title: Breast cancer survivors' perceptions of survivorship care options.
abstract: OBJECTIVE
  As the number of breast cancer survivors increases, a durable model of comprehensive survivor care is needed, incorporating providers and/or visit types both within and outside of oncology. The objective of this study was to explore survivors' comfort with different clinician types or with a telephone/Internet-based virtual visit as components of survivorship care.
  
  
  METHODS
  Breast cancer survivors participating in a general survivorship survey completed an additional breast cancer-specific questionnaire evaluating the self-perceived impact of follow-up visits to various clinician types, or follow-up by a virtual visit, on survival, worrying, and stress related to cancer.
  
  
  RESULTS
  A total of 218 breast cancer survivors completed the questionnaire. Most favored medical oncologist follow-up visits over those with primary care physicians (PCPs) or nurse practitioners (NPs) in terms of reduced worrying about cancer (odds ratio [OR], 2.21; P < .001), reduced stress around the visit (OR, 1.40; P = .002), and improved effect on cancer survival (OR, 2.38; P < .001). However, the majority also displayed substantial comfort with both PCPs and NPs in the same domains. Patients rated a virtual visit as having a less favorable impact on cancer survival and cancer-related worrying compared with in-person visits with clinicians.
  
  
  CONCLUSIONS
  Breast cancer survivors are comfortable with both PCPs and NPs providing follow-up care, although they indicate a preference for medical oncologists. Given patients' negative impressions of a virtual visit, increased familiarity with and research investigating this emerging concept are needed. The NP-led survivorship clinic model, with increased guidance for PCPs, offers a promising route for improving quality of and satisfaction with survivor care.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA. emayer@partners.org
authors.forename: Erica L
authors.initials: EL
authors.lastname: Mayer
authors.forename: Adrienne B
authors.initials: AB
authors.lastname: Gropper
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.forename: Ann H
authors.initials: AH
authors.lastname: Partridge
authors.forename: Danielle B
authors.initials: DB
authors.lastname: Cameron
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology / Q000628:therapy; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy*; D018567:Breast Neoplasms, Male / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*