Individualizing surveillance mammography for older breast cancer survivors

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PROJECT SUMMARY/ABSTRACT The long-term goals of this work are to optimize surveillance mammography use for older breast cancer survivors and decrease overscreening for a group in critical need of evidence-based, unified approaches for follow-up care. The proposed study will address significant knowledge gaps through expert consensus and prospective data collection. This study will provide a framework for discussions on how/when to stop mammography in older breast cancer survivors with limited life expectancy (who typically have a low risk for in- breast recurrences with rates similar to that of screening populations) and how to optimally discuss life expectancy with patients, with the goal to enhance communication between patients and clinicians as well as between primary care clinicians (PCs) and specialists. In this unique, multilevel proposal, we will build on our prior work to develop consensus on mammography and follow-up care for breast cancer survivors aged ≥75 by (a) refining expert-panel recommendations, (b) examining clinician and patient attitudes towards these recommendations and discussing life expectancy, and (c) testing a communication tool to facilitate decision- making, all through direct engagement of clinicians and patients. In Aim 1, we will convene experts and patients to refine recommendations for mammography and follow-up care for breast cancer survivors age ≥75 and further develop and cognitively test a communication tool that summarizes recommendations for clinicians and patients with a focus on how to comfortably include conversations on life expectancy comfortably. We will then conduct 30 telephone-based patient interviews and 4-6 focus groups with oncologists and PCs to obtain their opinions about the communication tool, how to communicate the benefits/risks of mammography, and optimal strategies for discussing life expectancy and cessation of mammography and coordination of care. In Aim 2, we will test the communication tool with 45 older breast cancer survivors age ≥75 and their oncologists using a pre-post intervention study. Here, we will examine the feasibility and acceptability of the tool and the effect of using the tool on women's intentions for mammography. We will also explore communication strategies across medical specialties. We hypothesize that our communication tool will be feasible, acceptable for patients and providers, and lead to fewer women intending to receive mammography in the next year. This study will provide preliminary data for a larger pilot and eventual, prospective, randomized study, with the overarching goal to further assess impact, improve coordination of care, and disseminate our novel and urgently needed intervention. The goals of this study are undoubtedly in line with the missions set forth by the NIH and NCI to address the research gaps in older patients. Further, with approximately 70,000 women age ≥75 per year diagnosed with breast cancer in the United States and a growing population of older breast cancer patients, efforts to improve and equalize the quality of follow-up care we deliver will become increasingly important.