ReviewSupportive 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
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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