FFH Network × Susan G. Komen × [Your Cancer Center / Survivorship Clinic]
🎀 Prepared Patient Series · Oncology Survivorship

Become a Certified Prepared Patient
for Breast Cancer Survivorship

A guided learning path for the post-treatment chapter. Treatment is over; the journey isn't. Survivorship is its own phase — ASCO describes acute, extended, and permanent survivorship — with its own surveillance schedule, late-effect map, and adherence work. For HR-positive disease (~70% of survivors), endocrine therapy adherence over 5–10 years is the single biggest controllable lever on recurrence. The modifiable lifestyle stack — weight toward BMI <25, ≥150 min/week exercise + 2× resistance, Mediterranean-style diet, alcohol moderation — collectively reduces recurrence ~20–30%. Late effects to track: lymphedema, cardiotoxicity (anthracycline / trastuzumab / left-sided RT), bone loss (AI users), cognitive ('chemo brain'), peripheral neuropathy, early menopause, depression / anxiety (~30–40%). Surveillance: annual mammogram, no routine PET / CT / tumor markers in asymptomatic patients. Equity: AA mortality ~40% higher; Latina later-stage; rural access lags. A longer, fuller life — and the skills to help others.

3HEALTH-LITERACY LAYERS
10EVIDENCE-BASED COMPETENCIES
3IDENTITIES YOU EARN
1SURVIVORSHIP CARE PLAN
1
Learn It
→
2
Live It
→
3
Share It
Force Field strength: 0% (0/10 competencies)
Demo FFH client preview — synthetic data for walk-through. Use these buttons to populate or reset the demo experience.
Customizable Welcome from [Your Cancer Center Name]. Need help with this course? Call our Survivorship Clinic navigator [Navigator name, RN / SW — (555) 123-4567], M–F 8a–5p, or the Susan G. Komen helpline 1-877-465-6636 or Living Beyond Breast Cancer Helpline 1-888-753-5222. You can also message us through the [MyChart patient portal].
🛡 Force Field Fact Sheet New here? Start with the one-page Force Field Fact Sheet — 16 squares of essential breast cancer survivorship knowledge, plain-language, printable, free. Then come back for your full Certified Prepared Patient course. Open Fact Sheet →
🏅Your Path to Certification

Earn your way up three evidence-based tiers. Each builds on the last. Finish all three and receive your Certified Prepared Patient · Breast Cancer Survivor badge and printable certificate, recognized across the FFH Network.

Tier 1

Aware · Identity: Self-Advocate

You know your body, your subtype, and your survivorship phase. Layer 1 — Survivorship Literacy.

  • Complete Modules 1–4 (Survivorship Literacy)
  • Pass the "What Survivorship Is" quiz (≥80%)
  • Identify your subtype (HR+ / HER2+ / TNBC), stage, anthracycline cumulative dose, trastuzumab duration, RT field + side, surgery, endocrine therapy + planned duration, BRCA / multi-gene panel result, and surveillance schedule (annual mammogram + DXA cadence + cardio-oncology echo if applicable)
  • Build your written Treatment Summary / Survivorship Care Plan + monthly arm-circumference + PHQ-9 / GAD-7 trackers with the FFH "Notice and Name" framework
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Tier 2

Active · Identity: Care Team Member

You partner with your team and navigate the system. Layer 2 — Care & System Literacy.

  • Complete Modules 5–7 (Make Every Visit Count · When to Call vs ED · Comorbidity Awareness)
  • Demonstrate teach-back on your endocrine therapy plan, the modifiable lifestyle stack (weight / exercise / Mediterranean / alcohol), and your "when to call vs 911" decision rule for the late-effect + recurrence-signal map
  • Complete one "great visit" prep + debrief
  • Build your When-to-Call plan + Care Team card; cardio-oncology referral if anthracycline / trastuzumab / left-sided RT; lymphedema PT contact saved
  • Successfully resolve one prior auth (endocrine therapy, denosumab/bisphosphonate, lymphedema garment via Lymphedema Treatment Act), copay-help application, or survivorship-clinic-navigator engagement
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Tier 3 · Certified

Certified Prepared Patient · Identity: Ambassador

You teach, mentor, address disparities, and shape research & policy. Layer 3 — Advocacy & Ambassadorship.

  • Complete Modules 8–10 (Family & Care Team · Talk to Kids/Partner/Employer + Mentor · Mastery & Graduation)
  • Mentor 1 newly-finished-treatment survivor via Susan G. Komen / SHARE / BCRF / Living Beyond Breast Cancer / Young Survival Coalition / Sisters Network OR present at a survivorship-clinic / primary-care education session
  • Sign the Prepared Patient Pledge
  • Complete the BRCA / hereditary-risk family conversation if applicable (cascade testing for daughters, sisters, sons); advance care planning if relevant
  • Submit one advocacy action (story, feedback letter, AA / Latina / rural-equity piece, clinical-trial-access advocacy, Lymphedema Treatment Act follow-up, Survivorship Care Plan policy comment)
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📋Master Pre / Post Assessment 7 Likert dimensions · open to take or review

Where You Stand — Confidence Before & After

Seven dimensions of being a Prepared Patient. Answer once at the start of your journey and again at the end. Your goal is to see real growth across understanding, self-management, communication, and optimal utilization — knowing when to call your team, when to use Day Hospital, and when to go to the ER. Your answers stay on this device unless you choose to share with your clinician.

📈 Your Pre→Post Growth

Saved on this device · No backend yet · PHIT integration after Banner demo
📞Know Who to Call — Before the ER

Survivorship runs as a long arc — acute (treatment + first months), extended (the first few years, when endocrine therapy and surveillance are ramping), and permanent (years to decades, when cadence settles but late-effect and recurrence vigilance continue). Most days are routine. Some days bring symptom-tracking or refill calls. The high-leverage signals — late effects (lymphedema, cardiotoxicity, bone fracture, cognitive crash) and recurrence signals (axial bone pain, neuro deficit, persistent SOB, new breast / chest-wall changes) — deserve recognition cold. Knowing the right number to call — your survivorship clinic, your oncology team, the ALA / Susan G. Komen helpline, or 911 — saves time, dignity, and life. Save these numbers in your phone today. The numbers below are placeholders — your institution will fill in the right ones for you.

🚨 Crushing chest pain, stroke signs, suicidal crisis, severe new neuro deficit — 911 / 988

Crushing chest pain or new severe shortness of breath = 911 — possible cardiotoxicity event, MI, or PE (anthracycline / trastuzumab / left-sided RT survivors are at higher risk). Stroke signs (sudden facial droop, arm weakness, slurred speech, severe headache) = 911. Severe new neurologic deficit / cord-compression symptoms (back pain + leg weakness / numbness / bowel-bladder change — concerning for spinal metastasis) = 911. Suicidal ideation or active self-harm crisis = call 988 Suicide and Crisis Lifeline (free, 24/7) and/or 911.

🧭 New persistent bone pain, lymphedema progression, cardio symptoms, mood crash — same-day call

For new persistent bone pain (especially axial spine / hip / ribs — concerning for metastasis; pain at rest / night / progressive matters), arm swelling progressing or skin changes (lymphedema needs early PT), exertional fatigue / SOB / chest pain (cardiotoxicity), persistent depression / anxiety / fear-of-recurrence affecting function (PHQ-9 ≥10 or GAD-7 ≥10), postmenopausal vaginal bleeding on tamoxifen (rule out endometrial cancer), or new persistent breast / chest-wall change, call your [Survivorship Clinic Triage Line: (555) 123-4567]. Most issues are addressable in clinic.

💬 Routine questions, refills, scheduling, peer + mental-health support

Use [MyChart portal] first — most messages answered within 1 business day. For endocrine therapy / denosumab / bisphosphonate refills or copay help, call [Specialty Pharmacy: (555) 222-9050]. For peer mentoring, hereditary-risk questions, and local resources, call the Susan G. Komen helpline 1-877-465-6636 or Living Beyond Breast Cancer 1-888-753-5222 or SHARE 1-844-275-7427 — free, real humans, weekdays. For mental-health crisis: 988 Suicide and Crisis Lifeline.

🚑 Call 911 right away for any of these

Crushing chest pain · severe shortness of breath · stroke signs (face droop, arm weakness, slurred speech, severe headache) · cord-compression symptoms (back pain with leg weakness / numbness / bowel-bladder loss) · active suicidal crisis (call 988) · severe new neuro deficit / seizure · fall with head injury or possible fracture (especially in AI-treated bone-loss patients) · fever with rigors / low BP / suspected sepsis — 911.

📚Condition Literacy & the 10 Prepared Patient Competencies

A Prepared Patient builds three kinds of health literacy — and grows into three identities. Each competency works through the FFH three pillars: Learn It · Live It · Share It.

🛡️

Advocate for Self

You speak up for your own care, plan, pain, and goals.

🤝

Care Team Member

You partner with your team — not above, not below.

📣

Ambassador

You teach, mentor, and shape research, policy & access.

1

🧬 Condition Literacy Learn It · Tier 1 Aware

"I know my body and my disease." The foundation. Without this, nothing else holds.

Identity earned: Self-AdvocateCompetencies 1–4
1 🩺

What Survivorship Is

The IOM defines survivorship as the period from diagnosis through the rest of life. ASCO splits the post-treatment arc into three phases: acute, extended, permanent. "Treatment is over; the journey isn't." Survivorship has its own surveillance, late-effect map, and adherence work.

Learn ItLive It
My confidence (1–5)—
Pre: — · Post: —
2 🩸

Know My Numbers + Treatment Summary

Stage at diagnosis, ER / PR / HER2 status, subtype (HR+ / HER2+ / TNBC), Oncotype DX / MammaPrint if used, anthracycline cumulative dose mg/m², trastuzumab duration, RT field + side + dose, surgery type, axillary procedure, endocrine therapy + start date + planned duration, BRCA / multi-gene panel result. The IOM Survivorship Care Plan core. Bring it to every visit.

Learn ItLive It
My confidence (1–5)—
Pre: — · Post: —
3 🥗

Lifestyle Force Field — Weight, Exercise, Diet, Alcohol, Sleep

Real recurrence-reduction evidence. Weight management toward BMI <25 (WHEL, WINS, Nurses' Health). Exercise ≥150 min/week + 2× resistance (ACSM Roundtable on Exercise & Cancer). Mediterranean / DASH-style diet (WCRF/AICR). Alcohol ≤1 drink/day, ideally none. Smoking cessation. Sleep 7–9 hr. Vitamin D adequacy. Stack collectively reduces recurrence ~20–30%.

Learn ItLive It
My confidence (1–5)—
Pre: — · Post: —
4 💊

Endocrine Therapy & Adherence — The Make-or-Break

HR-positive: tamoxifen (premenopausal first-line) or aromatase inhibitor (anastrozole / letrozole / exemestane — postmenopausal first-line) for 5–10 years (often extended to 7–10+ for higher-risk). Real-world ~30–50% drop early. Manage side effects to enable adherence: hot flashes, joint pain, bone loss, GU symptoms. CYP2D6 + tamoxifen interactions matter (avoid paroxetine / fluoxetine / bupropion). Adherence is the medicine.

Learn ItLive It
My confidence (1–5)—
Pre: — · Post: —
2

🤝 Care & System Literacy Live It · Tier 2 Active

"I'm part of the team. I navigate the system." Where most preventable ED visits, late-effect crises, and frustration happen — and where this course pays off the most. Optimal utilization lives here.

Identity earned: Care-Team MemberCompetencies 5–7
5 📊

Make Every Visit Count — SHARE Approach + Teach-Back

AHRQ SHARE Approach (Seek, Help, Assess, Reach, Evaluate). Teach-back at every visit. 3-question max written priority list. Treatment Summary + med list + second pair of ears. Survivorship visits cover endocrine therapy, late effects, surveillance, mental health — preparation multiplies value.

Learn ItLive It
My confidence (1–5)—
Pre: — · Post: —
6 🚨

When to Call vs Go to ED — Late Effects + Recurrence Signals

Crushing chest pain / severe SOB / stroke signs / cord-compression symptoms / suicidal crisis (988) = 911. New persistent axial bone pain (worse at rest / night) / lymphedema progression / exertional fatigue or chest pain (cardiotoxicity) / postmenopausal bleeding on tamoxifen / new persistent breast or chest-wall change / PHQ-9 ≥10 = same-day call. Most issues are addressable in clinic.

Learn ItLive It
My confidence (1–5)—
Pre: — · Post: —
7 🌐

Comorbidity Awareness — Cardiotoxicity, Bone Loss, CIPN, Cognition, Mental Health, Metabolic

Breast Cancer Survivor-specific Module 7. The survivorship comorbidity ecosystem. Cardiotoxicity (anthracycline / trastuzumab / left-sided RT — cardio-oncology). AI-related osteoporosis (DXA + Ca / vit D / bisphosphonate or denosumab). Taxane-induced peripheral neuropathy. Cognitive 'chemo brain'. Fertility / early-menopause / GU symptoms. Depression / anxiety ~30–40% — cross-references Depression + Anxiety courses. Metabolic syndrome from treatment + weight gain (cluster CROSS-REFERENCED, not embedded).

Learn ItLive It
My confidence (1–5)—
Pre: — · Post: —
3

📣 Advocacy & Ambassadorship Share It · Tier 3 Certified

"I speak up. I lift others. I shape the future." This is what turns a Prepared Patient into a force multiplier for the whole community.

Identity earned: AmbassadorCompetencies 8–10
8 🤝

Family, Caregiver, and the Care Team — Long-Arc Partnership + the Survivorship Care Plan

The partner helps with endocrine therapy adherence, late-effect recognition (lymphedema, mood, cognitive change), intimacy / body-image conversations. Team: medical oncology + breast surgery + radiation oncology + PCP (transitioning over years) + cardio-oncology (if anthracycline / trastuzumab / left-RT) + lymphedema-trained PT + pelvic-floor / sexual-health specialist + gyn / menopause specialist + behavioral health + genetic counseling (if BRCA / hereditary indication) + Komen / SHARE / BCRF / LBBC / YSC / Sisters Network peer support.

Learn It
My confidence (1–5)—
Pre: — · Post: —
9 🎤

Sharing — Talk to Kids, Partner, Employer; Body Image / Intimacy; BRCA; Mentor

Kids: plain language about being "in survivorship now"; older kids may face hereditary-risk testing. Partner: intimacy, body image, scars / reconstruction, early-menopause / GU symptoms, fertility loss — name them explicitly. Employer: ADA covers cognitive accommodations ('chemo brain'), schedule flex for surveillance imaging. BRCA / hereditary-risk family conversation (cascade testing for daughters, sisters, sons) is a powerful Ambassador move. Mentor via Komen / SHARE / BCRF / LBBC / YSC / Sisters Network / Latinas Contra Cancer.

My confidence (1–5)—
Pre: — · Post: —
10 🏆

Mastery & Graduation — Endocrine Adherence, Lifestyle Stack, Transition to Permanent Survivorship

Endocrine therapy adherence held steady through the full 5–10+ year course. Lifestyle stack (weight / exercise / Mediterranean / alcohol / sleep) habituated. Surveillance schedule (annual mammogram, DXA, cardio-oncology echo if applicable) on rails. Mental-health rhythm (PHQ-9 / GAD-7) maintained. BRCA / hereditary cascade testing complete if applicable. Komen / SHARE / BCRF / LBBC peer mentoring active. Earn Certified Prepared Patient · Breast Cancer Survivor.

Learn It
My confidence (1–5)—
Pre: — · Post: —
👥My Care Team

Your team is bigger than just the doctor — and the care partner is part of it. Click any card to edit, or click the + tile to add a new team member. Saved on this device. The Force Field Emergency Card below auto-syncs from this list. Starter roster pre-populated for breast cancer survivorship — your institution can edit any row. The Force Field Emergency Card auto-syncs from this list.

Edit Team Member

📖Glossary — words you'll hear 10 plain-English terms · click any to expand

Plain-English definitions for terms doctors and labs use. Tap to expand.

Survivorship (IOM definition)
Per the Institute of Medicine 2005 report From Cancer Patient to Cancer Survivor: Lost in Transition, the period from diagnosis through the rest of life. ASCO splits the post-treatment arc into acute, extended, and permanent survivorship phases. "Treatment is over; the journey isn't."
Subtype (HR+ / HER2+ / TNBC)
Breast cancer is biologically heterogeneous. HR-positive (~70%): estrogen and/or progesterone receptor positive — endocrine therapy works. HER2-positive (~15–20%): HER2 oncogene amplified — trastuzumab and other HER2-targeted agents work. Triple-negative (TNBC) (~10–15%): ER/PR/HER2 all negative — no targeted hormonal or HER2 therapy; chemo is the mainstay; recurrence risk highest in first 3–5 years; more common in younger and AA women.
Endocrine therapy (tamoxifen / aromatase inhibitor)
For HR-positive disease, the dominant ongoing post-treatment medicine. Tamoxifen (selective estrogen receptor modulator) — premenopausal first-line; risks endometrial cancer + venous thromboembolism; CYP2D6-metabolized (avoid potent inhibitors — paroxetine, fluoxetine, bupropion). Aromatase inhibitors (anastrozole, letrozole, exemestane) — postmenopausal first-line; risks bone loss, joint pain, lipid changes, GU symptoms. Duration 5–10 years (sometimes 10–15 for higher-risk).
Lymphedema
Swelling of the arm (and sometimes chest wall) on the surgery side from disrupted lymphatic drainage after axillary surgery and/or radiation. Risk ~5–40% lifelong, depending on extent. Early signs: arm heaviness, tightness, decreased range of motion. Early lymphedema-trained PT referral changes the trajectory. Compression garments now covered by Medicare under the Lymphedema Treatment Act (effective 2024).
Cardiotoxicity
Heart-muscle injury from cancer treatment. Anthracyclines (doxorubicin, epirubicin) accumulate cardiac toxicity at higher cumulative doses. Trastuzumab (Herceptin) cardiac effect is generally reversible but warrants echo monitoring. Left-sided radiation raises long-term coronary artery disease risk. Cardio-oncology surveillance with echo / GLS as indicated.
"Chemo brain" (cancer-related cognitive impairment)
Slower processing speed, word-finding difficulty, and attention/memory issues described by many survivors during and after chemotherapy. Usually improves over months to a year or two but can persist. Cognitive rehabilitation, exercise, sleep, and treatment of mood / anxiety help. Not "in your head" — measurable on neuropsych testing.
CIPN (Chemotherapy-Induced Peripheral Neuropathy)
Numbness, tingling, and sometimes pain in the feet and hands from taxanes (paclitaxel, docetaxel) and other chemo agents. Often slowly improves after treatment. Duloxetine has the best evidence among medications. Acupuncture and exercise show modest benefit.
Survivorship Care Plan (SCP)
A written document — recommended by the IOM 2005 report and ASCO — summarizing the diagnosis, treatment received (anthracycline cumulative dose, trastuzumab duration, RT field/dose, surgery, endocrine therapy plan), surveillance schedule, late-effect map, and long-term care recommendations. Every survivor should have one. Bring it to every visit (oncology, primary care, ED, dental).
BRCA1 / BRCA2 (and other hereditary genes)
Genes whose mutations substantially raise breast and ovarian cancer risk. ~5–10% of breast cancers are hereditary. Other genes: PALB2, CHEK2, ATM. Genetic counseling and multi-gene panel testing are recommended for diagnoses under age 50, family-history patterns, AAJ ancestry, triple-negative under 60, male breast cancer, and others. Cascade testing in family members (daughters, sisters, sons) saves lives in the next generation.
Oncotype DX / MammaPrint (genomic recurrence score)
Tumor genomic tests that predict recurrence risk and chemotherapy benefit in early-stage HR-positive disease. Helps the post-surgery decision: chemotherapy or skip it. The result is part of your Treatment Summary; carry it lifelong.
Mediterranean / DASH diet
High in vegetables, fruits, whole grains, legumes, nuts, fish, olive oil; low in processed meats, sugar-sweetened beverages, refined carbs. Multiple WCRF/AICR-aligned observational studies support meaningful recurrence-reduction in HR-positive disease. Combined with exercise + weight management, the lifestyle stack collectively reduces recurrence ~20–30%.
ACSM Roundtable (Exercise & Cancer)
The American College of Sports Medicine consensus: ≥150 minutes/week moderate aerobic exercise + 2× resistance training per week in cancer survivors. Among the strongest survivorship recommendations. Effects: recurrence reduction, mortality reduction, fatigue reduction, mood, bone protection (especially in AI users), cognition.
PHQ-9 / GAD-7
Brief, validated self-report screeners for depression (PHQ-9) and generalized anxiety (GAD-7). Score ranges roughly: 0–4 minimal, 5–9 mild, 10–14 moderate, 15+ severe. Survivors should self-check monthly during the extended phase. Score ≥10 warrants a clinical conversation. Cross-reference: Prepared Patient · Depression and Prepared Patient · Anxiety courses (Sprint 6).
Lymphedema Treatment Act (LTA)
U.S. federal law that, effective 2024, requires Medicare coverage for compression garments, bandages, and related supplies for lymphedema treatment. Many private payers follow. Ask your survivorship navigator to cite the LTA when requesting coverage.
🧪Lab Test Tutor — what your numbers mean click to expand

Lab Test Tutor — what your numbers mean

Don't just see a number — know what it means and what to ask. Your "normal" may be different from a friend's. Ask your team to write your personal baseline in the column on the right.

TestWhat it measuresTypical adult rangeWhat to ask if it's offMy baseline
Treatment Summary (lifetime)Stage at diagnosis · ER/PR/HER2 · subtype · Oncotype DX or MammaPrint (if used) · surgery + axillary procedure · anthracycline cumulative dose mg/m² · trastuzumab duration · RT field + side + total Gy · endocrine therapy + start date + planned duration · BRCA / multi-gene panel result. The IOM Survivorship Care Plan core. Carry it to every visit.Personalized lifetime data setCan I have my written Survivorship Care Plan / Treatment Summary?[fill in]
Annual mammogramPer ASCO / ACS / NCCN: annual mammogram of the contralateral or remaining breast tissue at minimum. No routine MRI unless high-risk (BRCA carriers, lifetime risk ≥20%, dense-breast protocol).Annual; symptom-based imaging only beyond thatWhen is my next mammogram due? Do I need MRI given my risk profile?[fill in]
Clinical breast exam (CBE)Physical exam of breasts and axilla by oncology / surgery. Q3–6 months for the first 3 years, then annually.q3–6 mo first 3 yrs, then annuallyIs my CBE on schedule? Any new finding to look at?[fill in]
DXA bone densityBone-density scan. Baseline + every 1–2 years on aromatase inhibitors (AIs) — AIs accelerate bone loss. Score: T-score >-1 normal · -1 to -2.5 osteopenia · ≤-2.5 osteoporosis.T-score >-1 desirable; treat osteoporosisWhen is my next DXA? Should I be on Ca / vitamin D / bisphosphonate or denosumab?[fill in]
Lipid panel + A1c (if on AI)AIs cause lipid changes and metabolic effects. Annual lipid panel + A1c is reasonable for survivors on AIs.LDL <100 (or per ASCVD risk) · A1c <5.7%Is my lipid panel on schedule? Should I be on a statin?[fill in]
Echo / cardiac monitoring (cardio-oncology)Indicated for survivors with anthracycline exposure (cumulative dose threshold), trastuzumab exposure, or left-sided RT. Echo / GLS surveillance + cardio-oncology referral if any change.LVEF ≥50%; GLS within normalDo I need cardio-oncology echo given my treatment? At what cadence?[fill in]
Pelvic exam (especially on tamoxifen)Annual pelvic exam — and any postmenopausal vaginal bleeding warrants prompt evaluation. Tamoxifen modestly raises endometrial cancer risk.No abnormal bleeding; symptomatic eval promptIf on tamoxifen, am I current with pelvic exam? Any abnormal bleeding to evaluate?[fill in]
PHQ-9 / GAD-7 (mental health)PHQ-9 for depression, GAD-7 for anxiety. Survivors should self-check monthly during the extended phase. Score ≥10 warrants a clinical conversation. Cross-references Prepared Patient · Depression and Prepared Patient · Anxiety courses.0–4 minimal · 5–9 mild · 10–14 moderate · 15+ severeShould I screen with PHQ-9 / GAD-7 today? If ≥10, what's the plan?[fill in]
Arm circumference (lymphedema baseline)Tape-measure or perometer measurement of the surgery-side arm. Baseline + monthly self-check or periodic. Increase >2 cm or asymmetric swelling = call lymphedema PT.Symmetric to non-surgery side; track changesShould I have a lymphedema baseline measurement done? When do I call?[fill in]
NO routine PET / CT / tumor markersASCO Choosing Wisely: in asymptomatic survivors, routine PET, CT, bone scan, or tumor markers (CA 15-3, CA 27.29, CEA) do NOT improve outcomes and lead to false alarms. Symptom-based imaging only.Symptom-driven onlyWhy are we (or aren't we) ordering this scan / marker today?[fill in]
BRCA / multi-gene panel (if not done)Recommended for diagnoses under 50, family-history patterns (multiple breast/ovarian/pancreatic/prostate cancers), AAJ ancestry, triple-negative under 60, male breast cancer, others. Cascade testing for daughters / sisters / sons saves lives in the next generation.Negative / VUS / positive (BRCA1/2, PALB2, CHEK2, ATM, etc.)Was I tested? Are there family members who should have cascade testing?[fill in]
Med list with CYP2D6 review (if on tamoxifen)Tamoxifen is metabolized by CYP2D6. Avoid potent CYP2D6 inhibitors — paroxetine, fluoxetine, bupropion (for hot flashes use venlafaxine instead). Always tell every clinician about your endocrine therapy before any prescription.Hepatic dosing + CYP2D6 awareness; pharmacist consultAre any of my new meds problematic with tamoxifen? Should I switch SSRIs?[fill in]
➕Add-On Modules & Earnable Badges

Stackable modules that match your situation. Complete one to earn an extra badge on your certificate. Your institution can add their own.

Add-on
💊 Endocrine Therapy Adherence Routine

The single highest-leverage habit in HR-positive survivorship. Pillbox + auto-refill + daily reminder + place pill where you'll see it. If side effects (hot flashes, joint pain, GU symptoms) are pushing you off — call the team this week, not next year. Switch agents, manage side effects, stay on therapy.

Add-on
📏 Lymphedema Arm-Measurement + Compression Garment

Tape-measure baseline + monthly self-check on the surgery-side arm. Increase >2 cm or new heaviness / tightness → call lymphedema-trained PT same day. Compression garments now Medicare-covered under the Lymphedema Treatment Act (effective 2024).

Add-on
🦴 DXA-Driven Bone Health Protocol

Baseline DXA + every 1–2 years on AIs. Adequate calcium (~1200 mg/day) + vitamin D (target per labs). Bisphosphonate (zoledronic acid IV q6mo or alendronate weekly) or denosumab q6mo if osteoporosis or rapid loss. Resistance training preserves bone.

Add-on
❤️ Cardio-Oncology Echo Cadence

If anthracycline / trastuzumab / left-sided RT: echo + GLS surveillance per cardio-oncology. Watch exertional fatigue, SOB, chest pain. Statins are appropriate per ASCVD risk; aerobic + resistance exercise is protective.

Add-on
🧠 PHQ-9 + GAD-7 Monthly Self-Check

Brief monthly mood / anxiety self-check. Score ≥10 = clinical conversation. Cross-link Prepared Patient · Depression and · Anxiety courses (Sprint 6) for full treatment context.

Add-on
💞 Sexual Health / Pelvic-Floor PT Routine

Vaginal dryness, painful intercourse, decreased libido, body-image changes are real and routinely under-addressed. Vaginal moisturizers, low-dose vaginal estrogen (with oncology input), pelvic-floor PT, sexual-health specialist, couples therapy as appropriate.

Add-on
🧬 BRCA / Genetic Counseling Visit

If you fit a hereditary-risk pattern (diagnosed under 50, family-history pattern, AAJ ancestry, triple-negative under 60, male breast cancer, others) and have not been tested — genetic counseling now. Cascade testing for daughters / sisters / sons saves lives.

Add-on
📋 Survivorship Care Plan Request

Per the IOM 2005 standard, every survivor should have a written Survivorship Care Plan summarizing diagnosis, treatment, surveillance, late-effect map, long-term care recommendations. Ask your oncology team if you don't have one.

Add-on
📅 Surveillance Mammogram + DXA Annual Cadence

Annual mammogram. DXA every 1–2 years on AIs. NO routine PET / CT / tumor markers in asymptomatic patients (ASCO Choosing Wisely). Symptom-based imaging only.

Add-on
🧠 Cognitive Rehab for "Chemo Brain"

Cancer-related cognitive impairment is real. Cognitive rehabilitation, exercise, sleep hygiene, treatment of mood and anxiety all help. Apps (BrainHQ etc.) have modest evidence. Most survivors improve over months to a couple years.

Add-on
🌱 Fertility / Early-Menopause Decisions

For younger survivors: fertility-preservation options (egg / embryo cryopreservation if not done before treatment), GnRH agonist co-administration during chemo. For early menopause: hot-flash management (gabapentin, SNRI venlafaxine, CBT, acupuncture), GU symptom care.

Trial
🧪 In a Breast Cancer Survivorship Clinical Trial?

Protocol literacy, side-effect tracking, when to call the study coordinator vs your usual oncology team. Trials currently enrolling in: extended endocrine therapy, abemaciclib in adjuvant HR+ high-risk, lifestyle-intervention RCTs (BWEL, INTERVAL), de-escalation studies.

Add-on
📋 Advance Care Planning (if relevant)

For survivors with metastatic disease or complex comorbidities: POA, healthcare proxy, advance directive, POLST/MOLST, will, financial plan — done while capacity is clear and the conversation is calm.

Custom
+ Add Your Institution's Module

Drop in your own — survivorship clinic onboarding, cardio-oncology integration, lymphedema PT pathway, sexual-health / pelvic-floor PT program, hereditary-risk genetic-counseling pathway, identity-aligned mentor program, anything.

🛡️Force Field Emergency Card Fridge · Wallet · EMT-ready

🛡️ Force Field Emergency Card FRIDGE · WALLET · EMT-READY

A one-page emergency record for any EMT, ER, new doctor, or transition visit. Print one for the fridge, one for your wallet. Updates anytime. This is the document you hand to a stranger when you can't speak for yourself.

🤝 My Care Team — call list for any clinician picking up my care
📘My Health Passport Patient-Owned Journal

📘 My Health Passport PATIENT-OWNED JOURNAL

This is your record — not your hospital's. Log every visit, capture every question for next time, and watch your own trends. Many of you get care at more than one hospital, on more than one record system. This Passport travels with you. Future versions will let you import data directly from your patient portals (the "Blue Button" vision).

        Blue Button vision: A future release will let you connect your patient portals (Epic MyChart, Cerner, Athena, VA, others) and pull your labs, meds, and visit history straight in. Until then, this Passport is your single, portable record across institutions — you own it.
        🩺Working With a Prepared Patient

        Your patient is going through a structured, evidence-based course for the post-treatment chapter of breast cancer. Here's how to get the most out of every visit, support endocrine therapy adherence, surface late effects early, partner with the caregiver, and address equity. Built on the AHRQ SHARE Approach, the IOM teach-back method, the IOM 2005 From Cancer Patient to Cancer Survivor framework, ASCO Survivorship Guidelines, ACS Breast Cancer Survivorship Care Guidelines, NCCN Survivorship, ESC / ACC cardio-oncology, and WCRF/AICR lifestyle recommendations.

        The SHARE Approach — your 5-step playbook

        Use these steps in any order. Cycle back. Use teach-back at every transition. Source: AHRQ Pub. No. 25-0005 (Oct 2024).

        💬Teach-Back & Risk Communication

        The two highest-yield, lowest-cost SDM techniques. Use both at every visit.

        🔁 Teach-Back (1–2 min)
        • "Just so I know I explained it well — what would you tell your spouse about why we're starting letrozole? About the bone-health protocol with calcium / vitamin D / DXA? About what to call us for vs going to the ED?"
        • Open-ended ("what" / "how"), not yes/no.
        • If they get it wrong: "I must not have explained it well — let me try a different way." Then teach-back again.
        • Use it for: endocrine therapy adherence + side-effect management, the modifiable lifestyle stack, late-effect recognition (lymphedema, cardiotoxicity, bone loss, cognitive, mental health), surveillance schedule, BRCA / hereditary cascade testing.
        • Document teach-back in your note — it's a quality measure and a billable element of care.
        🔢 Communicating Numbers
        • Use absolute risk, not relative. "13 out of 100" beats "13%" beats "1 in 8" beats "low risk."
        • Keep denominators & timeframes constant when comparing options.
        • Show, don't tell: icon arrays, Wong-Baker FACES, written summary.
        • For lab numbers: give the action threshold, not just the value. "Your DXA T-score moved from -1.0 to -1.5 in two years on letrozole — at -2.5 we add a bisphosphonate. We're not there yet, but it's a good time to step up calcium, vitamin D, and resistance training."
        ⚠️Breast Cancer Survivor-Specific Clinical Guardrails

        Survivorship Care Plan & Treatment Summary

        • Generate a written Survivorship Care Plan (SCP) per IOM 2005 / ASCO standard — every survivor should have one. Include subtype, stage, anthracycline cumulative dose mg/m², trastuzumab duration, RT field + side + dose, surgery + axillary procedure, endocrine therapy + planned duration, BRCA / multi-gene panel result, surveillance schedule, late-effect map.
        • Transition planning: explicit plan for transitioning surveillance and comorbidity management to PCP over the extended phase. Many survivorship clinics now formalize this.

        Endocrine Therapy & Adherence (HR-Positive)

        • Tamoxifen (premenopausal first-line) — endometrial + VTE risk; CYP2D6-metabolized (avoid potent inhibitors — paroxetine, fluoxetine, bupropion).
        • Aromatase inhibitors (anastrozole, letrozole, exemestane — postmenopausal first-line) — bone loss, joint pain (~50%), lipid changes, GU symptoms.
        • Duration 5 yrs typical; extend to 7–10 yrs (often 10 with overall extended approach) for higher-risk; some 10–15.
        • Adherence is dismal in real-world data (~30–50% drop early) — manage side effects to enable adherence; switch agents; brief trial of tamoxifen for AI joint pain; CBT and SNRIs for hot flashes; vaginal moisturizers and low-dose vaginal estrogen with oncology agreement for GU symptoms.

        Surveillance (per ASCO / ACS / NCCN)

        • Annual mammogram (contralateral or remaining breast tissue at minimum). No routine MRI unless high-risk (BRCA carriers, lifetime risk ≥20%, dense-breast protocol).
        • Clinical breast exam q3–6 mo first 3 yrs, then annually.
        • NO routine PET / CT / bone scan / tumor markers (CA 15-3, CA 27.29, CEA) in asymptomatic patients (ASCO Choosing Wisely). Symptom-based imaging only.
        • Pelvic exam annually (especially on tamoxifen — endometrial cancer risk; postmenopausal bleeding warrants prompt eval).
        • DXA baseline + every 1–2 years on AIs.
        • Lipid panel + A1c if on AIs (metabolic effects).
        • Echo / cardiac monitoring per cardio-oncology if anthracycline / trastuzumab / left-sided RT.
        • Mental health screening (PHQ-9 / GAD-7) at oncology visits.

        Late-Effect & Comorbidity Management

        • Lymphedema: early lymphedema-trained PT referral at first sign; baseline arm-circumference; compression garments now Medicare-covered (Lymphedema Treatment Act 2024).
        • Cardiotoxicity: cardio-oncology referral if anthracycline / trastuzumab / left-sided RT; echo + GLS surveillance; statins per ASCVD risk.
        • Bone health: DXA-driven; calcium ~1200 mg/day + vitamin D to target; bisphosphonate (zoledronic acid q6mo, alendronate weekly) or denosumab q6mo for osteoporosis or rapid loss.
        • CIPN: duloxetine has best evidence; acupuncture and exercise modest benefit.
        • Cognitive: cognitive rehabilitation, exercise, sleep hygiene, treat mood / anxiety; most improve over 1–2 years.
        • Mental health: PHQ-9 / GAD-7 monthly; ≥10 → behavioral health linkage; cross-link Depression / Anxiety courses.
        • Sexual health / GU symptoms: vaginal moisturizers, low-dose vaginal estrogen with onc agreement, pelvic-floor PT, sexual-health specialist.
        • Genetic counseling: dx under 50, family-history pattern, AAJ ancestry, TNBC under 60, male breast cancer, others — refer with cascade-testing in mind.
        • Lifestyle stack: BMI <25, ≥150 min/week exercise + 2× resistance (ACSM Roundtable), Mediterranean / DASH-style diet, alcohol ≤1 drink/day or none, smoking cessation, sleep 7–9 hr — collectively ~20–30% recurrence reduction.
        🌍Cultural Competence & Trust

        Breast cancer survivorship disparities are specific and addressable. African American women: ~40% higher mortality despite slightly lower incidence; triple-negative more common; younger age at diagnosis; longer time from screening to treatment; underrepresentation in clinical trials and genomic testing. Latina women: later-stage at diagnosis; language and access barriers; underuse of genetic testing despite hereditary patterns. AAPI women: low routine screening uptake in some communities; rising incidence in younger women. Rural women: distance to oncology / radiation / cardio-oncology / lymphedema PT. Younger survivors (<40): fertility, body image, parenting, career — different arc that adult-oncology survivorship clinics often miss. SGM patients: chest-wall surgery and hormonal-therapy data are thin. Repair starts in your office.

        • Refer to genetic counseling per NCCN criteria — don't wait for self-advocacy. Cascade testing for daughters / sisters / sons saves lives in the next generation.
        • Refer to clinical trials regardless of who is in front of you. Underrepresentation in oncology trials is a clinical-pathway problem, not a patient problem.
        • Refer to cardio-oncology + lymphedema PT + sexual-health early — these specialists are undersized in many systems but high-leverage. Identify the regional partners.
        • Use qualified medical interpreters — never family, never minor children except in true emergencies. Survivorship-care-plan, hereditary-risk, and intimacy / sexual-health conversations must be done in the patient's primary language.
        • Invite the care partner in. With patient consent — decisions about endocrine therapy adherence, late-effect recognition, and intimacy / body-image are family conversations in many cultures.
        • Name the disparity when it's relevant. "I know AA / Latina / rural / young survivors face access challenges in our system. We try to push back against that here. Tell me if anything feels off."
        🏥Customize for Your Institution

        Clone this course and replace the highlighted blocks with your own information. Each editable field below is a placeholder — change it once and it propagates through the patient view.

        📞 What Should Replace the When-to-Call Block
        • 24/7 oncology on-call number
        • Survivorship Clinic outpatient hours & address
        • Specialty pharmacy line (endocrine therapy, denosumab/bisphosphonate, biosimilar trastuzumab)
        • Cardio-oncology direct line
        • Lymphedema PT contact
        • Behavioral health rapid-access line + 988 Suicide and Crisis Lifeline
        • Susan G. Komen / Living Beyond Breast Cancer / SHARE local resources
        • Patient portal login URL with caregiver proxy
        👤 Who Is Your Survivorship Care Navigator?
        • Name, role, photo, calendly/booking link.
        • What teach-back / device check-ins they own (endocrine adherence, lymphedema arm-circumference baseline, DXA-driven bone health protocol, monthly PHQ-9 / GAD-7).
        • How patients and care partners reach them between visits.
        • How they handle prior-auth navigation (extended endocrine, denosumab, lymphedema garments via Lymphedema Treatment Act), copay help, BRCA / multi-gene panel coordination.
        📚 Add Your Own Modules
        • Your clinical trial protocols (extended endocrine, abemaciclib in adjuvant high-risk HR+, lifestyle-intervention RCTs like BWEL / INTERVAL, de-escalation studies).
        • Oncology dietitian onboarding letter — Mediterranean / DASH-style framing, weight-management resources, alcohol-moderation language.
        • Insurance & financial-aid pathways (Komen Financial Assistance, CancerCare Co-Pay Assistance, Patient Advocate Foundation, NeedyMeds, Lymphedema Treatment Act citation).
        • Local peer support partners (Komen / SHARE / BCRF / LBBC / YSC chapter, Sisters Network for AA, Latinas Contra Cancer, identity-aligned mentor pairs).
        🎨 Re-skin in 2 Lines of CSS
        • --inst-primary: your brand color
        • Replace the FFH × Susan G. Komen × [Your Cancer Center] cobrand in the hero
        • Drop in your logo PNG (white version) — same 48px height as FFH logo

        📚 Evidence Base — what this course is built on

        Course content is educational and not a substitute for medical advice from your own clinicians. Institutions cloning this course are responsible for accuracy of all customized blocks.

        Prepared Patient · Breast Cancer SurvivorChapter 1 · Learn It

        1Module title

        Module description.

        Take the Pre-Check, work through Learn It → Live It → Share It, then take the Post-Check (≥4/5 to mark complete).