Breast Cancer Survivorship Care Demands Rigorous Systemic Change

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Dr Nunnery sat down with Hil Moss, MBA, MPH, a breast cancer survivor and the co-founder and chief executive officer of OncoveryCare, the first virtual survivorship clinic delivering cancer survivorship care.

Their conversation centered on the often-overlooked gap in breast cancer survivorship care, beginning with Moss's personal story. Diagnosed with breast cancer at age 28, just weeks into her MBA program, Moss described a 15-month active treatment phase that anchored her in a clear plan, as well as the disorienting transition that followed once her treatment ended. She explained that the period after active treatment surfaced both mental health challenges and difficult physical effects, including adverse effects associated with tamoxifen.

Moss then contextualized why the cancer care system underinvests in survivorship, framing it as a care-model design problem. She explained that the episodic, high-throughput oncology model was built decades ago for a smaller population at a time when survival rates were far lower, and emphasized that this model has not been reconceptualized for today's growing population of survivors living longer with late cancer and treatment effects. She described the resulting problem, in which patients bounce between oncology and primary care.

Turning to OncoveryCare, Moss detailed its telemedicine model, which integrates directly with oncology teams and deploys a survivorship-trained team to address both the visible symptoms and invisible risks of survivorship, as well as behavioral health support. Finally, Moss advocated for the measurement of hard survivorship outcomes, including medication adherence and mortality, highlighted an endocrine therapy survivorship program, and urged clinicians to simply ask patients about their survivorship challenges to determine how best to help them in the months and years following their treatment.