Delivering Survivorship Care to Women in Low-Resource Settings: A Report From India

Purpose The concept of cancer survivorship care as a distinct phase of cancer treatment is relatively new in the developing world. India has a growing population of survivors of breast cancer, but the resources to meet their needs are limited; therefore, to be cost effective, it is important to identify areas that cause the most disruption in their quality of life (QOL). This study was conducted with the following objectives: to estimate the prevalence of various survivorship issues, identify most important issues that limit QOL, and collect information about patients’ perspectives of their supportive care needs to design a plan of follow-up and supportive care.Methods This descriptive, hospital-based, cross-sectional study was conducted in 230 survivors of breast cancer in an academic health care setting in northern India. A checklist of 14 commonly reported survivorship issues as well as questionnaires for QOL assessment—FACT-B and SF-36 —were administered to participants. A semistructured interview was conducted to identify supportive care needs from the patient’s perspective. Main outcome measures were frequencies of survivorship issues and QOL scores among three groups divided on the basis of time elapsed since treatment ( 5 years follow-up), stepwise regression analysis to identify issues that have the most significant impact on QOL, and a theme-based analysis of survivors’ interviews to identify supportive care needs.Results The most prevalent survivorship issues were fatigue (60%), restriction of shoulder movement (59.6%), body and joint pain (63.5%), chemotherapy-induced cessation of menstruation (73.3%), and loss of sexual desire (60%). Issues that had a maximum impact on QOL scores were emotional distress (r = −11.375), fatigue (r = −9.27), and premature menopause and its related symptoms (r = −2.085). An analysis of interviews demonstrated maximum unmet needs in the area related to health care information, psychosocial support to cope with breast cancer diagnosis and treatment, relief of physical symptoms, and access to follow-up and supportive care.Conclusion Supportive care services should be designed to address the above-mentioned areas on a priority basis so as to make effective use of limited available resources.AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.