title: A survivorship care plan for breast cancer survivors: extended results of a randomized clinical trial.
abstract: OBJECTIVE
  Prevailing wisdom suggests that implementation of a survivorship care plan (SCP) will address deficits in survivorship care planning and delivery for cancer patients. Here, we present 24-month results of a randomized clinical trial on health service and patient-reported outcomes among breast cancer patients transferred to their primary care physician for follow-up care. The 24-month assessments represent the long-term benefit and sustainability of the implantation of a SCP.
  
  
  METHODS
  In all, 408 patients with early-stage breast cancer were randomized to the SCP or control group. Patient self-completed questionnaires, supplemented with telephone interviews, during the 24-month study period assessed health service and patient-reported outcomes. The primary outcome was cancer-specific distress. Secondary outcomes included health-related quality of life, patient satisfaction, continuity and coordination of care, and health service outcomes such as adherence to guidelines.
  
  
  RESULTS
  Over the course of 24 months, there were no differences between both groups in health service and patient-reported outcomes. Women from Quebec compared to those from Western Canada (p < 0.001), women within 2 years of completion of primary treatment compared to a longer period (p = 0.013), and those with a higher SF-36 mental component score compared to a lower score (p = 0.044) were positively associated with adherence to guidelines.
  
  
  CONCLUSIONS
  The implementation of a SCP in the transition of survivorship care from cancer center to primary care did not contribute to improved health service or patient-reported outcomes in this study population. Therefore, additional research is needed before widespread implementation of a SCP in clinical practice.
  
  
  CONCLUSIONS
  The transition of survivorship care from cancer center to the primary care setting showed no negative effect on health service and patient-reported outcomes.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. a.boekhout@nki.nl.|Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. a.boekhout@nki.nl.
authors.forename: Annelies H
authors.initials: AH
authors.lastname: Boekhout
authors.affiliation: Center de Recherché du CHU de Québec, Québec, Québec, Canada.|Département de Médecine Sociale et Préventive, Université Laval, Québec, Québec, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maunsell
authors.affiliation: Ontario Clinical Oncology Group, Hamilton, Ontario, Canada.|Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Pond
authors.affiliation: Ontario Clinical Oncology Group, Hamilton, Ontario, Canada.|Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jim A
authors.initials: JA
authors.lastname: Julian
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
authors.affiliation: Ontario Clinical Oncology Group, Hamilton, Ontario, Canada.|Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mark N
authors.initials: MN
authors.lastname: Levine
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.|Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000534:rehabilitation*; D002170:Canada / Q000453:epidemiology; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006308:Health Systems Plans / Q000592:standards; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D011788:Quality of Life; D011792:Quebec / Q000453:epidemiology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data
keywords: Breast cancer; Randomized clinical trial; Survivorship care plan