Faul Leigh Anne, Luta Gheorghe, Sheppard Vanessa, Isaacs Claudine, Cohen Harvey J, Muss Hyman B, Yung Rachel, Clapp Jonathan D, Winer Eric, Hudis Clifford, Tallarico Michelle, Wang Julhy, Barry William T, Mandelblatt Jeanne S
Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA,
J Cancer Surviv. 2014 Dec;8(4):627-37. doi: 10.1007/s11764-014-0371-5. Epub 2014 Jun 11.
Survivorship care plans (SCP) are recommended for all cancer patients and could be especially useful to survivors 65 years and over ("older"). This study examined receipt of SCPs among older breast cancer survivors and whether SCPs were associated with improved patient-reported outcomes.
Three hundred and twenty-eight older women diagnosed with invasive, nonmetastatic breast cancer between 2007-2011 were recruited from 78 cooperative-group sites. Participants completed telephone interviews at baseline and 1-year posttreatment. Regression analyses examined SCP receipt (yes/no) and functioning (EORTC-QLQ-C30), cancer worry, and experiences of survivorship care (care coordination, knowledge).
Only 35% of women received SCPs. For each 1-year increase in age, there was a 5% lower odds of receiving an SCP (odds ratio (OR) = 0.94, 95% confidence interval (CI) 0.91-0.98, p = 0.007). Besides age, no other factor predicted SCPs. SCP receipt was associated with greater knowledge and understanding of requisite follow-up care (p < 0.05); however, functioning was not significantly different among those with vs. without SCPs.
Receipt of care plans was limited. SCPs improved understanding of breast cancer follow-up care among older survivors, but did not impact functioning one year post-treatment.
To impact functioning and salient needs of the growing cohort of older survivors, survivorship care plans likely should be tailored to geriatric-specific issues. To improve functioning, SCP content should expand to include exercise, nutrition, polypharmacy, social support and management of symptom burden from cancer, and other comorbid conditions. To improve follow-up care for cancer survivors, SCPs should delineate shared care roles between oncology and primary care in managing recurrence surveillance, screening, and cancer sequelae.
建议为所有癌症患者制定生存护理计划（SCP），这对65岁及以上的幸存者（“老年患者”）可能特别有用。本研究调查了老年乳腺癌幸存者接受SCP的情况，以及SCP是否与改善患者报告的结局相关。
从78个协作组站点招募了328名在2007年至2011年期间被诊断为浸润性、非转移性乳腺癌的老年女性。参与者在基线和治疗后1年完成电话访谈。回归分析研究了SCP的接受情况（是/否）以及功能（EORTC-QLQ-C30）、癌症担忧和生存护理体验（护理协调、知识）。
只有35%的女性接受了SCP。年龄每增加1岁，接受SCP的几率降低5%（优势比（OR）=0.94，95%置信区间（CI）0.91-0.98，p=0.007）。除年龄外，没有其他因素能预测SCP的接受情况。接受SCP与对必要后续护理有更多的了解相关（p<0.05）；然而，接受SCP和未接受SCP的患者在功能方面没有显著差异。
护理计划的接受情况有限。SCP提高了老年幸存者对乳腺癌后续护理的理解，但对治疗后1年的功能没有影响。
为了影响越来越多老年幸存者群体的功能和突出需求，生存护理计划可能应针对老年特定问题进行调整。为了改善功能，SCP的内容应扩展到包括运动、营养、多重用药、社会支持以及癌症和其他合并症症状负担的管理。为了改善癌症幸存者的后续护理，SCP应明确肿瘤学和初级护理在管理复发监测、筛查和癌症后遗症方面的共同护理角色。
