Identifying models of cancer survivorship care.

Abstract

1 Background: The growing population of cancer survivors (15.5 million in the US) face myriad health issues that require health care attention. Cancer is increasingly viewed as a chronic illness that, once treated, requires systematic and coordinated care. Little guidance, however, has been provided in terms of how programs should be organized and little research has been done to understand emerging models in the field. We aim to identify and describe the most common survivorship models of care to identify characteristics of care and provide guidance on how survivorship care should be delivered. Methods: We conducted a scan of 236 CoC-accredited cancer centers to identify characteristics that co-occur in survivorship programs and those that predict the provision of LIVESTRONG’s Essential Elements. We supplemented this approach with in-depth interviews and surveys of 32 survivorship programs to gain detailed organizational information. Results: Three models emerged from the data: The Consultative Specialized Survivorship Clinic provides a one-time onsite visit focusing on in-depth survivorship care planning and is typically led by an NP/PA. It is likely to enjoy more organizational support and to bill for services. The Longitudinal Specialized Survivorship Clinic provides ongoing care with most services delivered onsite, and is typically led by an NP/PA. It is likely to have some organizational support but less likely to bill for services. Oncology-Based Survivorship Care with Referral for Services provides ongoing survivorship care, often in tandem with treatment, but delivers most services via referral. It is typically physician-led and has no formal survivorship care planning protocol. It receives less organizational support and is less likely to bill for services. Models also differ in the numbers and types of services provided. Conclusions: These models reflect distinctive organizational and delivery system characteristics and can guide other institutions interested in providing survivorship care.