Elsevier

The Breast

Volume 22, Issue 5, October 2013, Pages 606-615
The Breast

Review
Supportive care after curative treatment for breast cancer (survivorship care): Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement

https://doi.org/10.1016/j.breast.2013.07.049Get rights and content

Abstract

Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed.

As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources.

Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment to follow-up care.

Section snippets

Breast cancer survivors in low- and middle-income countries

Globally, breast cancer 5-year relative survival rates range from 80 to 90% in high-income countries (HICs), to 60% in middle-income countries, to below 40% in low-income countries [1]; in parts of Africa, it may be as low as 12% [2]. These differences have been attributed to disparities in early detection, type of breast cancer, access to treatment, type of treatment, and social and cultural barriers. The concept of cancer survivorship itself as a distinct phase of cancer treatment is

Supportive care after curative treatment (survivorship care)

Supportive care for breast cancer, including survivorship care, is a distinct aspect of cancer treatment that should be integrated into breast cancer care programs in low- and middle-income countries (LMICs). The Institute of Medicine (IOM) describes survivorship care as encompassing five main areas: 1) surveillance for cancer recurrence or new cancers; 2) management of symptoms that persist after treatment ends; 3) evaluation of risk for, and when possible, prevention of, late-effects of

Defining “breast cancer survivors”

For the purposes of this consensus statement, “breast cancer survivors” are defined as patients who have entered the post-treatment phase after initial surgery, with or without chemotherapy and/or radiation (ie, 6 months of curative treatment). Companion Breast Health Global Initiative (BHGI) supportive care consensus statements cover supportive care during treatment, and supportive and palliative care for metastatic disease.

BHGI global summit and expert panel consensus process

All three BHGI supportive care consensus statements provide recommendations for breast cancer supportive care program implementation in low- and middle-income settings. Methods developed by the Breast Health Global Initiative (BHGI) for the structured creation of evidence-based, 4-tier resource-stratified guidelines and consensus statements (see Table 1) have been previously described [6], [7]. A systematic literature review was performed in preparation for the 5th BHGI Global Summit, which was

Fear of cancer – patient's own risk assessment

Studies in LMICs have documented breast cancer patients' fears and concerns about how the diagnosis of breast cancer, as well as breast cancer treatments, may impact their lives [20], [75]. Breast cancer patients taking endocrine therapy may have fear of recurrence related to extended treatment protocols, though others may feel protected by extended adjuvant therapy [76]. As more breast cancer patients in LMICs become survivors, fear of cancer recurrence may emerge as an area of concern,

Discussion

The most effective way to expand survivorship care in LMICs is through the involvement of primary care networks and community-based programs. We hope that by having shared tools, such as this consensus statement and the resource-stratified tables, breast cancer health professionals can engage in a global conversation and encourage efforts to implement and improve supportive care programs in LMICs for breast cancer survivors.

Recommendations included in this consensus report are part of the

Panelists

Kathy K. Albain (USA), Barbara L. Andersen (USA), Benjamin O. Anderson (BHGI Director, USA), Jose Luiz B. Bevilacqua (Brazil), Rolando Camacho-Rodriguez (Summit Co-chair, Cuba), Evandro de Azambuja (Belgium), Nagi S. El Saghir (Lebanon), Patricia A. Ganz (Panel Co-chair, USA), Julie R. Gralow (Summit Co-chair, USA), Ranjit Kaur (Malaysia), Anne McTiernan (USA), Claire Neal (USA), Ann H. Partridge (USA), Nagima Plokhikh (Kazakhstan), Eliezer Robinson (Israel), Julia H. Rowland (USA), Savitri

Conflict of interest statement

BOA received consulting compensation from GE Healthcare and Navidea Biopharmaceuticals; EDA received Consulting/Speaking compensation from Pertong Roche; JRG received grant/research support from Amgen, Genentech, Novartis, and Roche. All other authors and panel members reported no conflict of interest.

Acknowledgements

BHGI received (2012 Global Summit) grants and contributions from Fred Hutchinson Cancer Research Center, Susan G Komen for the Cure® (Contract ID: INT-3063.0/Tracking No: 221664), International Atomic Energy Agency Programme of Action for Cancer Therapy, National Cancer Institute, The Lancet Oncology, Elsevier, American Society of Clinical Oncology, Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer, Pan American Health Organization, European Society of Medical Oncology,

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