Abstract P1-09-29: A new model of care for breast cancer survivorship
Bibliographic record
Abstract
Abstract Background Breast cancer (BC) is the most common cancer diagnosed in women. With advances in diagnostics and therapy, early stage disease has an estimated 85% 10-year overall survival. Cancer survivors have unique needs including screening for recurrence, psychosocial concerns, as well as routine health maintenance. There is growing evidence to support the safe transition from oncologist to primary care. This is challenging in the era of complex adjuvant and extended adjuvant programs, which are standard of care for women with hormone receptor positive BC. In February 2013 the Wellness Beyond Cancer Program (WBCP), developed at the Ottawa Regional Cancer Program, started accepting BC patients. A risk stratification system enables the treating oncologist to determine the most appropriate care provider stream based on patient complexity and/or risk of relapse. There are three possible streams: primary care provider (PCP), nurse practitioner (NP), or oncologist. The program offers education on general and breast specific cancer survivorship issues. Unique to our program is a hormone re-assessment review (HRR), scheduled in advance, to discuss switching hormonal therapies and/or extended adjuvant strategies. A rapid re-entry system is in place for those with evidence of disease recurrence or a new primary. Specific aims The aims of our study are: 1. To describe unique aspects of WBCP developed for early stage BC patients 2. To assess efficacy of the WBCP 3. To evaluate safety of the HRR 4. To examine patient and primary care giver satisfaction with the program Methods All BC patients eligible for discharge through the WBCP will be included in the evaluation. We will evaluate patients by examining needs assessments completed at time of referral and one year later, as well as completed patient and PCP satisfaction surveys. The proportion of patients with changing scores, increasing or decreasing, will reflect improvements or worsening of needs. The proportion of both patients and PCP that are/are not satisfied with the program will be recorded and examined further. For the HRR we will code the proportion of patients where the consult was requested and was "scheduled vs. not scheduled". Finally, the number/proportion of patients and reasons for re-entry will be captured. Results February 2013–June 2014, 1339 BC patients were referred to the program, 584 patients to PCP, 740 to NP, and 15 remaining with their oncologist. Early results are reported here with results of the surveys expected by December 2014. 7 patients have required re-entry for disease recurrence and 30 HRR have been booked. No cancer specific negative outcomes have been reported. Survey results addressing patient needs, empowerment and concerns are being collated, with PCP satisfaction results to be reported. Conclusion Our institution has endorsed evidence-based recommendations for an organized survivorship program and has taken it a step further by developing a strategy to address the unique long term needs of hormone positive early stage breast cancer. Early feedback supports that this program has increased patient and caregiver knowledge of survivorship issues and anticipates improved patient empowerment, without compromising cancer specific outcomes. Citation Format: Moira Rushton, Robin Morash, Gail Larocque, Carrie Liska, Roanne Segal. A new model of care for breast cancer survivorship [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-29.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.003 | 0.009 |
| Research integrity | 0.002 | 0.005 |
| Insufficient payload (model declined to judge) | 0.026 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".