title: Supportive care after curative treatment for breast cancer (survivorship care): resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.
abstract: Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources. Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment to follow-up care.
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Cheng Har
authors.initials: CH
authors.lastname: Yip
authors.forename: Julie R
authors.initials: JR
authors.lastname: Gralow
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Distelhorst
authors.forename: Kathy S
authors.initials: KS
authors.lastname: Albain
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Andersen
authors.forename: Jose Luiz B
authors.initials: JL
authors.lastname: Bevilacqua
authors.forename: Evandro
authors.initials: E
authors.lastname: de Azambuja
authors.forename: Nagi S
authors.initials: NS
authors.lastname: El Saghir
authors.forename: Ranjit
authors.initials: R
authors.lastname: Kaur
authors.forename: Anne
authors.initials: A
authors.lastname: McTiernan
authors.forename: Ann H
authors.initials: AH
authors.lastname: Partridge
authors.forename: Julia H
authors.initials: JH
authors.lastname: Rowland
authors.forename: Savitri
authors.initials: S
authors.lastname: Singh-Carlson
authors.forename: Mary M
authors.initials: MM
authors.lastname: Vargo
authors.forename: Beti
authors.initials: B
authors.lastname: Thompson
authors.forename: Benjamin O
authors.initials: BO
authors.lastname: Anderson
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D001828:Body Image / Q000523:psychology; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000523:psychology* / Q000628:therapy*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003906:Developing Countries; D005221:Fatigue / Q000628:therapy; D005260:Female; D006282:Health Personnel / Q000193:education; D006801:Humans; D008019:Life Style; D008209:Lymphedema / Q000628:therapy; D008593:Menopause; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D059408:Pain Management; D010353:Patient Education as Topic; D011183:Postoperative Complications / Q000628:therapy; D040841:Resource Allocation; D012648:Self Care; D012725:Sexual Behavior / Q000523:psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy; D017741:Survivors / Q000523:psychology*
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; Low- and middle-income countries; Resource allocations; Supportive care; Survivorship