Patients’ experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): quality of life and service use results

Jenkins, Valerie; Matthews, L; Solis-Trapala, I; Gage, H; May, S; Williams, P; Bloomfield, D; Zammit, C; Elwell-Sutton, D; Betal, D; Finlay, J; Nicholson, K; Kothari, M; Santos, R; Stewart, E; Bell, S; McKinna, F; Teoh, M

Abstract

Purpose
To describe trends and explore factors associated with quality of life (QoL) and psychological morbidity and assess breast cancer (BC) health service use over a 12-month period for patients joining the supported self-management (SSM)/patient-initiated follow-up (PIFU) pathway.

Methods
Participants completed questionnaires at baseline, 3, 6, 9 and 12 months that measured QoL (FACT-B, EQ 5D-5L), self-efficacy (GSE), psychological morbidity (GHQ-12), roles and responsibilities (PRRS) and service use (cost diary).

Results
99/110 patients completed all timepoints; 32% (35/110) had received chemotherapy. The chemotherapy group had poorer QoL; FACT-B total score mean differences were 8.53 (95% CI: 3.42 to 13.64), 5.38 (95% CI: 0.17 to 10.58) and 8.00 (95% CI: 2.76 to 13.24) at 6, 9 and 12 months, respectively. The odds of psychological morbidity (GHQ12 >4) were 5.5-fold greater for those treated with chemotherapy. Financial and caring burdens (PRRS) were worse for this group (mean difference in change at 9 months 3.25 (95% CI: 0.42 to 6.07)). GSE and GHQ-12 scores impacted FACT-B total scores, indicating QoL decline for those with high baseline psychological morbidity. Chemotherapy patients or those with high psychological morbidity or were unable to carry out normal activities had the highest service costs. Over the 12 months, 68.2% participants phoned/emailed breast care nurses, and 53.3% visited a hospital breast clinician.

Conclusion
The data suggest that chemotherapy patients and/or those with heightened psychological morbidity might benefit from closer monitoring and/or supportive interventions whilst on the SSM/PIFU pathway. Reduced access due to COVID-19 could have affected service use.

• Journal Article Type: Article
• Acceptance Date: Aug 16, 2023
• Online Publication Date: Sep 12, 2023
• Publication Date: Oct 1, 2023
• Deposit Date: Sep 20, 2023
• Publicly Available Date: Sep 20, 2023
• Journal: Supportive Care in Cancer
• Print ISSN: 0941-4355
• Electronic ISSN: 1433-7339
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 31
• Issue: 10
• Article Number: 570
• DOI: https://doi.org/10.1007/s00520-023-08002-z
• Keywords: Breast cancer, Psychological morbidity, Supported self-management, Patient experience, Quality of survivorship, Quality of life