A comprehensive framework and key guideline recommendations for the provision of evidence-based breast cancer survivorship care within the primary care setting.

Breast cancer survivors continue to experience physical and psychosocial health care needs post-treatment. Primary care involvement is increasing as cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up. Research suggests primary care providers (PCPs) are willing to provide survivorship care but many lack knowledge and confidence to provide evidence-based care. Although clinical practice guidelines (CPGs) exist for follow-up surveillance and certain aspects of survivorship care, no single comprehensive guideline addresses all significant breast cancer survivorship issues encountered in primary care. The purpose of this research was to create a comprehensive clinical practice framework to guide the provision of breast cancer survivorship care in primary care settings. This study consisted of an extensive search, appraisal and synthesis of CPGs for post-treatment breast cancer care using a modified Delphi method. Breast cancer survivorship issues and relevant CPGs were mapped to four essential components of survivorship care to create a comprehensive clinical practice framework to guide provision of breast cancer survivorship care. The completed framework consists of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations and a one-page list of guideline sources. The framework and key guideline recommendations were verified by a panel of experts for comprehensiveness, importance and relevance to primary care. This framework may serve as a tool to remind PCPs about issues impacting breast cancer survivors, as well as the evidence-based recommendations and resources to provide the associated care.

Luctkar-Flude M ，Aiken A ，McColl MA ，Tranmer J ... -  《-》

Are primary care providers implementing evidence-based care for breast cancer survivors?

Luctkar-Flude M ，Aiken A ，McColl MA ，Tranmer J ，Langley H ... -  《-》

Evidence-based recommendations on care for breast cancer survivors for primary care providers: a review of evidence-based breast cancer guidelines.

To review evidence-based (EB) recommendations on survivorship care for primary care providers (PCPs) in EB breast cancer guidelines. Guidelines were collected via experts and via literature database, guideline database and cancer agency websites searches. EB guidelines in any language published between 2012 and 2017 were collected. EB recommendations on survivorship care relevant for PCPs were extracted and grouped into three categories (recurrence detection, long-term effects and recurrence prevention). The content of the recommendations was analysed and summarised in the number and type of clinical topics addressed. The Appraisal of Guidelines for Research and Evaluation II instrument was used to evaluate the methodological quality of the guidelines. Six guidelines, of which two were of acceptable methodological quality, were included. One was specifically made for general practitioners. Fifteen clinical topics were identified. Guidelines differed in the clinical topics addressed and for some identical topics in the content of the recommendations. Many recommendations were based on low-quality evidence. Recurrence detection received most attention, physical examination and mammography were often highlighted. Potential complications largely varied in number and type. Intimacy concerns, vaginal dryness, dyspareunia, fatigue, menopausal symptoms, peripheral neuropathy and lymphedema were reported in more than one guideline. Recurrence prevention was mentioned in four guidelines; all recommended physical activity. The number of EB recommendations in guidelines is limited. Moreover, recommendations differ between guidelines and most are based on low-quality evidence. More high-quality research is needed to develop and adapt guidelines to support PCPs in providing optimal breast cancer survivorship care.

Spronk I ，Korevaar JC ，Schellevis FG ，Albreht T ，Burgers JS ... -  《-》

Implementing a survivorship care plan for patients with breast cancer.

Miller R 《Clinical Journal of Oncology Nursing》

Late and long-term effects of breast cancer treatment and surveillance management for the general practitioner.

To examine the most common long-term and late effects of breast cancer treatment, the American Society of Clinical Oncology guidelines for surveillance, and recommendations for the primary care provider's role in delivering breast cancer survivorship care. A comprehensive literature review was conducted using CINAHL, PubMed, Google Scholar, and hand searches using the search terms breast cancer, survivor, and long-term or late effects. Articles published in English from 2002 to 2012 that addressed the long-term or late effects of adults with breast cancer were included. Findings are discussed categorically, including the most common late and long-term psychosocial effects from relevant studies. Topics relevant to survivors included challenges to psychosocial, emotional, and cognitive well-being; satisfaction with life; sexuality; body image; anxiety; fear of recurrence and post-traumatic stress disorder; depression; cognitive dysfunction challenges to physical well-being; adverse cardiovascular events; fatigue; lymphedema; musculoskeletal symptoms; accelerated bone loss and fractures; pain; skin changes due to radiation; disease recurrence; and new breast cancers. With earlier detection methods and improvements in treatment options making breast cancer a highly survivable disease, there are more survivors of breast cancer than ever. The clinicians' role in survivorship care is more important than ever to manage the potential long-term and late effects of treatment, physical and emotional well-being, and recurrent disease surveillance. However, the clinician's role in cancer follow-up care is often poorly defined leading to a lack of awareness about the needs of survivors of breast cancer, suboptimal communication between providers and survivors, and an overall deficiency in quality care.

Kenyon M ，Mayer DK ，Owens AK 《-》