The Survivorship Visit is an important part of the care continuum of the breast cancer patient and serves to help them transition from active treatment to clinical surveillance. At this visit the patient is given their survivorship care plan which summarizes their diagnosis and treatment, addresses long term and late side effects of treatment, maps out their follow up care, and outlines strategies for healthy living to reduce their risk of cancer recurrence.
The visit is scheduled typically within six-months of completing active treatment and no longer than one-year from date of diagnosis. A 90 minute block of time is reserved for this visit, so that there is ample time to address patient concerns. There are three parts to the visit:
I. Clinical Exam—during this part of the visit the following items are addressed:
- The patient is given a questionnaire to rate their survivorship concerns.
- Arm circumference is measured and compared against their pre-treatment measurements.
- Signs and symptoms of local recurrence are reviewed with the patient and the importance of breast self-awareness is reinforced.
- Breast asymmetry is assessed and management options are discussed.
- Breast skin changes are assessed and the patient is given guidance on monitoring for potential long term skin changes.
- Upper extremity range of motion and strength are assessed and a referral to physical therapy is made if indicated.
- Lymphedema symptoms in the breast and upper extremity are assessed and a referral for lymphedema therapy is made if indicated.
- Assessment of patient’s tolerance of hormonal therapy (if applicable).
II. Delivery of the Survivorship Care Plan—during this part of the visit the provider reviews the written document with the patient. The Survivorship Care Plan serves to:
- Provide a summary of the patient’s diagnosis, stage, and treatment of their breast cancer
- Record any ongoing therapy (hormonal or immunotherapy) and addresses common side effects
- Address persistent symptoms or side effects at the conclusion of active therapy
- Review the signs and symptoms of local and systemic recurrence
- Address potential late and long-term side effects of breast cancer treatment
- Map out the patient’s schedule of follow up visits and with which provider
- Map out the timing of their next mammogram (if applicable)
- Address any additional surveillance requirements (i.e., DEXA scans for patients on aromatase inhibitors, annual GYN exams for patients on tamoxifen).
- Address survivorship concerns (from the questionnaire). These are reviewed and discussed with the patient. Resources are offered and referrals are made as needed.
- Address fear of recurrence and resources are given to the patient regarding available support groups in our community. Referrals to Behavioral Health are made if appropriate.
- Address the importance of healthy lifestyle habits that help reduce the risk of cancer recurrence.
- Referrals for medical nutrition therapy are made if desired.
- Information on the Livestrong program through the YMCA is offered
- Resources for tobacco cessation are given to the patient.
III. Additional information—at the conclusion of the Survivorship Visit the patient is also given:
- A copy of their pathology report from their breast cancer surgery
- Additional breast cancer survivorship materials
- Information on eligibility for active clinical research
- A copy of ‘Facing Forward’ from the National Cancer Institute.
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