MA07.03 Current Practice of Lung Cancer Survivorship Care: Is a Care Plan Enough?

Abstract

Survivorship care in cancer patients involves 4 essential components: surveillance (detect recurrence of cancer), prevention of cancer (smoking cessation and encouraging age appropriate malignancy work-up), management of cancer and treatment-related side effects; and coordination of care between oncology teams and primary care provider. National and international oncology groups have endorsed Survivorship care plans (SCP) with or without a dedicated survivorship care visit (SCV) as an important aspect of quality cancer care. The aim of this study is to evaluate the impact of SCP and SCVs in people treated for lung cancer at the Lifespan Cancer Institute. We performed a retrospective chart review analysis of 1630 survivors seen at our tertiary level cancer center from December 2014 to December 2017. As routine practice, all persons with cancer at our center complete the NCCN Distress Thermometer (DT); at the time of cancer diagnosis. Demographics and clinical data were gathered using Tumor registry and our electronic medical records. Descriptive statistics and qualitative analysis were performed. Subgroup analysis was performed for age, insurance, marital status, and race. Categorical data were analyzed using Fisher’s Exact Test or Chi-Square. Multinomial logistic regression was performed for multivariate analysis. All analyses were performed in STATA 15.0. There were 312 (19% of the entire 1630 patient cohort) lung cancer survivors enrolled into this study, mean age was 39 +/- 9.5 years. Compared to entire survivorship cohort, significantly more men were present in the lung cancer (43% vs 34%, p<0.0005); and significantly more of the lung cancer survivors were without a partner (47.5 vs 41%, p<0.05). Forty-five percent of people with lung cancer reported a DT of 4 or more, consistent with severe distress at presentation. Symptoms that were significantly associated with distress were primarily emotional/mental: depression, fear, nervousness, sadness, worry and loss of interest; and others were nausea, neuropathy, appearance, memory/concentration and ADLs (bathing, dressing etc). Only 32% (n=98, p<0.005) received a SCP and only a tiny minority (8%, n=25) presented for a SCV. The primary reason for non-attendance of a SCV was patient preference. However, of those referred for services at the time survivorship care was rendered, overwhelming majority followed up with the referral (n= 30 of 33 referred, 91%). Attending a SCV was significantly associated with compliance for referral services, compared to those with SCP only (22/22 vs 8/11, p<.05). Severe distress is present at the time of diagnosis in nearly 50% of people with lung cancer, which also presents an opportunity to positively intervene to enhance quality of life at the very first meeting. Despite the young age in this cohort, very few patients avail themselves of a SCV, and only one third get a SCP. However, access to referrals is significantly tied to receiving these documents. To encourage compliance with SCV/SCPs, we are making efforts to incorporate survivorship care as part of initial cancer surveillance visit with the primary oncologist.