Structured Guidance for Care Delivery May Result in Better Counselling for Patients With Breast Cancer

Nurse Navigator Janeen Bazan, RN, OCN, BSN, talks about the 4R Care Sequence® and its impact on the care of patients with breast cancer at the 2021 Oncology Nursing Society Annual Congress.

According to a poster presentation at the recent 2021 Oncology Nursing Society (ONS) Annual Congress, breast cancer care may benefit from guidance in a new care delivery model.

The 4R Care Sequence® is a one-page, multimodality, personalized care project plan that is used by multidisciplinary teams to plan and deliver care. The 4 Rs in the title represent the right information, care, patient, and time. It incorporates recommendations for patient-centric care pathway plans from the Institute of Medicine, Medicare’s Oncology Care Model and National Comprehensive Cancer Network guidelines, which include multi-modality planning from diagnosis to survivorship that specifies the clinical team, identification of therapy, and adverse effects and supportive care.

“The 4R model provides a roadmap for the patient and also for the patient’s care team,” said Janeen Bazan, RN, OCN, BSN, lead author of the poster and an oncology nurse navigator from Advocate Sherman Hospital, during the presentation. “It’s very helpful in time management for the patient.”

To understand how the 4R Care Sequence® plans impacted care, investigators surveyed 77 patients with stage 0 to 3 breast cancer from September 2019 to August 2020 at Advocate Sherman Hospital. Of the patients, 28 received 4R Care Sequences® and 49 received a baseline control model.

A survey given to all patients asked whether or not the patients’ care provider instructed them to do certain activities. The investigators found that all patients who received the 4R Care Sequences® were more likely to have been counseled in 8 areas:

  • Getting an immunization (flu, pneumonia, shingles) before starting cancer treatment (52% of baseline cohort, 70% of 4R cohort)
  • Seeing a dentist before starting cancer treatment (13% of baseline cohort, 33% of 4R cohort)
  • Getting a genetic counseling appointment before surgical decision (39% of baseline cohort, 44% of 4R cohort)
  • Managing weight if over or under weight (16% of baseline cohort, 26% of 4R cohort)
  • Getting a nutritionist consult about how to eat during cancer treatment (15% of baseline cohort, 26% of 4R cohort)
  • Getting emotional support (46% of baseline cohort, 52% of 4R cohort)
  • Keeping up appointments with primary care for routine care (67% of baseline cohort, 75% of 4R cohort)
  • Caring for a chronic disease (43% of baseline cohort, 46% of 4R cohort)

Early results showed that the use of the 4R Care Sequences® improved the referrals of recommended breast cancer care. Due to the small sample size, Bazan reported that the results are not statistically significant, however, the trend is still encouraging. The researchers’ plan to continue using 4R Care Sequences, collecting patient surveys and assessing their impact.

“I’m very excited to look at our next data and share with other programs, and hopefully bring in other cancer types,” Bazan said.

Reference

Bazan J. Early results: Impact of 4R (Right Info / Care / Patient / Time) care sequence plans, provided to patients by oncology nurses, on timing and sequence of guideline recommended care. Presented at: Oncology Nursing Society 46th Annual Congress; April 20, 22, 27, and 29, 2021. ePoster 1567. Accessed May 5, 2021. https://bit.ly/3eXEb0n

Related Videos
Sara M. Tolaney, MD, MPH, discusses how, compared with antibody-drug conjugates, chemotherapy produces low response rates and disease control in the treatment of those with hormone receptor–positive, HER2-negative metastatic breast cancer.
Hope Rugo, MD, speaks to the importance of identifying patients with aromatase inhibitor–resistant, hormone receptor–positive, HER2-negative advanced breast cancer who are undergoing treatment with capivasertib/fulvestrant who may be at a high risk of developing diabetes or hyperglycemia.
Sara M. Tolaney, MD, MPH, describes the benefit of sacituzumab govitecan for patients with HER2-low metastatic breast cancer seen in the final overall survival analysis of the phase 3 TROPiCS-02 study.
An expert from Vanderbilt University Medical Center says that patients with relapsed/refractory multiple myeloma may be able to live a normal life following response to salvage treatment with bispecific monoclonal antibodies.
A recovery tracker and other digital tools may be useful in helping to manage patient symptoms following debulking surgery for gynecologic cancer, according to an expert from Memorial Sloan Kettering Cancer Center.
Common symptoms following debulking surgery for gynecologic cancer appear to include pain, diarrhea, and nausea, according to an expert from Memorial Sloan Kettering Cancer Center.
Patients who use a recovery tracker tool appear to experience lower hospital readmission rates following gynecologic cancer debulking surgery compared with those who did not.
Medical oncologists and gynecologic oncologists alike have a shared responsibility to help treat symptoms of neuropathy in patients undergoing chemotherapy for gynecologic cancer, according to an expert from Duke University Medical Center.
Future research assessing cryocompression for those with gynecologic cancers will make use of different products to make the intervention easier and more accessible for patients.
Cryocompression demonstrates potential for preventing chemotherapy-induced neuropathy for those with gynecologic cancers, according to an expert from Duke University Medical Center.