Evaluation of a remote electronic assessment of survivors with tailored follow-up recommendations and survivorship messaging (REASSURE) to improve the delivery of follow-up for low-risk breast cancer survivors.

Abstract

1669 Background: Current follow-up care for the 2 million+ low-risk breast cancer survivors fails to adequately address survivors’ needs and burdens survivors and oncology teams. We evaluated a novel approach to follow-up that comprehensively assesses survivors’ symptoms and concerns and uses that information to tailor follow-up frequency. Methods: We conducted a randomized trial at an academic and community breast clinic. Eligible survivors had a history of stage I breast cancer that was ER or PR +/Her2-, were 6-36 months from diagnosis, and did not receive chemotherapy. Survivors were randomized 1:1 to REASSURE versus usual care and followed for 18-months. REASSURE was developed through stakeholder engagement and comprises three components integrated around follow-up visits: 1) Online patient-reported symptoms and concerns (PRO), 2) Tailored follow-up visit recommendations based on the PRO, and 3) Survivorship messaging. The primary outcome was survivors’ preparedness for survivorship and confidence about follow-up, measured at 18-months by the Preparing for Life as a (New) Survivor (PLANS) scale. Secondary outcomes included number of oncology follow-up visits, proportion of reported symptoms that were discussed, and acceptability of REASSURE. Continuous variables were analyzed using t-tests or Wilcoxon tests. The proportion of symptoms discussed was analyzed using a generalized linear mixed model for binomial data. Results: Of the 104 consented patients, 3 did not complete any study activities and 1 withdrew (n=100). The median age was 63 (range 36-86), most were White (98%), and 19% resided in a rural locale. Preparedness for survivorship and confidence did not differ between REASSURE and usual care (Table). Symptoms or concerns were reported on 50.4% of PRO assessments. In the REASSURE arm, 80% of survivors accepted the recommendation to forgo a visit. Fewer follow-up visits were observed with REASSURE (M=2.1, SD 1.0) than usual care (M=2.6, SD 1.0), p=0.007. There was no difference in likelihood of discussing symptoms. REASSURE was acceptable to survivors, with 78% saying they would recommend REASSURE to others. Conclusions: In this implementation of a novel tailored approach to follow-up for low-risk breast cancer survivors, we did not find improvement in preparedness for survivorship. However, we demonstrated a decrease in number of follow-up visits with strong survivor support for this approach. Further research will focus on implementing REASSURE in more diverse clinical settings. Clinical trial information: NCT05609435 . REASSUREM (SD) or % Usual CareM (SD) or % P value PRIMARY OUTCOMES  Preparedness 29.3 (1.7) 28.9 (2.1) 0.36  Confidence 24.0 (14.4) 18.7 (13.6) 0.08 SECONDARY OUTCOMES  # of follow-up visits 2.1 (1.0) 2.6 (1.0) 0.007  % of symptoms discussed 89.3% 83.0% 0.29  % of survivors who would recommend REASSURE 78% NA