The Institute of Medicine and others have strongly recommended survivors exiting active treatment receive a comprehensive survivorship care plan addressing surveillance, late effects symptoms, psychosocial needs, and general health maintenance, as well as indicating which providers will handle which components of the plan. Despite this recommendation, survivorship care planning and communication are often inadequate, leaving survivors confused and uncertain about their care. In addition, little is known about communication- related barriers to survivorship care, which may be of particular concern for rural-residing survivors who often live at some distance from their oncology specialist(s) and have limited primary care access. To reduce confusion and uncertainty, and to avoid duplication of medical effort, we envision a formal planning and communication process that integrates patient preferences with recommendations from multiple providers to generate a comprehensive survivorship care plan. [We believe effective implementation of this process requires a clinically-oriented individual like a nurse, nurse practitioner, physician assistant, or physician to facilitate and coordinate communications between survivors and their primary care and oncology specialty providers.] Our goal is to generate information needed to create and evaluate a process designed specifically to accommodate the needs of rural-residing survivors while also meeting the needs of suburban and urban survivors. Thus we aim to: (1) describe breast cancer survivors'knowledge about, perceived importance of, and barriers to survivorship care planning and communication;(2) assess survivors'current and preferred communication with oncology specialists and primary care providers about their survivorship care plans;and (3) explore the relationship between current survivor and provider survivorship care planning and communication with survivors'cancer-related uncertainty and quality of life. All data will be collected via a survey relying heavily on questions drawn from previously validated instruments and administered via hard copy mail, on-line or telephone interview. Our analytic approach will include descriptive statistics, correlation, and regression modeling. Both this proposal and the resulting testable intervention of a clinical model of survivorship care planning and communication will substantially advance our understanding of cancer survivorship care, particularly for rural-residing breast cancer survivors.

Public Health Relevance

Experts have recommended that the often difficult transition from active treatment to cancer survivorship care be eased by preparation and communication of a survivorship care plan. Our study will gather information about rural-, suburban- and urban-residing cancer survivors'needs and preferences for survivorship care planning and communication. This information will help us design and evaluate a care planning process designed specifically to accommodate the needs of rural-residing survivors while also meeting the needs of suburban- and urban-residing survivors.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-NRCS-T (08))
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Castro, Kathleen M
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Wake Forest University Health Sciences
Public Health & Prev Medicine
Schools of Medicine
United States
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Palmer, Nynikka R A; Weaver, Kathryn E; Hauser, Sally P et al. (2015) Disparities in barriers to follow-up care between African American and White breast cancer survivors. Support Care Cancer 23:3201-9
Geiger, Ann M (2012) Trastuzumab and congestive heart failure: what can we learn from use in the community? J Natl Cancer Inst 104:1269-70