Abstract P6-12-12: How can we improve vulnerability score in breast cancer survivors? A pilot experience in an underprivileged community
Authors: Jaouen A , Festa A , Boubaya M , Levy V , Zelek L 
Published: May 2016

Abstract
BACKGROUND: We decided to evaluate the evolution of vulnerability in breast cancer survivors receiving an individualized survivorship care plan and living in an area (Seine-Saint-Denis, SSD), which is among the poorest in France with a median household income is 68% lower than in Paris. In SSD, cancer is the leading cause of premature mortality. Whereas it is widely admitted in France that 25% of patients are faced with financial difficulties after breast cancer, this proportion reaches 40% in SSD.
PATIENTS AND METHODS: Ac'Santé93 is a non-profit organization whose aim is to provide supportive care, health education and individualized assistance to patients and families, and to facilitate timely access to quality medical and psychosocial care. Vulnerability was evaluated using a 11-item standardized score (EPICES) previously investigated by French Health Examination Centers. Strictly speaking this score was aimed at measuring precarity, a concept referring to a social condition assumed to face worsening. This score is more strongly related to health status than the administrative classification of poverty (Sass, Sante Publique 2006). Vulnerability was defined by a score ≥30 and considered as severe when ≥40. In SSD two thirds of the population are affected by vulnerability. Patients included in the study were scored after cancer diagnosis (E1) and 6 mos. after the first evaluation (E2). Patients were divided into tertiles according to E1: 30-40, 40-67 and 67-100. Psychosocial comorbidities, demographic data, and supportive care received were also recorded. Actions undertaken were divided in three categories: social/advocacy (e.g. help with filling out administrative forms), individual (e.g. dietician consultation) and group (e.g. group sessions led by a sport instructor).
RESULTS: Over the year 2014, 120 breast cancer survivors were included and had E1 and E2 scores. Median E1 and E2 were 52.1 and 47.3 and the mean difference was 7.2 (p&lt;0.0001). The score improved for 72% of pts but worsened in 16% and remained stable in 12%. Whereas a significant improvement of E2 was observed whatever E1 in patients included in a support group, it was not the case in the other patients (social/advocacy and/or individual). Surprisingly, the effect of support groups on vulnerability score was significantly greater in the highest tertile of pts (E1 from 67 to 100). Being in the highest tertile at inclusion was also the strongest predictor for improvement in all patients (RR=7.7, p=0.007). Younger patients were at significantly higher risk of worsening: median age was 49.2 in case of worsening v 54.3 in case of improvement (p=0.047).
CONCLUSION: Survivorship care plans can improve vulnerability in most pts. Paradoxically, it seems easier to improve vulnerability in pts with highest initial scores. Furthermore these patients are those who benefit the most from support groups. We hypothesize that desocialization is frequently underestimated in this population, and that support groups, besides their primary goal, act through developing social links. Finally, the finding that younger patients are at higher risk for worsening vulnerability underscores the burden of unmet needs in youngest breast cancer survivors.
Citation Format: Jaouen A, Festa A, Boubaya M, Levy V, Zelek L. How can we improve vulnerability score in breast cancer survivors? A pilot experience in an underprivileged community. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-12.