Patient Priorities Care for older breast cancer survivors: A patient-centered approach to improve quality of breast cancer survivorship.

Abstract

TPS1662 Background: Older adult breast cancer survivors have higher rates of chronic conditions compared with other cancer survivors and may have a higher treatment burden. High treatment burden is associated with poor quality of life and increased healthcare utilization. Aligning care with patient priorities can reduce the treatment burden during survivorship care. Patient Priorities Care (PPC) is an approach designed to align care around each patient’s goals to help decrease treatment burden. Although the PPC approach was previously designed for patients with multiple chronic conditions, we sought feedback from stakeholders, including older patients with a history of breast cancer, to adapt the PPC approach to breast cancer survivorship context. This quality improvement project aims to use PPC and patient’s self-defined goals to improve the quality of survivorship care for older adults breast cancer survivors. Methods: We are conducting a multicenter, randomized quality improvement project with a hybrid implementation-effectiveness design to evaluate the impact of the adapted PPC approach compared to standard survivorship care on treatment burden and quality of life (NCT06478589). We are recruiting 120 older adult breast cancer survivors from outpatient oncology and primary care clinics. Eligible patients are: (1) ≥65 years of age; (2) stage I-III breast cancer, who had finished active breast cancer treatment and are in the first year of survivorship care; (3) have evidence of burdensome care; (4) English-speaking; and (5) able to provide informed consent. Enrollment started in December 2024. Patients are stratified based on treatment burden at baseline; patients with a score of > 15 on the treatment burden questionnaire (TBQ) undergo simple randomization with a 2:1 ratio to either the PPC or standard survivorship care group. The PPC for Breast Cancer Survivorship intervention consists of: (1) a 30-minute priorities identification visit with a facilitator, 2) delivery of a structured patient priorities report to the survivorship care team, 3) survivorship care alignment using the patient’s priorities. The primary outcome measures are differences in treatment burden (TBQ) and quality of life (FACT-B) from baseline at 3 to 6 months. Secondary outcomes include goal attainment achievement at 3,6 months for patients in the intervention group and adherence to standard and priorities-based breast cancer survivorship recommendations at 12 months for both groups. Descriptive statistics will be used to report patients' baseline and clinical characteristics. All analysis will be intention to treat. The effect of the intervention on changes (baseline to 3, 6 months) in the TBQ and FAST-B scores using Bayesian analysis. For the goal attainment differences, we will compare the differences in goal ratings from baseline at 3, 6 months within the Patient Priorities Group. Clinical trial information: NCT04513977 .