Abstract P2-13-18: Catalyzing navigation for breast cancer survivors (CaNBCS)
Authors: Niharika Dixit, Barbara Cicerelli, Roy Cherian, Nancy Burke
Journal: Cancer Research (2020)

Abstract Background; Survivorship care plans (SCPs) are personalized documents, provided at the end of the treatment by patients’ oncology clinicians that summarize the diagnosis and treatment, late and long-term adverse effects, ongoing surveillance for recurrence, screening for new cancers, and health maintenance of cancer survivors. Considered as a tool for cancer survivors, experts in cancer survivorship and accrediting organizations such as Commission on Cancer (CoC) have endorsed the use of SCPs even in the absence of firm evidence of their efficacy. Safety net hospitals are at the forefront of providing care for vulnerable low-income cancer survivors who may also have low educational attainment, low health literacy, and limited English proficiency. Cancer survivors who are racial and ethnic minorities and low income may experience higher symptom burden and limitation of function. Prior work has shown that patients who in safety net health setting, do not benefit from SCPs and only 25% share them with their primary care providers. Methods This study is a pilot randomized clinical trial to assess the role of patient navigation in cancer survivors. Breast cancer survivors were randomized to SCPs with or without patient navigation. In the intervention, arm navigators discussed the survivorship care planning and issues with patients at the time of delivery, 6 weeks by phone, at 3 months and then at 6 months. The primary outcome was breast cancer-related quality of life (QOL) was assessed by FACT B questionnaire. The secondary outcome was self-efficacy. In addition, we conducted focus groups for cancer survivors, patient navigators, and oncology providers to understand their perspective. Cancer survivors who had completed the treatment for breast cancer within 1-5 years were eligible to participate in the study. Participants spoke English(N=20), Chinese (n =10) or Spanish (n=10). Results: There were 20 participants in each arm, 10 English speaking and 5 each Spanish and Chinese speaking. At 6 months and final follow up, 32 patients were available for analysis. One patient developed metastatic cancer, two patients had changes in their insurance status and five were not available for final analysis. We performed Wilcoxon non-parametric analysis to assess changes in all five domains of FACT B. There were trends towards improvement in the change in emotional well-being score, functional well-being score and overall QOL in the intervention arm, but it was not statistically significant. Physical well-being score change was similar. There was no difference in the mean self-efficacy scores for both arms. At baseline, 57.7% breast cancer survivors reported being not all/a little bit satisfied with their sex life and 53.9% reported not all/a little bit feeling sexually attractive. 87.5 % of survivors reported having accepted their illness quite a bit/ very much. Conclusions Our study successfully recruited patient from a diverse patient population in safety net settings. Patient navigation combined with survivorship care showed encouraging trends in improvement in emotional well-being, physical well-being, and QOL, although it was not statistically significant. There was no difference in mean self-efficacy score. We are currently analyzing the qualitative data to assess the implementation of the intervention. Citation Format: Niharika Dixit, Barbara Cicerelli, Roy Cherian, Nancy Burke. Catalyzing navigation for breast cancer survivors (CaNBCS) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-18.