Community-based patient navigation and preventative care among women surviving breast cancer.

Abstract

1602 Background: Routine physical exams, mammograms, and Pap smears are essential to long-term follow-up for breast cancer survivors, enabling detection of recurrence and guiding overall health maintenance. Barriers to preventive care adherence over time can be addressed by community-based organizations (CBOs) by providing information and supportive services, including navigation to screening. We studied adherence to preventive care and screening among breast cancer survivors who engaged a national cancer control CBO–examining how sociodemographics, cancer care factors, and quality of life (QoL) were associated with adherence. Methods: A secondary data analysis was conducted among N = 777 breast cancer survivors who contacted a CBO for resources, including no-cost patient navigation. Patient-reported outcomes were assessed after 30 days, along with survivorship care planning (SCP) and QoL. An index score was created based upon women’s self-reported adherence to receiving routine physical exams, mammograms, and Pap smears at recommended intervals. Results: Among survivors, 37% were age < = 46, 19% were non-white, 63% were in a partnered relationship, 23% rated their QoL (general health) as fair/poor, and 47% carried a pathogenic variant in BRCA . Medical providers caring for these survivors included primary care physicians (53.6%) and oncology specialists (46.4%). For index scores, 66% were adherent to all 3 recommendations for follow-up, 29% to 2 recommendations, and 6% to < = 1 recommendation. The most adhered to recommendation was a physical exam (97%), and the least was a Pap smear (73%): 88% of survivors reported mammograms at recommended intervals. At the bivariate level, breast cancer survivors who were younger (t, df = 4.59, 711, p < .001), non-white, (t, df = -3.27, 267, p < .001), in a partnered relationship (t, df = 1.76, 54, p < .05), and with better QoL (r = -.09 p < .01) were more adherent to guideline-based care. A trend was observed for SCP: survivors who received care summaries (56%), including follow-up instructions (64%), and in written form (45%), were more likely to adhere (r = 0.05, p < .10). In a multivariable regression model adjusting for partnership status and SCP, younger survivors (B = 1.13, p < .001), who were non-white (B = 1.0, p < .01), and with better QoL (B = .09, p < .05) were more adherent. Conclusions: Survivors can benefit from guideline-based cancer prevention and screening with CBO-led support. Tailored SCP is essential to reinforce life-saving health behaviors and enhance follow-up adherence.