in their survivorship 
care; and general questions pertaining to the overall look and feel of the site and what they liked 
and/or disliked in viewing all the website pages.  
 
Based on their feedback, ConnectedCancerCare was enhanced as follows: 1) “to-do” list was 
combined into the patient checklist and renamed “My Next Steps,” 2) information sections were 
renamed to clarify content (i.e. My primary care doctor became Primary care during 
survivorship), and 3) greater emphasis was added to onboarding patients and explaining the 
importance of scheduling a PCP appointment. The modifications made as a result of user 
testing will provide patients with a better understanding of the primary purpose of the website 
(i.e. PCP involvement in survivorship care). 

 
 
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Patients also made suggestions for future enhancements to the CCC site which included: 
expanding the resources section, additional tailoring to specific patient needs, providing a 
feature to help patients locate a PCP, and integrating the site with the patient portal. These 
suggestions, combined with feedback we receive from pilot participants who participate in the 
debriefing interviews, will help inform future enhanced versions of the CCC tool. 
4.  Methods  
 
Conceptual Model. The overall conceptual model for this study was informed by the Chronic 
Care Model39 and prior research by our team about treatment decision making, care 
coordination and the interplay between the health care system, patients and providers during 
cancer treatment.27,28,33,40-42 (Figure 2) 
 
 
 
4.1.  Design  
The proposed study is a randomized control pilot trial of at least 60 and up to 70 women newly 
diagnosed with early-stage breast cancer who are finishing primary treatment. Participants will 
be randomized either to the intervention arm (CCC website that will provide information on 
team-based follow-up care for both cancer surveillance and preventive care) or the control arm 
(static online survivorship care plan template which was adapted from the ASCO breast cancer 
survivorship template). The feasibility and acceptability of the tool and correlations with patient-
reported outcomes will be assessed 3 months following the completion of the baseline survey. A 
sample of 8-10 patients in the intervention arm will then be invited to participate in debriefing 
interviews to collect feedback regarding their experience with the CCC tool. We will also ask for 
feedback from 4-6 providers (2-3 medical oncologists and 2-3 PCP’s) whose patients 
participated in the study. Due to time and budget constraints, we are only able to include a 
sample of patients and providers in our debriefing interviews. 
 
4.2. Subject Recruitment 
Since this pilot study is testing a behavioral intervention and not a therapeutic intervention, the 
following outlines our standard approach to recruitment and enrollment of subjects, which have 
been successfully used in prior studies of UM breast cancer patients. For subject recruitment, 

 
 
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we will follow the approach used previously by Dr. Hawley in her iCanDecide recruitment (HUM 
62261). The iCanDecide Study was a two-armed randomized controlled trial of an interactive 
and tailored website with the goal of helping newly diagnosed and early stage breast cancer 
patients make informed treatment decisions. Employing the same recruitment strategy as used 
in the pilot study for iCanDecide, a trained clinical research associate will recruit a sample of at 
least 60 and up to 70 women from the University of Michigan Breast Cancer Clinic who are 
completing primary treatment for early-stage breast cancer, ages 21-84, and finishing their 
active treatment visits with their medical oncologist. A study coordinator will identify eligible 
patients for the pilot testing by reviewing MiChart scheduled oncology visits for patients nearing 
the end of their treatment and reports from the breast oncology meetings. Patients’ eligibility for 
participation in the study will be verified with the UM breast oncology care team and the PI. 
Once an eligible patient is identified as being at the end of their primary treatment, the study 
coordinator will identify their next scheduled visit with medical oncology and plan to be there in 
person to initiate recruitment. At that visit, the study will be introduced to the patient by the 
attending oncologist, and those who are interested in participating will then meet with the study 
coordinator to discuss the following packet of materials: (1) a cover letter written at a 6th grade 
reading level containing instructions, information about the study including the risks and 
benefits, their rights as participants and that participation is voluntary; (2) log-in information to 
access the website which contains the informed consent for them to complete; (3) a copy of the 
informed consent which they will complete online; (4) information about how to receive a $20.00 
electronic Amazon gift card once subjects have completed the online baseline questionnaire, (5) 
a local telephone number to call with questions or concerns, and (6) an additional $20 Amazon 
gift card included in the study packet to encourage enrollment of participants. For patients’ 
convenience, the study coordinator will provide patients’ with the option to view the CCC 
website or access it via a laptop computer or ipad. When a patient logs into the website, she will 
be asked to verify personal information and complete the informed consent. The PI and study 
coordinator(s) will verify subjects’ enrollment into the study via their online completion of the 
consent form and baseline questionnaire, as indicated on the CCC Administrative Dashboard. 
 
This process will request contact information, including providing an address and telephone 
number to support following up after the follow-up survey has been emailed to participants if 
needed, sending the electronic gift card to participants via email, and contacting those 
interested in participating in debriefing interviews at the completion of the study.  
 
Inclusion Criteria: 
1.  Ability to voluntarily provide written IRB-approved informed consent and 
communicate satisfactorily with the investigator, to participate fully in the study, and 
comply with all its requirements.  
2.  Women diagnosed with Stages 0-II breast cancer 
3.  Women who are currently receiving care from a breast oncologist at UMCCC 
4.  Women who are completing their primary treatment for breast cancer and 
transitioning into survivorship  
5.  Access and ability to use the Internet  
 
Exclusion Criteria:  
1. Women who are unable to speak and/or read English  
 
 
4.3. Subject Selection 
After completion of the baseline questionnaire, participants will be randomized to either enter 
the ConnectedCancerCare website (n=30-35), or a static website (n=30-35) which contains a 
brief survivorship care plan template in PDF format (see Appendix). We will employ block 
randomization, with a block size of 6 (10-12 blocks total) to ensure that the study group 
assignments are equally distributed throughout recruitment.    

 
 
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4.4.  Intervention (ConnectedCancerCare)  
 
Overview: The CCC tool is a personalized, navigation website that is tailored to patients’ 
preferences for provider roles in follow-up care, their satisfaction with their current PCP, and 
their worry about cancer recurrence. This pilot study is designed to determine whether an 
informative and tailored website can assist in guiding patients to utilize team-based care for their 
follow-up cancer care. The tool involves a website and text-based reminder system to help 
patients transition from active cancer treatment to ongoing/survivorship, team-based care and 
includes three research phases: 1) baseline survey and 2) 3-month follow-up survey among all 
participants; and 3) patient/provider interviews among a sample of participants in the 
intervention arm to assess patients’ understanding of survivorship care, usage of the website, 
and increased knowledge of team-based survivorship care as a result of using the tool. This tool 
was developed by the UM Center for Health Communications Research (CHCR) under the 
direction of the PI, Dr. Wallner, with input from oncologists, primary care physicians and other 
study co-investigators, and then beta tested among breast cancer patients. We believe this tool 
will be of benefit to patients comfortable using the internet and to clinicians who value additional 
information about their patients’ preferences and concerns.  
 
Development: CCC 
was developed using 
“agile development”,43-
45 which included 
content development 
and usability testing as 
used previously by the 
investigators in a trial 
of a patient decision 
aid for breast cancer treatment.26 CCC was developed 
using an iterative, agile cycle, which included planning 
(content decisions), design (graphical display and media 
elements), development (programming) and testing 
(feedback from stakeholders on draft versions). Testing 
included an iterative process of tailoring, timing, data, 
and functionality. The next phase (Phase 2) includes the 
pilot evaluation detailed in this protocol (Figure 3).  
                           
Content: The content of the CCC navigation tool was 
developed by Drs. Wallner and Hawley, along with 
clinical experts in the UM-RCC and CHCR. The 
development built upon the existing programming of the 
iCanDecide tool, a novel treatment decision-making tool 
developed by Dr. Hawley, which recently was evaluated 
in a full-scale randomized control trial with 500 patients 
(REF). CCC includes content focused on four areas as 
outlined in the conceptual model:  
 
1) Inform: This section provides the patient with key facts about survivorship guidelines and 
what to expect from team-based care.  
 

 
 
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2) Clarify: This section provides tailored content to clarify appropriate provider roles in 
delivering team-based care based on their collected preferences. The preferences outlined 
in the questionnaire section are used to tailor the content on this page.  
 
3) Communicate: This section promotes communication with the oncologist and PCP about 
this topic and includes tips and suggestions on how to communicate with their physicians 
and get the most out of their clinic visits.  
 
4) To do list for follow-up care and reminders: This sections outlines for patients what 
services they will need during survivorship, based on clinical guidelines. Customized alerts 
will be sent to participants to remind them to schedule their follow-up visits with their PCP, 
according to the guideline-recommended schedule and to complete their follow-up survey. A 
total of three reminders for each event have been built into the website program, and 
subjects are given the choice of how they want to receive reminders (i.e. text or email). 
Currently, the ConnectedCancerCare website is not linked to MiChart; however, that is a 
desired feature for future development. 
 
Screen shots of the website content and information on how to access the website directly are 
included in Appendices 5.  
 
4.4.1.  Baseline Questionnaire: After completing the online consent, patients will begin the 
online questionnaire which collects information that is used to tailor the content of the website. 
The survey is included in the Appendix. Measures used to tailor the website content include the 
following:  
 
a. Knowledge of guidelines for breast cancer follow-up screening and preventive care  
b. Current PCP (yes/no) 
c. Preferences for providers in team-based (PCP or oncologist) 
d. Satisfaction with care coordination at the time of transition 
e. Communication with providers about continuing care 
f. Worry about recurrence  
 
We will also ask patients to provide the contact information for their medical oncologist and 
primary care physician as part of the baseline questionnaire, which will be used to fax a provider 
summary to both physicians’ offices. The research coordinator will 
then verify this contact information using MiChart and the internet 
(for address verification) as needed. 
 
4.4.2. Provider Summary: The results of the baseline 
questionnaire will populate a short patient summary and highlight 
any critical misconceptions, or expectations the patient has about 
her care and who will be managing it, any gaps in knowledge she 
has about follow-up care, and a short checklist for her to use to 
guide her continuing care. Providers of patients randomized to the 
CCC intervention website will receive a summary based upon 
patients’ answers to the baseline questionnaire for the six areas 
outlined in the Provider Summary. They include:  1) patient 
diagnosis and treatment; 2) knowledge of follow-up care; 3) 
preferences for follow-up care from PCP vs. Oncologist; 4) hormone 
therapy requirement; 5) personal health concerns; and 6) level of 
recurrence worry.  Providers of patients in the control group will not receive a summary report 
for these patients. 
 

 
 
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4.4.3. Follow-up Questionnaire:  At three months, patients in both groups (intervention and 
control) will be emailed and prompted to complete a brief, online survey by logging back into the 
CCC website. The survey includes multiple measures of acceptability and usability in the 
intervention group only (primary outcomes) as they relate to viewing the tool (described in detail 
in section 5 below). Also, we will explore the influence of the intervention on secondary patient-
reported outcomes including whether they scheduled a visit with their PCP and their knowledge 
about continuing (survivorship) care, as outlined in section 5 below.  
 
4.4.4. Patient Contacts:  If a patient decides to participate, they will log into the CCC website 
using the unique assigned ID access code provided with the recruitment letter. Upon initial login, 
they will consent online, create their account (by inputting their email and phone number) and 
begin the baseline survey. They will receive one automated email reminder 2 days later if the 
baseline questionnaire is not completed, and up to 2 personalized phone contacts from the 
study coordinator within 14 days if the baseline questionnaire remains uncompleted. Upon 
completion of the baseline questionnaire, participants randomized to the intervention arm will 
receive weekly reminders via email, and possibly text messages if they opted into texting at 
account creation to make an appointment with their PCP. Three months from baseline 
completion, participants will receive a 1-week advance alert email (and a text if they opted in) for 
the follow-up questionnaire, followed by a second email alert in the next week, indicating the 
survey’s availability on the CCC website. Participants will receive one automated email reminder 
5 days later if the follow-up questionnaire is not completed. We will employ a modified version of 
the Dillman method, which includes up to 3 contacts for follow-up to maximize response rates 
and to identify non-respondents, that has proven to be successful in our previous work. 
 
4.4.5. Debriefing Interviews: A sample of 8-10 patients who participated in the pilot testing 
and 4-6 of their physicians (2-3 medical oncologists and 2-3 primary care physicians) will be 
contacted via phone and invited to participate in debriefing interviews about the usefulness 
of the tool and future implementation strategies. A question will be included at the end of the 
follow-up survey which solicits their interest in being contacted after the study ends to 
discuss their experience with ConnectedCancerCare in more detail. For those who respond 
yes, we will select the first 8-10 people and contact them via phone to conduct a brief 20-
minute audiotaped, interview (questions are in the Appendix), to gather their feedback about 
their experience with the tool.  
 
4.5.  Time and Events Table 
 
 
Study Events 
 
Pre-study  
(after completing 
primary treatment)  
Time 1  
(When viewing 
the website 
initially)  
Time 2 
3 months post-
baseline 
questionnaire 
completion) 
Time 3 
1-3 months post-
follow-up 
questionnaire 
completion) 
Informed Consent 
X 
 
 
 
Baseline 
Questionnaire  
X 
 
 
 
 Randomization  
 
X 
 
 
View intervention or 
control website 
 
X 
 
 
Follow-up 
questionnaire 
 
 
X 
 
Debriefing 
Interviews 
 
 
 
 X 
 
5.  Measures 
 

 
 
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The measures described in detail below were selected after literature review, and were directly 
informed by our conceptual model and the results of our prior work and pilot data. The 
measures are described by specific aim below:  
 
 
Aim 1A: Feasibility  
Feasibility will be defined by the successful recruitment of at least 60 women with half 
randomized to the intervention website and half to the control website over a 9-month time 
period. Based upon positive response rates of patients in previous studies of survivorship 
interventions and the iCanDecide pilot trial, we anticipate approaching approximately 87 women 
in order to achieve a similar response rate of 80% enrollment (n=70). We will also assess the 
proportion of those successfully recruited who complete the baseline survey and the follow-up 
survey. In addition, we will capture paradata including participants’ average number of page 
views, and average time on website.  
 
Aim 1B: Acceptability  
Acceptability and usability will be defined by asking participants in the intervention arm to rate 
their experiences with the tool on 5 point Likert-type scales, as follows: (1) CCC was easy to 
use, (2) CCC was helpful during my transition to survivorship, (3) CCC helped me think about 
when to see my PCP and when to see my oncologist, (4) I would recommend CCC to other 
patients, (5) The time it took to go through the website (6) The amount of info.  
 
Based on our prior work, we will use a cut off of 50% of more reporting a score above 3 as 
acceptable within that domain. We will also examine the distributions within each domain and 
determine how we can make the next versions of the tool more acceptable to patients as 
needed. We will then create a summary score of acceptability by averaging the responses to the 
6 items, with a score of 3 or more indicating the tool was acceptable to the majority of patients. 
 
Aim 2: Exploratory patient-reported outcomes 
We will collect patient-reported outcomes in both the intervention and control groups. We will 
then explore whether the intervention (compared to control) is correlated with the following 
measures: Knowledge about continuing care guidelines measured by items used in our previous 
studies adapted to continuing care (categorical);27 Preferences for team-based care (PCP or 
oncologist); Satisfaction with care measured by a care coordination question used in previous 
CanSORT studies tailored to the timing of transition (categorical);40 Communication with 
providers about continuing care measured by an item from the SPARCCS adapted to the 
patient perspective (categorical).18,25 We will explore follow-up visit scheduling (yes/no) using 
patient-reported measure of whether or not they have scheduled a visit with their PCP since 
viewing the tool (or control). We will also ask patients whether they have seen their oncologist 
(yes/no) since viewing the tool and verify their responses using MiChart data. 
 
Aim 3: Debriefing interviews  
Guiding questions with prompts will be used to obtain patient and provider feedback (See 
Appendix for draft interview guide). Patients will be asked about the content of the tool, how 
they used the tool (or not), and whether it improved their care transition experience. In addition 
to these questions, providers will also be asked about their experience with the tool summary, 
how well it fit into their clinical practice, with the goal of understanding how to best imbed the 
tool into current clinical work-flow.  
 
6. Procedures 
 
6.1. Data Management:  We use established human subjects’ protection protocols that address 
the limited use of personal health information, transfer of de-identified datasets within our 

 
 
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institution, storage of information from various data sources and surveillance and response to 
adverse events. The primary risks of the study are related to breaches in confidentiality and 
patient concerns about the use of their medical information. We have a long track record of 
employing the highest standards of patient confidentiality. However, we will respond promptly to 
any patients or providers who contact the staff or investigators about any concerns related to 
the study. 
 
For pilot testing, the study coordinator will assign a unique study ID to each potential 
participant. A secure, unique ID access code generated by the website will be used by the 
participants when they log into the website. Access to the password protected, encrypted, 
study database will be restricted to the principal investigator and selected members of the 
study staff. For the physician interviews, the digital recordings and transcripts will also be de-
identified and stored in password-protected files, which will only be accessible to the principal 
investigator and study staff. Patient and provider contact information will be kept in encrypted 
and password-protected files and used until the study and reporting is completed. The 
research data, which includes health-related data about the participants collected through the 
CCC intervention, will be stored for the required 7 years in a secured online server after which 
time the online data files will be electronically and securely deleted from the server, 
destroying all data. 
 
Weekly meetings with Dr. Wallner and the study staff will address any adverse events that 
could result from pilot study participation (e.g. increased anxiety) and patient and physician 
interview participation. These are anticipated to be rare and will be handled on an individual 
basis. Any adverse events will be reported to the IRBMED of the University of Michigan 
according to current IRBMED reporting guidelines.  
 
7.  Data Analysis Plan 
 
Aim 1a: Feasibility 
To determine feasibility, we will first assess whether we were successfully able to recruit 80% of 
our target population (N=87) into the study to achieve a maximum sample size of N=70. We will 
then generate descriptive statistics of the feasibility measures described above, including % of 
patients who complete each questionnaire, and average number of page views and time on 
website.   
 
Aim 1b: Acceptability 
The distribution within each of the 5 measures of acceptability will be determined and mean 
scores >3 within each domain will be examined. For any domain that has a mean score below 3, 
we will then use that information to inform future adaptations of the tool to increase the 
acceptability. The distribution of the acceptability summary score of will then be assessed and 
the proportion of patients with a score of 3 or more will be calculated. 
 
Aim 2: Exploratory Patient-Reported Outcomes 
We will then explore comparing knowledge, satisfaction, communication and utilization among 
the 30-35 women who engaged with the tool to the 30-35 who received the standard of care 
using chi-square tests and two-sided student t-tests where appropriate. This is designed to be a 
pilot study to determine if patients who engage with tool score higher on key knowledge, 
communication, and satisfaction items compared to those who received the control.  
 
Aim 3: Patient and Provider Debriefing Interviews 
To better understand what worked and did not work following the pilot testing and the underlying 
mechanisms of the intervention, we will conduct a formative assessment with both patients and 

 
 
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providers who had a patient who enrolled in the study. All interviews will be audio recorded and 
transcribed and analyzed using Dedoose and NVivo software. The investigator team will review 
the transcripts to identify overall themes which will help to refine the tool as needed and guide 
the future implementation of it into a broader system-level tool used in clinical practice. 
7.1.  Power Calculations  
We hypothesize that 50% of more of our sample will report an acceptability score of 3 or higher. 
With a sample size of 30 in the intervention group, we can obtain a two-sided 95% confident 
interval with a width equal to 0.374 when we assume 50% patients will report the tool being 
acceptable and usable. Since 0.375 is a clinical meaningful and a reasonable width for 
confidence intervals, we show that our study will have sufficient power to examine the extent of 
acceptability and usability among patients regarding our intervention tools.  
  
 
8.  Protection of Human Subjects 
Risks to Human Subjects: Risks to participants in this study are minimal, since this is an 
informational and educational tool similar to the type of information patients seek on their own or 
receive from their oncologist or primary care physician. The website-based navigation tool being 
studied contains similar educational content found in survivorship care guidelines available on 
the internet or from their medical oncologist. It is possible breast cancer patients may be 
experiencing distress or anxiety as they complete their primary treatment, however, all subjects 
will be informed that participation is completely voluntary, that they may drop out at any time, 
and it will not affect their medical care, as stated in the informed consent form. Upon initial login 
they will be asked to consent prior to viewing information on the website. The consent form will 
explain that their clinician will be able to view their own patients’ responses on the dashboard 
website.   
After consenting, patients will be directed to complete a baseline survey. As in our prior work, 
the survey will be kept as brief as possible to minimize participant burden. Our experience has 
found participants and non-participants view this type of research very favorably and are eager 
to provide feedback on the development of these types of tools, as evidenced by many moving 
comments about our prior studies and high response rates. There is a very small possibility that 
information on the website may upset patients. If patients do need support or want further 
clarification, the principal investigator will address it in a timely and professional manner. For 
debriefing interviews, we will use trained qualitative researchers to ensure appropriate 
questions are asked, and that patients and physicians are comfortable with the process. They 
will be informed up front in the consent form that interviews will be audio recorded. There is a 
very small possibility that the questions asked during the interviews may upset physicians. If 
patients or physicians require additional support or want further clarification, the principal 
investigator will address it in a timely and professional manner. 
Patient eligibility criteria:  Patients eligible for the study will be female breast cancer 
patients age 21-84, with stage I-ll (including DCIS) invasive breast cancer who have 
recently completed active cancer treatment(s) and are transitioning to follow-up care with 
their oncologist and PCP. 
Vulnerable populations: There is no inclusion of fetuses, neonates, children, prisoners, 
institutionalized individuals, or others who may be considered vulnerable populations, 
except that it is possible that a subject might be pregnant. Because this involves surveys 
and reviewing an informational website, it should have no additional risk for a pregnant 
woman.  
Excluded are: Patients for whom there is a clinical/nonclinical reason for which the 
surgeon determines the patient is not eligible for the study; patients who do not have 
internet access or email addresses, and patients who do not read or speak English. 

 
 
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Patient Recruitment for Pilot Testing Patients will be recruited through the Breast Cancer 
Clinic at the University of Michigan Rogel Cancer Center. Patients eligible for the pilot testing 
will be those who have recently finished their primary treatment for newly-diagnosed stage I-II 
female breast cancer and have scheduled their transition visit with the medical oncologist. For 
the pilot, we will recruit English speaking women with internet access. 
 
Patient and Physician Recruitment for Debriefing Interviews: As stated in section 4.4, a 
convenience sample of 8-10 patients who participated in the intervention arm and answered 
that they were willing to be contacted for additional information regarding their experience 
with using the website on the follow-up survey will be invited to participate in debriefing 
interviews. We will contact these participants via email and invite them to participate in the 
debriefing interviews about the usefulness of the tool and future implementation strategies. 
Debriefing interviews will also be held with 4-6 of their physicians (2-3 medical oncologists 
and 2-3 primary care physicians) to obtain their views on the usefulness and usage of the 
tool by their patients and future enhancements. 
 
Sources of Materials: All data to be used in this project will come from: 1) electronic 
patient surveys (pilot testing), 2) MiChart patient records (participant eligibility), and 3) patient 
and provider interviews. Survey data will include baseline data collected through the 
navigation tool, and then follow-up survey data for participants in the intervention three months 
later. Digital audio recordings will be taken during each physician and patient debriefing 
interview to be transcribed and analyzed. 
 
8.1. Adequacy of Protection Against Risks:  We use established human subjects’ protection 
protocols that address the limited use of personal health information, transfer of de-identified 
datasets within our institution, storage of information from various data sources and surveillance 
and response to adverse events. The primary risks of the study are related to breaches in 
confidentiality and patient concerns about the use of their medical information. We have a long 
track record of employing the highest standards of patient confidentiality. However, we will 
respond promptly to any patients or providers who contact the staff or investigators about any 
concerns related to the study. 
 
9.  Data Safety and Monitoring 
 
9.1. Data Security and Confidentiality: For pilot testing, the study coordinator will assign a 
unique study ID access code to each potential participant. This study ID will be used by the 
participants when they log into the website. Access to the password protected, encrypted, 
database will be restricted to the principal investigator and selected members of the study 
staff. For the physician interviews, the digital recordings and transcripts will also be de-
identified and stored in password-protected files, which will only be accessible to the principal 
investigator and study staff. 
 
9.2. Project Data Management and Coordination: Weekly meetings with Dr. Wallner and 
the study staff will address matters related to the safety of study participants, validity and 
integrity of the data, recruitment rate relative to expectation, adherence to the protocol, data 
completeness, and any adverse events that could result from pilot study participation (e.g. 
increased anxiety), patient and physician usability testing, or interview participation. These 
are anticipated to be rare and will be handled on an individual basis. At these regular 
meetings, the protocol specific Data and Safety Monitoring Report will be completed and 
signed by the Principal Investigator or by one of the study coordinators.  
 

 
 
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9.3. Data Safety Monitoring Plan (DSM): This study will be monitored in accordance with the 
NCI approved University of Michigan Rogel Cancer Center Data Safety and Monitoring Plan. 
The PI for the study will oversee the data safety and monitoring issues, working closely with 
study staff and the group’s biostatistician. Datasets will be managed by Drs. Wallner and 
Hawley with guidance for the bio-statistical core by Dr. Li for the ConnectedCancerCare (CCC) 
Study. We do not anticipate many adverse events from voluntary participation in this minimal 
risk study. Viewing the intervention is educational, and should not cause undue anxiety, concern 
or worry. The intervention is similar to information available on the internet, or from their 
clinician’s office with the exception that the navigation tool provides more tailored information for 
patients to understand the components of their ongoing continuing care. The CanSORT Data 
Safety and Monitoring Board for this study will consist of those individuals identified as co-
investigators for this study: Drs. Katz, Hawley, Ayanian, and Sales. Data issues, including 
recruitment, enrollment and attrition will be discussed, as will any adverse events. The DSM 
board will meet monthly or more frequently if deemed necessary to discuss matters related 
addressing any adverse events that might result from study participants’ adherence to the 
protocol, and data completeness.   
 
Any adverse events, including increased participant anxiety or other concerns, will be 
immediately reported to the PI, discussed via weekly staff meetings between the PI and study 
staff. Data Safety and Monitoring Reports will also be submitted to the University of Michigan 
Rogel Cancer Center Data and Safety Monitoring Committee (DSCM) every six months for 
review. 
 
The study itself does not provide treatments of any kind; this is done by the clinicians as is 
usual care. No products, medications or tests are being delivered as part of this study.  
 
10. Adverse Event Reporting 
While we do not anticipate many adverse events from participation in this minimal risk study, 
possible adverse events could include increased anxiety about breast cancer follow-up care 
from participating in the study. If desired by the participant, referral to counseling or support 
services can be made. We anticipate that any anxiety caused by the program will be 
minimal, and could be addressed by website reminders to patients to discuss concerns with 
their clinicians. All participants will have a UM oncology specialist working with them to 
transition them to survivorship care. We will provide a contact sheet to the clinicians and 
patients, so they can reach the study team at any point with questions or concerns. We will 
follow IRBMED guidelines for reporting. 
 
10.1. Pilot Test Safety We do not anticipate many adverse events for participants in this 
study. This is a minimal risk study and participation is voluntary. Viewing the intervention is 
educational, and should not cause undue anxiety, concern or worry. The intervention is 
similar to information they would obtain online if searching on their own, or from their 
clinician’s office. The exception is that the navigation tool provides more tailored information, 
which should make it easier for patients to understand the components of their continuing 
care. It is possible that viewing the tool ahead of their visit with the oncologist could increase 
anxiety about discussing their follow-up care. Should increased anxiety occur, the following 
will be done to address and ameliorate concerns: 1) the participant has the chance to 
discuss these issues with his or her oncologist at the transition visit; 2) the clinician will report 
to us any issues that appear to be related to the study and are concerning; 3) participants 
may contact the study team at any time to express questions or concerns, in which case the 
study PI and/or local staff will refer them to appropriate counseling and/or discuss their 
concerns with them at that time, and 4) the participant may choose to stop 
participation in the study. Any adverse event such as this will be discussed via weekly 
staff meetings between the PI and study staff; such events will be recorded by the PI and 

 
 
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reported to the study sponsor. Adverse events will only be reported to the UM 
IRBMED according to the Standard AE reporting guidelines.  Should there be 
concerns that are not sufficiently addressed (i.e. frequently occurring AEs), the protocol will be 
modified. Online informed consent will be obtained from all participants prior to participating 
in any phase of the study, and will include the contact information of the local and 
overseeing PIs and study coordinator that the individual may contact at any point with 
questions or concerns. 
 
11.  Potential Benefits of the Proposed Research to Human Subjects and Others 
This study has an excellent risk/benefit ratio. On a broader scale, participation will contribute 
to our understanding of quality of continuing care for breast cancer survivors, and the findings 
from this study will inform the full-scale evaluation of an intervention to improve the quality of 
cancer survivorship care. For these reasons, we believe the anticipated benefits to society 
outweigh the small potential risk to individual participants. The study also has the potential to 
increase the quality of continuing care for breast cancer patients directly. If proven effective, 
the ConnectedCancerCare tool can be translated into clinical practice to fulfill a critical need: 
it can help support patients through their transition from treatment to survivorship, while 
promoting team-based care between the oncologist and primary care providers who care for 
them. 
 
 
 
 
 
 
 
 
 
 
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