In British Columbia (BC), women taking adjuvant endocrine therapy (AET) for early breast cancer are followed by their oncologist for a variable length of time before discharge to their family physician (FP). Many women have physical and psychological needs beyond the scope of their FPs or the capacity of their oncologists to follow longitudinally. In addition, non-adherence to AET occur in over 40% of patients and is associated with increased mortality (Hershman, D Breast Cancer Res Treat 2011). We postulated that establishment of a dedicated service to assess and address symptoms and signs experienced while taking AET could improve quality of life (QOL) and potentially improve adherence.
With funding from the BC Cancer Foundation and in collaboration with the BC Women’s Hospital (BCWH), we established a transitional clinical service led by a Nurse Practitioner. Women taking AET are identified by their Medical Oncologists and referred to the ABCS, located at BCWH. All patients have baseline demographic and QOL assessment (FACT-B+4 and PROMIS sexual function and satisfaction V.2), to be repeated at 12 and 24 months. Adherence will be assessed and compared to BC Cancer historical controls using the provincial pharmacy database. The intent is to transition all patients back to their FPs.
The clinic opened April 2018. As of Jan 10th 2019: 237 patients were referred, 121 were seen (with the remainder scheduled through June) and 120 completed baseline assessments. Prevalent issues include upper body (shoulder, neck, breast) pain, fatigue, joint pain, insomnia, anxiety, depression, genitourinary and sexual concerns. Women have been referred to self-care (online) and multidisciplinary supportive care resources including dietician, exercise specialist, physiotherapist, counsellor, rheumatologist, sleep clinic, sexual health specialist and gynecologist. Informal feedback suggests high patient satisfaction with the service. Two patients have been discharged so far.
The ABCS was established to specifically address the needs of women on AET. Multiple baseline issues are being recognized and managed. It is too early to assess the objective impact of this service on adherence and QOL. This is planned with longer follow up.
BC Cancer and BC Women’s Hospital and Health Centre.
BC Cancer Foundation and BC Women’s Hospital and Health Centre.
T. Shenkier, C. Lohrisch: Advisory board: NanoString, Genomic Health. K. Gelmon: Research funds: AstraZeneca, BMS, Pfizer, Roche; Honorarium personal fund: AstraZeneca, Lilly, Novartis, Pfizer Genomic health, BMS, NanoString, Merck. S. Chia: Advisory boards: Novartis, Pfizer, Hoffman LaRoche. All other authors have declared no conflicts of interest.