The care of more than 3 million breast cancer survivors in the United States consumes about one third of overall breast cancer expenditures, reported Michelle E. Melisko, MD[1] (University of California, San Francisco) in a stimulating education session at the 2016 San Antonio Breast Cancer Symposium (SABCS).
From an economic perspective alone, this is a wake-up call for all stakeholders. The breast cancer community is now engaged in a search for models for delivery of cancer-related services for patients who have completed active therapy. The diversity of care required by cancer survivors poses significant challenges to devising universal guidelines.
The Quandary Over Survivorship Care Plans
The optimal model and strategy remain unclear, said Dr Melisko, but must involve four main domains: prevention, surveillance, intervention, and coordination. Current models favored in the United States are those in which the care of cancer survivors is shared between the oncologist and primary care clinician or between the oncologist and physician extenders (nurse practitioners and physician assistants), consultative clinics, physician extender-led survivorship clinics, and multidisciplinary survivorship clinics.
Dr Melisko's message was clear: We need better tools to stratify patients on the basis of relapse risk.
