Implementation Of Survivorship Care Plans Research Articles

Survivorship Care Planning: Why Is It Taking So Long?

Survivorship care planning is a process that focuses on the transition from active cancer treatment to a coordinated and comprehensive care system to address patients' unique needs. Survivorship care plans (SCPs) are increasingly viewed as a key component of survivorship care planning. SCPs have been recommended for >10 years to promote care coordination, communication, and record-keeping efficiency; however, SCP implementation has been challenging. We elaborate on the challenges of SCP implementation, summarize evidence regarding potential methods of promoting SCP implementation, and describe a research agenda for generating more definitive evidence to support SCP implementation in practice.

Race is a Strong Predictor of Receipt of a Written Survivorship Care Plan: Results from the National Health Interview Survey.

The purpose of this study is to investigate the prevalence of receipt of written documentation of follow up care and of cancer treatments and to examine the predictors of receipt of such written documentation. Data from the 2010 National Health Interview Survey was used to identify individuals 18 years or older with a history of cancer. Binary and multinomial logistic regression were used to investigate patient-level variables associated with receipt of written documentation of cancer treatment, written advice about follow-up care, or both written documents. Patient-level variables included in the analysis were age, gender, region of residence, race/ethnicity, marital status, education level, insurance coverage, cancer type, employment status, and psychosocial support. Of the 1185 responses to the questions used to access receipt of a SCP, the prevalence of any receipt of a written documentation was 68%, where 30% obtained written advice only and 8% were provided a written treatment summary only; only 31% received both. Non-white race, cancer type, and psychosocial services were associated with increased odds of receiving written documentation. Patient-level characteristics are associated with receipt of care plan documentation. Further work needs to investigate the interaction of provider and patient-level characteristics. Understanding patient-level characteristics associated with receipt of written documentation may help uncover strategies for improved survivorship care plan implementation.

Examining the role of treatment complexity in survivorship care planning.

242 Background: The cancer survivor population will reach 19M by 2025, increasing demand on primary care providers to manage late and long-term effects of treatment. To improve care quality, the IOM recommends survivorship care plans (SCPs) that include two components: a treatment summary (TS) detailing disease and treatment characteristics; and evidence based follow up care instructions (FCI). SCPs remain underutilized despite evidence they enhance physician communication, increase self-efficacy and improve health outcomes of cancer survivors. Little is known about treatment related and socio-demographic factors associated with receipt of SCPs and their components. The purpose of this study was to examine the relationship between care complexity, operationalized as multiple cancers or treatments, and survivor reported SCP receipt. Methods: This was a secondary analysis of data collected in the 2012 LIVESTRONG Survey for People Affected by Cancer, an online self-selection survey. Descriptive statistics and multivariate regression were used to examine relationships between survivor characteristics and SCP receipt among 3,599 respondents. Results: Half (52%) of survivors received a complete SCP. Care complexity was significantly associated with lower odds of SCP receipt. Each additional treatment modality lowered odds of receipt by 8% (95% CI 0.86-0.99). Survivors with multiple diagnoses had 19% lower odds of receipt than those with single diagnoses (CI 0.68-0.95). Other predictors of SCP receipt were being female (OR 0.56; 95% CI 0.48-0.65), having at least a bachelor’s degree (OR 0.77; CI 0.60-0.99), age over 66 years (OR 1.38; CI 1.01-1.89), and race of “other” (OR 1.56; CI 1.14-2.13). Similar results were found for receipt of TS alone. Conclusions: Only 52% of survivors received SCPs as recommended by the IOM. Increased case complexity was associated with lower odds of SCP receipt, suggesting patients at highest risk are least likely to receive coordination. Results indicate the need to identify and eliminate barriers to SCP implementation, with special focus on high risk patients. Future research should investigate these findings in diverse populations and identify specific characteristics associated with SCP receipt.

Survivorship care plans: Processes, effective strategies, and challenges in a rural state.

47 Background: Annually, South Dakota (SD) averages nearly 4,000 new cancer cases with over 40,000 cancer survivors residing in the state. While the cancer incidence and survivorship rates in SD may be similar to the rest of the nation, SD’s unique geographic and demographic landscape offers challenges in cancer survivorship care. The purpose of this presentation is to illustrate the development and implementation of cancer survivorship care plans (SCP) at three health systems in the rural state of SD. Each of these health systems is unique in its history, culture, and infrastructure. Collectively, they serve most cancer patients living in SD. Methods: An observational qualitative design was used. Key players at each health system were interviewed using a structured interview. The interviews were audio-recorded and transcribed. The authors synthesized the transcriptions with member-checking completed for each system. Results: Processes for development and implementation of SCPs similar across health systems were (a) gathering a leadership team or making a designated staff role for survivorship care, (b) developing a SCP template(s), (c) provider/staff in-put and endorsement, and (d) tracking and identifying patients for scheduling and receipt. On the other hand, the health systems approached SCP completion and delivery differently. For example, at one health system multiple individuals from the patient’s care team were responsible for SCP population and completion. Effective strategies across health systems comprised incorporating prior SCP work, open communication, and standardization of SCPs with flexibility in implementation. Challenges included incompatibilities of electronic health record platforms for automatic SCP template population and adequate staffing for the complexities of enacting SCPs. Key findings suggest a process framework is beneficial for the development and implementation of SCPs. Conclusions: As health systems consider developing and implementing SCPs, consideration of the following recommendations for a process framework may be helpful: building a foundation, gathering resources, reviewing the evidence, eliciting input, and implementing in stages.

An evaluation of survivorship care plan program.

62 Background: The Commission on Cancer mandated the development and implementation of survivorship care plans (SCP) in 2015. Minimal evidence exists to suggest SCP are meaningful to survivors and primary care physicians (PCP). We sought to evaluate the usefulness of the SCP as perceived by both survivors and PCP. Methods: Phase I was 8-month pilot using a 7-page SCP detailing medical information and follow up sections addressed to the survivor and to the PCP. To evaluate patient and PCP views on the SCP, a telephone survey was created for patients and a two-page Likert scale survey for PCP was faxed. Phase I evaluations revealed 90% of survivors did not look past page 2 of the document and 16% of PCP felt it was too long and busy to read. The SCP was edited for a 3-page version and implemented in Phase II over 11-months. Results: In Phase I, 78 SCP were delivered to survivors, 58% were surveyed. Of PCP, 24% responded. In Phase II, 895 SCP were delivered, and 274 (31%) survivors surveyed. In Phase I and II, when asked to identify themselves as a cancer survivor, 282 (88%) confirmed and 21 (7%) were unsure. After reviewing the SCP, 93.1% understood their plan of care; 79.6% understood potential late effects; 33% were aware of support or resources available; 96% would recommend to another cancer survivor to get one. In Phase II, 16% (43) of PCP responded. Overall replies were positive: 61% found resource list helpful; 66% wanted more specific information about patient potential late effects; 87% agreed knowing symptoms of late effects is helpful. 70% wanted clarity on follow up tests needed and who should order. PCP overwhelmingly agreed (88%) the SCP is helpful. 90% agreed that knowing ongoing side effects of treatment was important. Conclusions: Survivors liked having their cancer treatment in one concise document and PCP physicians feel that the SCP is meeting their basic needs. PCP are interested in more specific long term side effects to monitor in their patients and direction on what follow-up tests are needed and who is ordering them. Further research is needed to study the impact of SCP on survivors’ health.

Use of telemedicine in the delivery of survivorship care plans among breast cancer survivors: Lessons learned at Kaiser Permanente East Bay.

77 Background: Beginning in 2015, the National Accreditation Program for Breast Centers (NAPBC) requires accredited facilities to provide Survivorship Care Plans (SCP) to breast cancer patients treated with curative intent. Here we describe lessons learned with the use of telemedicine in the delivery of SCPs at Kaiser Permanente East Bay. Methods: SCP implementation followed a two-step process: patients who are diagnosed and complete treatment in 2016 are given a SCP at their last surgical or medical oncology appointment (YTD, n=8); 2) patients diagnosed in 2015 who completed treatment in 2015-2016 were contacted by a physician assistant and offered an appointment by telephone or in-person to deliver the care plan (n=152). Both clinic and telemedicine appointments consist of a detailed review of treatment received, post-treatment follow-up care, discussion of health education resources, and provision of referrals as appropriate. Patients also have the opportunity to ask questions about treatment and follow-up care. Results: Among patients diagnosed in 2015 who were offered a TAV or in-person visit, 44.0% preferred a telephone appointment. Actual appointment duration ranged from 10 to 30 minutes. Lack of co-payment and fees associated with transportation as well as loss of income due to taking time off work were the primary factors cited choosing telemedicine over in-person clinic appointments. Interestingly, no differences in member satisfaction scores for in-person vs. telephone visits were observed. Conclusions: Findings suggest telemedicine may be effective in the delivery of SCPs. Similar to rural settings, use of telemedicine in urban settings has a unique capacity to increase service to breast cancer patients.

How will cancer survivors use survivorship care plans?

Background: Survivorship care plans (SCPs) are internationally endorsed as an important tool to enhance post-treatment survivorship care. To support broad implementation of SCPs, we investigated survivors’ preferences regarding SCPs.Material and methods: The study was conducted at a comprehensive cancer center. Eligible patients from 10 clinical services, generally up to 12 months following end of treatment (EOT) were approached in clinics or via telephone. A purpose-designed survey assessed survivors’ intended use of a SCP and preferences regarding format and content. Intended minimum sample size of 200.Results: Two hundred and thirty surveys were returned (response rate 68%). Of the 230 participants, over 55% had completed treatment within six months, 35% between six and 12 months, and 10% were receiving ongoing treatments. Most (82%) had not received a SCP and more than one third (42%) reported receiving no information resources at EOT. Almost all (98%) desired further information. Most common information elements desired in a SCP: ‘list of symptoms to watch out for and report’ (76%), ‘summary of treatment received’ (70%) and ‘things I can do to look after myself’ (67%). Most common suggested uses were as: ‘a record of cancer treatment’ (63%), ‘a reminder of things to do to look after myself ’ (57%) and ‘to help me understand my cancer experience’ (56%). Over half (52%) would share the information with their general practitioner. Most indicated preference for paper-based SCPs (91%). There was support for both brief (36%) and detailed versions (42%). Over half requested the information be delivered in a face-to-face discussion with a health professional. Regular telephone support from the treating health care team was most commonly suggested as an additional service to support survivors after EOT.Conclusions: Although similar to international findings, results suggest alternate ways of providing the information that survivors desire. Most desired SCP elements have been defined. A flexible approach to SCP interventions is justified.

Perceptions of Survivorship Care among Latina Women with Breast Cancer in Los Angeles County.

Cancer "survivorship" is a distinct and important aspect of the cancer experience. More research is needed about survivorship care in underserved populations such as Latinas. This study examined issues of breast cancer survivorship care among Latinas to understand their experiences and needs, to inform the design of future programs. Six English- and six Spanish-language focus groups were conducted, with a nonprobability sample. About 74 Latinas who varied in terms of characteristics including stage, time since diagnosis, and English proficiency were recruited through support groups, health fairs, and promotoras. A semi-structured question guide was used to examine experiences with follow-up care, barriers, and meaning associated with breast cancer survivorship. Results indicate numerous gaps and unmet needs in Latinas' survivorship care experiences, including problems with finances, continuity of care, unmet needs for information, and symptom management. Participants identified sources of support including patient navigators, and assigned both positive and negative meanings to survivorship. This research lays a foundation for future work to develop interventions addressing Latina breast cancer survivors' unmet needs. Recommendations include enhancing peer and professional support services for patients, family, and caregivers. Further work is also needed to promote the implementation of survivorship care plans.

The Impact of Survivorship Care Planning on Patients, General Practitioners, and Hospital-Based Staff.

In 2005, the Institute of Medicine recommended that all cancer patients receive a survivorship care plan (SCP). Despite widespread support, few centers have routinely implemented them. Understanding of their impact is limited. The aims of this study were to examine the impact of SCP delivery on patients and healthcare professionals at an Australian comprehensive cancer center and determine enablers and barriers to implementation. Six groups were surveyed: (1) patients who had received SCPs; (2) nurse coordinators using SCPs, (3) general practitioners (primary care, GPs) of patients who had received SCPs, (4) clinical service chairs, (5) heads of allied health, and (6) nurse coordinators not using SCPs (nonengaged nurse coordinators). Groups 1 to 3 completed written questionnaires. Groups 4 to 6 participated in semistructured interviews. Fifty patients, 7 nurse coordinators, 18 GPs, 7 clinical service chairs, 4 heads of allied health, and 8 nonengaged nurse coordinators participated. Eighty-seven percent of patients considered the SCP to be very or somewhat useful; 50% felt it helped them understand their cancer experience. All engaged nurse coordinators reported SCPs to be very or somewhat useful, and 86% believed SCPs improved communication with GPs. General practitioners felt SCPs were very or somewhat useful (67%) and wished to receive SCPs for future patients (83%). Organizational and clinical leadership, multidisciplinary engagement, resourcing, and timing of SCP delivery were considered critical enablers. Patients and healthcare professionals support the use of SCPs; however, they are resource intensive and require significant organizational support. Nurses are instrumental to SCP implementation. Attention to enablers and barriers is important for successful implementation.

Factors influencing implementation of a survivorship care plan\u2014a quantitative process evaluation of the ROGY Care trial

PurposeThe aim of this study is to investigate the factors that influence implementation of Survivorship Care Plans (SCPs) in the intervention arm of the ROGY Care trial by (1) assessing the level of SCP receipt in the ROGY Care trial and (2) identifying patient- and provider-level factors that influence SCP receipt.MethodsBetween 2011 and 2015, a pragmatic cluster randomized-controlled-trial was conducted on the effects of automatically generated SCPs. Endometrial (N = 117) and ovarian (N = 61) cancer patients were allocated to ‘SCP care’, as provided by their SCP care providers (N = 10). Associations between SCP receipt (self-reported SCP receipt and actually generated SCPs), patient-factors (socio-demographic-, clinical-, and personality factors), and care provider factors (profession and a-priori motivation regarding SCP provision) were tested in univariate analysis. The odds ratios of factors influencing self-reported SCP receipt were estimated with a multivariate regression model.ResultsOf all patients in the SCP care arm (N = 178), SCPs were generated by the care provider for 90 % of the patients and 70 % of the patients reported that they had received an SCP. Patients with older age, ovarian cancer, type D (distressed) personality, and patients that completed the questionnaire a longer period of time after the SCP consult were more likely to report no SCP receipt.ConclusionsSCP receipt was influenced by patient- but not care-provider factors.Implications for cancer survivorsCertain patient groups were less likely to report SCP receipt. Whether all patients are in need of an SCP, requires further investigation. If they do, more efforts need to be made towards the implementation of SCPs.

Feasibility Study of an Electronic Interface Between Internet-Based Survivorship Care Plans and Electronic Medical Records.

Survivorship care plans (SCPs) are recommended for all cancer survivors. Myriad barriers to implementation exist. This study was performed to evaluate the feasibility of interface development between an SCP and an electronic medical record (EMR). An information technology application was developed to extract data from the EMR in use at our center (Epic). Data were transferred to autopopulate an Internet-based tool for creation of SCPs (LIVESTRONG Care Plan) that had been previously used for the creation of more than 35,000 plans. Data (demographic characteristics, surgeries, chemotherapy drugs, radiation site) were extracted from the EMR and transferred to the care plan platform, without transfer of protected health information. Care plans were created and transferred back to the EMR. During clinical testing, SCPs were created by nurse practitioners during scheduled clinic visits for 146 sequential, eligible patients (67% breast cancer, 33% colorectal cancer). All patients received completed care for a single cancer diagnosis at our institution. All data points that were automatically populated were reviewed by practitioners, and missing/blank data fields were populated manually when necessary. Data entered into generated care plans were accurate in 97% of audited cases, and the process of care plan generation could be completed in < 1 minute. This is a feasible solution for the autopopulation of SCPs from the EMR. It represents a future methodology through which widespread implementation of SCPs may be undertaken. Future directions include further clinical testing, assessment of provider-perceived usefulness, and integration into routine clinical care.

Abstract P4-10-02: Cancer team approach for implementing survivorship care plans in the breast cancer survivorship clinic

Abstract Background: Recommendations from the Institute of Medicine are that cancer patients receive individualized survivorship care plan (SCP) and treatment summary. SCP includes guidelines for monitoring and maintaining health and is a communication tool shared with families and health care providers. Offering SCP and treatment summary to cancer survivors remains challenging due to time and resource limitations, inadequate reimbursement and survivor access. Methods: Survivorship starts when completing the initial treatment (surgery, chemotherapy or radiation therapy). A team of medical oncologists, nurse practitioner and patient navigator created a process of pre-screening and identifying breast cancer (BC) survivors. SCP and treatment summary were pre-populated, individualized for each patient, then finalized and discussed with the patients during their medical oncology clinic visit. Pre intervention data was retrospectively collected, including all BC cases from March 2014 to March 2015. Post intervention data was prospectively collected over eight weeks. Pre and post intervention SCP completion rates were compared with chi square analysis. Results: A baseline one year review of 1124 encounters noted 23 of 90 (25%) BC survivors received SCP. Ninety-six encounters occurred during the 8 week pilot period. Sixteen (16.6%) cases met the definition of BC survivor. During the pilot period, 15 out of 16 (93.7%) survivors received the SCP and treatment summary (p &amp;lt;0.0001). After the pilot period, 96.4% of BC survivors were seen in the BC survivorship clinic. Conclusions: We successfully piloted the implementation of SCP for BC survivors. Our team found that using clinic visit screening and pre-identifying patients that transition into the survivorship program resulted in improvement of compliance with survivorship measures. In BC survivorship clinic we address specific survivorship issues and review SCP and treatment summary. Citation Format: Danciu OC, Bharadwaj SN, Hoskins K. Cancer team approach for implementing survivorship care plans in the breast cancer survivorship clinic. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-10-02.

Implementation of survivorship care plans: Lessons learned at the Kaiser Permanente Oakland Medical Center.

75 Background: Beginning in 2015, the Commission on Cancer (CoC) requires accredited facilities to provide eligible patients with a Survivorship Care Plan (SCP). While the benefits of SCPs in the quality and continuity of care are well documented in the literature, there is a dearth of information regarding best practices for implementation. Here we describe lessons learned in the development of a SCP at the Kaiser Permanente Oakland Medical Center (OMC). Methods: Adult patients with a diagnosis of stage 1-3 cancer who received curative treatment were identified by the Northern California Kaiser Permanente Cancer Registrar. Consistent with CoC guidelines for 2015, 10% of all eligible patients (n = 1160) are required to receive a SCP 3-6 months following active treatment. Thus, a total of 116 patients with a diagnosis of breast, colon, lung/bronchus, prostate, or melanoma of the skin at OMC were given a SCP. The implementation timeframe was July to December 2015. Use of a modified ASCO template was recommended for its rigor across the required domains. Following template approval by the Comprehensive Cancer Committee (CCC), a workflow consisting of identifying patients’ last treatment and manual data entry by a Physician Assistant (PA) as well as automated data population in the Kaiser Permanente electronic medical record system was developed. Completed SCPs were then provided to patients during a clinic visit. The workflow process was refined as appropriate based on feedback from staff &amp; physicians. Results: Depending on the scope of treatment, mean preparation time is 10 minutes per plan using specific diagnosis codes via an electronic medical record system. Further, it takes 30 minutes for a PA or other Ancillary personnel to discuss the plan with a patient. Patient response was generally positive upon receipt of the plan. Conclusions: Successful SCP implementation is contingent upon engagement from multiple stakeholders. Per standard CoC 3.3, the implementation rate will increase annually from 10% in 2015 to 100% by 2019. Careful consideration to workflow processes and resources planning be must factored into achieving 100% compliance across all disease sites by 2019.

Challenges in the implementation of survivorship care plans in an NCI-designated cancer center.

68 Background: The development and initiation of Survivorship Care Plans (SCPs) across all disease sites was identified as a Strategic Initiative Goals for 2015 by the Clinical Cancer Committee. The 2012 Commission on Cancer requirements for certification provided an additional incentive to meet this goal. Establishing a process that includes the development and distribution of a SCP’s within the electronic medical record (EMR) is necessary to improve on the completion of SCP’s and to improve the utilization of surveillance tests in cancer survivors. We describe the process developed at a free-standing NCI cancer center to meet the standard of SCP provision to all cancer patients. Methods: A multi-disciplinary subcommittee of the Cancer Committee was designated to develop the overall strategic plan for the implementation of this standard. It met with disease teams to facilitate a treatment summary from Cancer Registry data, identify patient reported symptoms using a self report tablet (SupportScreen). Electronic care plans were created using survivorship research program templates and ASCO framework for each disease site team. The disease team Nurse Care Coordinator inputs information into the eSCP. Results: Templates have been established within the EMR in the documents section under survivorship care plan title. These can be initiated and modified when the Nurse Care Coordinator chooses to start them. The disease teams have established their time points for SCP presentation to their patients. Using the cancer registry to provide data related to staging, treatments and genetic testing has helped minimize development time. Individual survivor’s concerns will be reflected in patient reports and physician symptom documentation. This eSCP completion process is a pilot program within the breast cancer disease team and will be expanded to include patients with head &amp; neck and hematologic malignancies with a goal of including all patients by mid 2016. Conclusions: The goal of improving survivorship care coordination and compliance with surveillance guidelines is challenging. Maximizing available interdisciplinary resources has helped to create a viable Survivorship Care plan at our institution.

Moving forward after cancer: Implementation of transition appointments and follow-up care plans in Manitoba.

50 Background: Patient experience and local and international clinical research have focused attention on transitions in cancer care from treatment to follow-up. Deficiencies in the quality of survivorship care, including necessary testing, have been demonstrated. The Canadian Partnership Against Cancer has funded projects designed to enhance the implementation of survivorship care plans (SCPs) and to improve cancer system-primary care coordination. CancerCare Manitoba, a provincial agency, is a leader in this work. Methods: The Moving Forward After Cancer initiative combines the generation of standardized written SCPs from the EMR with enhanced patient assessment at the end of curative systemic / radiation therapy. A transition appointment (TA) is provided by the patient’s usual oncology providers and includes screening for distress, appropriate referrals, and provision of a personalized treatment summary and SCP to the patient, with copies to the primary care physician and surgeon. The TA often marks the transfer of medical responsibility to the primary care provider (PCP). Results: Transition appointments have been implemented for colorectal (2012), breast (2014), and lymphoma and gynecologic cancer patients (2015). A total of 364 TAs were done in Manitoba in 2014, of which 140 were with colorectal (stage II and III) and 224 with breast (stage I – III) patients, about 59% and 35% respectively of eligible patients. This is an increase of 385% from the 75 TAs done in 2013. Other patient outcomes being collected include perceptions of continuity of care, confidence in survivorship information, evaluation of the care plan documents and also PCP and oncology team perceptions. In order to support practice change, a workflow solution led by a designated team that is adaptable by all sites across the province has been developed. Conclusions: The provision of TAs and SCPs is being well adopted in Manitoba. We expect that this intervention willimprove the experience of both patients and health care providers and the quality of care at the time of transition to survivorship. Implementation is underway with other disease site groups with the goal of all patients receiving a TA as they transition into survivorship.

Assessing the impact of an online survivorship program.

e285 Background: In the report From Cancer Patient to Cancer Survivor: Lost in Transition (2006), the Institute of Medicine identified follow-up of cancer survivors as a missing link in cancer care and made recommendations to the medical establishment to fill that gap. So far, studies of recommendation effectiveness have revolved around survivorship care plan implementation. However, a 2013 study indicated that use of SCPs is still more the exception than the rule. Methods: We have created a unique online program that is intended to address two key mandates of the IOM report: 1) Educationfor theprevention of recurrent and new cancers, and 2) Self-carestrategiesto help deal with consequences of cancer and its treatment i.e. lymphedema, fatigue; [and] psychological distress. Dr. Helayne Waldman and Dr. Shani Foxhave fashioned an online, real time, 12 week education and support program for cancer survivors, the first of its type in the U.S. The focus of the content is on maintaining wellness after treatment and includes topics such as physical activity, dietary guidelines, inflammation control and stress management. The program also contains a coaching component, where participants track their activities and share information via live discussion and interactive blogs. Results: We have established a framework for gathering, analyzing and reporting our data. Our target sample size is 40-50 participants. At the program’s outset we will administer a 20 question self-assessment to test participants’ knowledge of self-care practices and attitudes about their current state of wellness. At the program’s end in December we'll readminister in order to measure the change in both knowledge and attitude. We’ll then conduct an analysis of the data, and will report our findings at the ASCO meeting in January. Conclusions: We believe that education and support for survivors is critical to their physical and emotional well-being. Unfortunately, there is currently no program available to do this in a live, interactive format from the comfort of one’s home. We believe PCPs, hospital support groups and other non-profits will find this type of program to be an invaluable resource in serving to educate and manage the concerns of cancer survivors and to move closer to realizing the promise of the IOM report.

Prostate cancer survivorship: Implementation of survivorship care plans to meet the mandate and enhance urologic practice through collaborative care.

Prostate cancer is the most common malignancy among the male survivorship population in the United States, representing 44% of approximately 7 million survivors. In the era of modern medicine and value-based care, successfully treating only the cancer is not sufficient. The cancer survivor represents an individual in need of restoration and protection against future events. A well-designed and well-supported survivorship program not only meets a mandate for accreditation, it logically translates into better patient care. This review summarizes the history of the survivorship movement, outlines some key elements of a survivorship program, and highlights the opportunity to apply these principles to improve cancer-related care, develop relationships with colleagues that may allow increased identification of men at risk, and expand both the experience and outcomes of individual specialists within men's health.

US radiation oncology practice patterns for posttreatment survivor care

PurposeIncreasing numbers of cancer survivors have driven a greater focus on care of cancer patients after treatment. Radiation oncologists have long considered follow-up of patients an integral part of practice. We sought to document current survivor-focused care patterns and identify barriers to meeting new regulatory commission guidelines for survivorship care plans (SCPs) and provide guidance for survivorship care. Methods and MaterialsA 23-question electronic survey was e-mailed to all practicing US physician American Society of Radiation Oncology members. Responses were collected for 25 days in March 2014. Survey data were descriptively analyzed. ResultsA total of 574 eligible providers responded, for a response percentage of 14.7%. Almost all providers follow their patients after treatment (97%). Length of follow-up was frequently extensive: 17% followed up to 2 years, 40% for 3-5 years, 12% for 6-10 years, and 31% indefinitely. Ancillary services, particularly social work and nutrition services, are commonly available onsite to patients in follow-up. Fewer than half of respondents (40%) indicated that they currently use SCPs for curative intent patients and those who do generally use internally developed templates. SCPs typically go to patients (91%), but infrequently to primary care providers (22%). The top 3 barriers to implementation of SCPs were cost (57%), duplicative survivorship care plans provided by other physicians (43%), and lack of consensus or professional guidelines (40%). Eighty-seven percent indicated that SCPs built into an electronic medical record system would be useful. ConclusionsA significant part of radiation oncology practice includes the care of those in the surveillance of follow-up phase of care. SCPs may be beneficial in improving communication with the patient and other care but are not widely used within our field. This survey identified key barriers to use of SCPs and provides specialty guidance for important information to be included in a radiation oncology oriented SCP.

Cancer team approach for prescreening and identifying breast cancer survivors as part of survivorship care plan implementation.

107 Background: Recommendations from the Institute of Medicine are that cancer patients receive individualized survivorship care plan (SCP)and treatment summary.SCP includes guidelines for monitoring and maintaining health and is a communication tool shared with families and health care providers. Offering SCP and treatment summary to cancer survivors remains challenging due to time and resource limitations, inadequate reimbursement and survivor access. Methods: Survivorship starts when completing the initial treatment (surgery, chemotherapy or radiation therapy). A team of medical oncologists, nurse practitioner and patient navigator created a process of pre-screening and identifying breast cancer (BC) survivors. SCP and treatment summary were pre-populated, individualized for each patient, then finalized and discussed with the patients during their medical oncology clinic visit.Pre intervention data was retrospectively collected, including all BC cases from March 2014 to March 2015. Post intervention data was prospectively collected over eight weeks. Pre and post intervention SCP completion rates were compared with chi square analysis. Results: A baseline one year review of 1124 encounters noted 23 of 90 (25%) BC survivors received SCP. Ninety-six encounters occurred during the 8 week pilot period. Sixteen (16.6%) cases met the definition of BC survivor. During the pilot period, 15 out of 16 (93.7%) survivors received the SCP and treatment summary (p &lt; 0.0001). Conclusions: We successfully piloted the implementation of SCP for BC survivors. Our team found that using clinic visit screening and pre-identifying patients that transition into the survivorship program resulted in improvement of compliance with survivorship measures. We plan to open a BC survivorship clinic to address survivorship issues and to review SCP and treatment summary.

Late effects in survivors of central nervous system tumors: reports by patients and proxies.

With the 5-year survival of patients with brain tumors increasing as treatment modalities are optimized, there are a large number of brain cancer survivors who experience long-term sequelae of their treatment. Patient-reported outcomes represent an important and often unrecorded aspect of survivorship. An Internet-based survivorship care plan tool which allowed patients or their proxies to answer a series of questions about the patient's illness course was used to collect patient-reported toxicity data for 254 individuals who had undergone treatment for brain cancer. Demographic, treatment, and side effect profiles data were reviewed. Median age of diagnosis was 42 years, and 88% (n = 223) of the patients were Caucasian. Only 11.1% (n = 29) had previously been offered a survivorship care plan. Of the total group of brain tumor survivors, 25.4% of responders described themselves as living with metastatic disease, while 14.5% of responders were experiencing recurrence status post treatment. Late effects most commonly reported for all brain malignancy survivors using this tool were cognitive changes, fatigue, skin changes, hearing loss, weakness, and numbness. The incidence of late effects varied with age at time of treatment and length of time since treatment. Individuals undergoing treatment for brain cancers experience a diverse array of long-term sequelae, and the majority of these patients do not have access to or familiarity with a survivorship care plan. Patient-focused tools to evaluate these side effects and access to survivorship plans are important for comprehensive reporting of late effects as well as implementation of survivorship care plans for long-term management of these effects. Understanding the late effects that patients experience will help providers council patients regarding expectations prior to treatment, as well as management of symptoms in the survivorship phase of care.