Implementation Of Survivorship Care Plans Research Articles

Cancer survivorship and long-term outcomes: navigating the challenges beyond treatment

The increasing number of cancer survivors due to advancements in early detection and treatment has shifted the focus of oncology to the long-term health and well-being of these individuals. Cancer survivorship encompasses a wide range of challenges that extend beyond the completion of treatment, including physical, psychological, social, and economic issues. This review explores the long-term physical health consequences of cancer treatment, such as neuropathy, cardiotoxicity, and chronic conditions, and highlights the psychological burdens, including anxiety, depression, and cognitive impairment, commonly faced by survivors. The article also addresses the social and economic impacts, such as difficulties in returning to work and financial toxicity, which further complicate the survivorship experience. Additionally, the review emphasizes the importance of assessing and improving the quality of life (QoL) for survivors through personalized interventions and the implementation of survivorship care plans (SCPs). Emerging research on biomarkers, telemedicine, and policy advocacy is discussed as critical components for advancing survivorship care. The review concludes that a comprehensive approach, including ongoing research, personalized care, and supportive policies, is essential to meet the diverse needs of cancer survivors and improve their long-term outcomes and QoL.

Survivorship care plans and fear of recurrence in patients with breast cancer (BC).

e13790 Background: A survivorship care plan (SCP) is recommended for all patients after curative treatment for cancer. It typically includes guidance on the type and interval of follow-up care as well as education on treatment received and potential long-term side effects. Fear of recurrence is a common unmet need reported by cancer survivors and is associated with higher depression and lower social functioning. It is unknown if SCPs are associated with reduced fear of recurrence. Methods: Between 7/2023-8/2023, active patients and survivors were recruited from Breastcancer.org and consented to participate in an anonymous online survey in English or Spanish. Eligibility included: US resident, age ≥18, and diagnosed with BC within the past 10 years. Survey assessed engagement in and satisfaction with survivorship care, receipt of a written SCP, and fear of recurrence (via the validated 9 question FCRI-SF, scored 0-36, higher scores indicate greater fear of recurrence) in patients with non-metastatic BC. Multivariate analysis (MVA) assessed relationship of SCP and FCRI-SF score ≥22 (indicating a clinically significant level of fear) after controlling for gender, age, race, ethnicity, and education. Results: Of 997 who completed the survey, 340 (34.1%) had completed all curative treatment and thus queried on receipt of SCP and fear of recurrence. Of this cohort, 97.4% identified as women, 78.8% White, 6.2% Black, and 3.3% Hispanic. Median age was 63 (interquartile range IQR 54-70) and median time since diagnosis 2.5 years (IQR 1.4-5.2). 76.2% had a college degree. Most were satisfied with their survivorship care (median score 4: scale: 1-very unsatisfied to 5-very satisfied). Less than a quarter (21.8%) had access to a cancer survivorship program at their facility; 60.0% did not; and 18.2% did not know. Of the 74 respondents who had access to a program, 56.8% used its services. 32.1% participants reported receiving a written SCP, 18.5% did not remember; almost half (49.4%) reported they did not receive one. Of those that received a SCP, most reported it was explained well to them (median score 4; scale: 1-poor to 5-excellent), and that they had “excellent” comprehension of the plan (median score 5). Median fear of recurrence score was 20 (IQR 14-25); 43.2% had a score ≥22, indicating a clinically significant level of fear. On MVA, patients who were older (OR 0.98, 95%CI 0.96-1.00, p=0.019) and who had received a SCP (OR 0.54, 95%CI 0.33-.88, p=0.013) were less likely to have clinically significant fear. Conclusions: Although overall satisfaction with survivorship care was high, less than one-third of surveyed BC survivors reported receiving a written SCP. Receipt of a SCP was associated with clinically significantly lower fear of recurrence. Future research should focus on provider barriers to SCP implementation, patient barriers to survivorship program use, and explore the role of SCP in mitigating psychosocial distress in diverse samples.

Care Processes and Quality-of-Life Outcomes Affecting the Gynecologic Cancer Survivorship Experience.

To describe and assess physical and psychosocial concerns and care processes related to cancer and treatment in gynecologic cancer survivors. 44 survivors of gynecologic cancer at City of Hope National Medical Center in southern California were enrolled. A descriptive mixed-methods approach was used. Data were collected on survivorship care plan implementation, supportive care referrals, and barriers to receiving care. Participants completed questionnaires assessing quality of life, unmet needs, and other outcomes at three, six, and nine months after enrollment. Changes over time were analyzed, and quantitative and qualitative results were compared. The most common unmet needs were stress reduction, side effect management, fear of cancer recurrence (FCR), and perception of adequate communication among the care team. Qualitative themes centered around communication, care coordination, FCR, financial distress, and need for information about peer support and healthy lifestyles. Nurses play a key role in coordinating care, assessing symptoms, and addressing psychosocial concerns. Providing education and coaching can reduce stress and facilitate survivors' self-management and self-efficacy.

Role of the nurse in the design, delivery, monitoring and coordination of cancer survivorship care plans: An integrative review.

Survivorship care plans (SCPs) are recommended as a tool for the care of cancer survivors. SCPs have been implemented with a multidisciplinary approach; however, the specific role of nurses in the SCP is unknown. Our aim is to determine the role of nurses and their degree of participation in cancer SCPs. Integrative review of the literature with systematic methodology. PubMed, CINAHL, PsycINFO, Web of Science, Cochrane and Cancerlit databases were reviewed. Articles published up to March 2021 were included. Of the 2,638 publications identified, 22studies met our inclusion criteria. Quality of included studies was assessed using Joanna Briggs Institute quality assessment tools. The studies showed that nurses play a key role and participate in different phases of the SCP, including design, delivery, monitoring and coordination among different levels of care, with varying degrees of involvement and responsibility; design and delivery of the SCP are the phases with the highest nurse participation (18 out of 22studies). The majority of SCPs are implemented in specialized, hospital-based care and focus on short-term cancer survivors, who are actively undergoing oncological treatments. This review shows that nurses actively participate in the design, implementation and coordination of SCPs. However, SCPs focus on the acute survival and treatment phases, and there is a gap in their use in long-term cancer survivorship. This gap may be one reason the needs of long-term cancer survivors are not covered. This review contributes to the current body of knowledge by addressing the role of nurses in cancer SCPs. We recommend the involvement of an advanced practice nurse as SCP coordinator to improve communication between cancer specialists and primary care providers and to promote continued care throughout the different phases of cancer survivorship, including long-term survival.

Receipt of Survivorship Care Plans and Self-Reported Health Status among Patients with Genitourinary Malignancy.

Implementation of survivorship care plans has been emphasized as a key component to improving care for cancer survivors. Our objective was to determine the prevalence of survivorship care plan receipt for survivors of genitourinary malignancy including kidney, prostate and bladder cancer, and evaluate whether receipt was associated with a measurable health benefit. Data from the Behavioral Risk Factor Surveillance System Cancer Survivorship modules in 2012, 2014, 2016 and 2017 were analyzed. The proportion of patients with bladder, kidney or prostate cancer receiving a survivorship care plan was calculated. Complex samples multivariable logistic regressions were performed to determine the association of survivorship care plan receipt with sociodemographic variables, and assess the relationship between survivorship care plan receipt and self-reported health status (general, physical and mental). Survivorship care plan distribution increased from 27.5% in 2012 to 39.5% in 2017. Patients with low income, less formal education and extremes of age were less likely to receive a survivorship care plan. Those receiving a survivorship care plan were less likely to report poor physical health (OR 0.70, CI 0.52-0.96, p=0.026). Subanalysis showed a similar result for physical health of patients with prostate cancer (OR 0.68, CI 0.48-0.96, p=0.030) and general health of patients with kidney cancer (OR 0.37, CI 0.19-0.75, p=0.006). Distribution of survivorship care plans to genitourinary malignancy survivors has increased since 2012 in response to advocacy from national organizations. Nonetheless, utilization is low and there is heterogeneity in the populations likely to receive a survivorship care plan. There is a measurable association between survivorship care plans and improved health status but further study is needed to determine causality.

Abstract P2-13-16: A multidisciplinary approach to implement personalized multifaceted care plans in standard breast cancer care: A quality improvement project

Abstract Background: IOM, ASCO and Commission on Cancer have emphasized the provision of survivorship care plans (SCPs) to cancer patients. Cancer Care Ontario (CCO) aims to ensure that SCPs are developed and shared with healthcare providers (HCPs) to facilitate integrated cancer care. In 2016, a randomized mixed-methods study at St. Michael’s Hospital (SMH) provided a paper based Personalized Multifaceted Care Plan (PMCPs) to breast cancer (BC) patients, which included an upfront treatment plan. The PMCP was generated by entering non-repetitive patient data into a care plan database software developed by the team. The study results showed that patients and primary care providers (PCPs) found PMCP to be useful. Despite the benefits, implementation of SCPs as standard of care remained a challenge due to lack of designated personnel for developing SCP and limited resources causing poor provider buy-in. In 2017, we initiated a quality improvement (QI) project to implement the PMCP by integrating it into existing workflow by involving the care team. Methods: This REB approved QI project was done in two phases. Phase 1 was to identify key members to create the PMCP and to secure the software to the SMH IT server. In phase 2, the PMCPs were delivered to newly diagnosed invasive BC patients, receiving chemotherapy. The PMCPs were also shared with respective PCPs. At SMH, new patients diagnosed with BC are seen initially at the Multidisciplinary Clinic (MDC) by a medical and radiation oncologist, and a patient navigator (PN) to plan treatment. In phase 1, the PN who coordinated the MDC was identified as the most appropriate care team member to initiate the PMCP. To incorporate the PMCP into the PN’s existing workflow, a Transfer of Accountability (TOA) document was designed using the care plan software to replace a patient summary that was created in silos. The TOA was electronically shared with the team and had most of the information provided in the PMCP. The primary outcome measures were proportion of information completed to generate the PMCP and care plans delivered by patients’ care team. Secondary Outcome measures were patient and provider satisfaction with PMCP assessed using surveys at three time points and single time point respectively. Data were summarized using median and IQR as well as frequency and percentages. Data was also shared at QI team meetings, practice patterns were observed for changes and incorporated into subsequent PDSA cycles. Results: From 2017 to 2019, 90% (120/134) of eligible BC patients were provided with the PMCP. At the first 2 PDSA cycles 100% PMCP preparation and delivery was done by research staff. We have achieved 80% compliance in Phase 1 by involving the PN in data entry for PMCP while preparing the TOA document. TOA had been incorporated into standard of care at MDC and a recent nursing project found that HCPs surveyed perceived TOA to be a useful tool in information exchange and care coordination. Patient satisfaction surveys for PMCP found their responses were consistent over all time points with high levels of agreement. Surveys also showed that 73% (86/117) patients agreed that the PMCP helped with communication with their PCPs and 81% (95/117) agreed it helped with communication with the team. Of the 25 PCPs and 5 oncology HCPs surveyed, 91% (22/25) PCPs and 100% (5/5) oncology HCPs agreed that the PMCP should be incorporated into BC care. Conclusions: Implementation of SCPs with a multidisciplinary approach is feasible in BC care. Integration of SCPs within the existing work flow and involvement of members of the care team can lead to increased SCP uptake, better care coordination, sustainability and provider buy-in. With the high patient and provider satisfaction with PMCP, and recommendation by CCO, we are in the process of integrating PMCPs for BC patients as standard of care in the oncology clinic. Citation Format: Rashida Haq, Amy Kong, Ronita Lee, Geetha Mukherji, Christine Brezden-Maesley, Pauline Gulasingam. A multidisciplinary approach to implement personalized multifaceted care plans in standard breast cancer care: A quality improvement project [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-16.

Implementation of Survivorship Care Plans in Patients With Glioblastoma.

Background: The outcomes and survival of patients diagnosed with glioblastoma are improving due to advancements in therapy and better symptom management. Focusing on survivorship is an important initiative for these patients. A quality improvement project performed by an advanced practitioner in adults with glioblastoma evaluated the efficacy and utility of survivorship care plans (SCP). Providing patients and their families with SCPs gives them important information about their cancer, treatment, and follow-up management and care. Methods: Survivors of a glioblastoma who were receiving an oral alkylating agent and/or bevacizumab, as well as those who had completed these therapies within the past year were included. Patients had received surgery and radiation. The National Comprehensive Cancer Network (NCCN) Distress Thermometer and a pre- and postintervention survey evaluated knowledge, distress, and rate of follow-up care. Results: Over 2 months, 18 eligible participants received the SCP with a long-term care coaching appointment with an advanced practitioner. Knowledge pertaining to long-term effects of therapy and chemotherapy regimen improved. Ratings of overall distress and patient-reported primary care follow-up remained the same. Conclusion: Providing patients with glioblastoma with an SCP and an educational visit can improve knowledge pertaining to their chemotherapy regimens and long-term effects of therapy. This can result in more effective long-term management and care.

Survivorship Care Plans in Cancer: A Meta-Analysis and Systematic Review of Care Plan Outcomes.

The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta-analysis compares patient-reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision. We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient-reported outcomes for SCP recipients versus controls were eligible for the meta-analysis. We performed random-effects meta-analyses using pooled standardized mean differences for each patient-reported outcome. Eight articles were eligible for the meta-analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self-reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self-efficacy or at 12 months on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects. SCPs appear feasible but do not improve survivors' patient-reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies. Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient-reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.

Use of remote symptom monitoring with breast cancer survivors using patient reported outcome measures through Epic Mychart.

208 Background: Electronic patient-reported outcome (PRO) monitoring has been found to improve quality of life and overall survival in patients with metastatic cancer patients during active treatment. There has been limited data using PROs to enhance clinical outcomes in cancer survivorship. This pilot study of breast cancer survivors assessed utilization and satisfaction of proactive PRO symptom and adherence monitoring through an EHR patient portal (EPIC MyChart). Methods: Eighty breast cancer survivors who had completed surgery, chemotherapy, and/or radiation and received a survivorship care plan were randomized 1:1 either to usual care or PRO monitoring. The PRO group received questions from the NIH PROMIS toolkit through EPIC MyChart monthly between visits for 6 months. The triage nurse received an EPIC Inbasket alert if the survivor reported moderate to severe symptoms, had not taken their medication(s), or reported they would like to speak to a nurse. Participants in the control group were assessed for sadness, anxiety and satisfaction with provider communication at their usual follow visits. Results: Of 239 surveys sent out, 214 (90%) were completed. Eighty-five (36%) surveys triggered Inbasket alerts to the nurse. The most common nursing response to alerts was calling the patient for counseling/education. Compared to control, the PRO monitoring group exhibited no difference in satisfaction at 3 months, but had significantly higher scores at 6 months for satisfaction with communication (P=0.005) and monitoring (P=0.002). Anxiety scores did not differ between groups. Conclusions: Remote electronic monitoring of symptoms and adherence through the EHR bet was feasible with high completion rates, improved satisfaction, and did not increase anxiety in breast cancer survivors. Follow up work is assessing PRO monitoring to improve efficiency of following cancer survivors, and implementation of survivorship care plans.

Improving the survivorship care plan process across an academic and community cancer center.

184 Background: The goal of a survivorship care plan (SCP) is to improve provider coordination and engage patients in their care. Despite requirements from professional societies, implementation of SCPs is challenging. From April to July 2018, 36% of eligible patients received an SCP at our institution. We aimed to identify barriers to SCP completion and implement interventions to increase their delivery for all cancer types at our academic and community cancer sites. Methods: We created a survey to assess physician, nursing and trainee perceptions and identify barriers to SCP completion. The survey was sent to providers within our medical, surgical, and radiation oncology departments. Providers were asked to rate their satisfaction with our current SCP process and identify obstacles and solutions to achieve SCP completion. In response, we held meetings between oncology attendings, trainees, tumor registry staff, and health information management personnel to design an improvement plan. Results: Of 178 providers, 74 (41.6%) responded. Four percent were satisfied with our current process. The most frequently cited barriers were time (62.1%), lack of clarity regarding who completes the SCP (52%), and insufficient personnel (47.3%). The most frequently cited solutions were dedicated personnel (84.9%), disease-specific templates (61.6%), and education regarding SCPs (48.1%). Based on these results, we: (1) Streamlined our SCP process by entering a partially-templated SCP into an eligible patient’s electronic medical record by our tumor registrar; (2) Asked for disease-specific recommendations that can be included in the template; (3) Asked providers to identify additional team members who assist with SCP completion so that SCPs can be appropriately queued; and (4) Designed an online educational module. Conclusions: We identified multiple barriers to SCP completion at our institution. In response, we implemented a multifaceted improvement plan across our academic and community cancer sites. An analysis of its effects are forthcoming.

A cross-sectional population-based survey looking at the impact of cancer survivorship care plans on meeting the needs of cancer survivors in the posttreatment stage.

The purpose of this study was to determine the impact of receiving a survivorship care plan (SCP) on meeting cancer survivors' overall, informational, physical, emotional, and practical needs. Since the recommendation for implementation of SCPs, there have been numerous studies on their effectiveness with mostly inconclusive results. All Nova Scotia survivors meeting specific inclusion and exclusion criteria were identified from the Nova Scotia Cancer Registry and sent the 83-item survey to assess experiences and needs across five domains (overall, informational, physical, emotional, and practical). Descriptive statistics (frequencies, percentages) and chi-square analyses were used to examine and report survey findings. The response rate was 44.6%, with 1514 respondents. SCPs were significantly associated (p< 0.00001) with receiving timely help and support to meet survivors' overall, informational, physical, emotional, and practical needs posttreatment. For the most part, survivors' clinical characteristics, such as cancer type, time since treatment, chronic comorbidities, and metastases, did not result in differences among the five outcomes. Those who received a SCP reported higher agreement on all five outcomes in comparison to those who did not receive a SCP. Further work should evaluate the delivery of SCPs and the components of SCPs that are most likely to contribute to positive survivor outcomes.

Using implementation science to initiate survivorship care plan practice change.

175 Background: Failure to address coordination of cancer survivorship care can result in physical disability, emotional distress, and increased health care costs. The Institute of Medicine (IOM) recommended Survivorship Care Plans (SCPs) to improve care coordination among cancer survivors. Despite evidence supporting SCPs there remains limited implementation of SCPs. The use of implementation science, frameworks, and strategies that address contextual and process factors, could improve use of SCPs in oncology clinics (Selove et al., 2016). Methods: This innovation used the Quality Implementation Framework (QIF) (Meyers, Durlak, &amp; Wandersman, 2012) to guide implementation. The QIF outlines steps and strategies for four phases of implementation; initial considerations regarding the host setting, creating a structure for implementation, ongoing structure once implementation begins, and improving future application. Results: During the project period (January 29, 2018 through April 23, 2018), 17 SCP visits were conducted; all 17 patients completed study surveys. In response to, “My health care providers work together as a team to ensure that my needs are met,” 65% reported strongly agree, 29% reported agree, 5% reported disagree, and 0% reported strongly disagree. When asked “My health care providers have informed me of what my follow-up care should be” 65% reported strongly agree and 35% reported agree. Of the 17 PCP surveys mailed, four were returned. In response to “For this patient the SCP helps me coordinate follow-up care,” three PCPs responded “agree.” When asked “For this patient, the SCP helps me provide better care,” three responded “strongly agree.” One PCP reported neutral feelings toward both statements. All PCPs reported SCP helped them better understand cancer treatment given and side effects. Conclusions: Successful SCP implementation, replicating outcomes of trials supporting SCPs, is attributable to the use of implementation science. Results from this project demonstrated SCPs achieved care coordination and patient satisfaction. SCPs enhanced PCPs’ understanding of cancer treatment and side effects which could increase likelihood PCPs discuss survivorship issues, as demonstrated in literature.

Patients' information coping styles influence the benefit of a survivorship care plan in the ROGY Care Trial: New insights for tailored delivery.

BackgroundIn efforts to improve the implementation of survivorship care plans (SCPs), the authors assessed whether the impact of SCPs on patient‐reported outcomes differed between patients with an information‐seeking coping style (monitoring) versus those with an information‐avoiding coping style (blunting).MethodsIn the Registration System Oncological Gynecology (ROGY) Care Trial, 12 hospitals in the Netherlands were randomized to deliver SCP care or usual care. All patients with newly diagnosed endometrial and ovarian cancer in the SCP care arm received an SCP that was generated automatically by their oncology provider through the web‐based ROGY registration system. Outcomes (satisfaction with information provision and care, illness perceptions, and health care use) were measured directly after initial treatment and after 6, 12, and 24 months. Information coping style was measured at 12 months after initial treatment.ResultsAmong patients who had a monitoring coping style (N = 123), those in the SCP care arm reported higher satisfaction with information provision (mean score: 73.9 vs 63.9, respectively; P = .04) and care (mean score: 74.5 vs 69.2, respectively; P = .03) compared with those in the usual care arm. Among patients who had a blunting coping style (N = 102), those in the SCP care arm reported a higher impact of the disease on life (mean score: 5.0 vs 4.5, respectively; P = .02) and a higher emotional impact of the disease (mean score: 5.4 vs 4.2, respectively; P = .01) compared with those in the usual care arm.ConclusionsSCPs may be beneficial for patients who desire information about their disease, whereas SCPs may be less beneficial for patients who avoid medical information, suggesting a need for tailored SCP delivery to improve survivorship care.

Continued Challenges to the Adoption and Implementation of Survivorship Care Plans.

Continued Challenges to the Adoption and Implementation of Survivorship Care Plans.

Survivorship care for early‐stage colorectal cancer: a national survey of general surgeons and colorectal surgeons

Few data are available on the optimal long-term care of early-stage colorectal cancer survivors, termed survivorship care. We aimed to investigate current practice in the management of patients following treatment for early-stage colorectal cancer. We performed an internet survey of members of the American Society for Colon and Rectal Surgeons about several aspects of long-term care, including allocation of clinician responsibility, challenges with transitions to primary care physicians (PCPs), long-term care plan provision and recommended surgical follow-up duration. Overall, 251 surgeons responded. Surgeons reported taking primary responsibility for managing adverse surgical effects (93.2%) and surveillance testing (imaging and laboratories 68.6%, endoscopy 82.4%). Barriers to PCP handoffs included patient preference for surgical follow-up (endorsed by 76.6%) and inadequate communication with PCPs (endorsed by 36.9%). Approximately one-third of surgeons routinely provide survivorship care plans to PCPs; surgeons who received formal survivorship training were more likely to do so compared to those without such training (OR 3.29, 95% CI 1.57, 6.92). Although only 20.4% of surgeons follow their patients beyond 5years, individuals in practice longer were more likely to continue long-term follow-up than those with ≤10years of experience. This is the largest survey of surgeons regarding long-term management for early-stage colorectal cancer and highlights the potential for improved coordination with PCPs and increased implementation of survivorship care plans.

Strategies for Successful Survivorship Care Plan Implementation: Results From a Qualitative Study.

Care for US cancer survivors is often fragmented, contributing to poor health outcomes. Care and outcomes may improve when survivors and follow-up care providers receive survivorship care plans (SCPs), written documents containing information regarding cancer diagnosis, treatment, surveillance plans, and health promotion. However, implementing SCPs is challenging. As such, we sought to identify strategies for successfully implementing SCPs. We measured SCP implementation using performance data from cancer programs participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative, an oncologist-led quality assessment and improvement program. We used semistructured interviews with cancer program employees (eg, physicians) to identify strategies for successfully implementing SCPs by comparing approaches in cancer programs that, according to Quality Oncology Practice Initiative performance indicators, developed and delivered SCPs to a relatively small proportion of eligible survivors and their follow-up care providers (ie, low performers; n = 6 participants in five programs) with approaches among programs with better performance (ie, moderate performers; n = 15 participants in nine programs). Ten of 14 cancer programs developed SCPs for ≥ 50% of eligible survivors; two of 14 delivered SCPs to any survivors; and eight of 14 delivered SCPs to ≥ 25% of follow-up care providers. We found that moderate performers proactively addressed SCP requirements, leveraged requirements to improve survivorship care, set internal targets, automated implementation, had active leaders and champions, and tasked appropriate employees with SCP implementation. SCP implementation remains challenging. We identified strategies for successfully implementing SCPs. Future research should examine how cancer programs have achieved these strategies; findings could contribute to an understanding of the changes needed to implement comprehensive survivorship care.

Survivorship Care Plan Implementation in US Cancer Programs: a National Survey of Cancer Care Providers.

Survivorship care plans (SCPs)-documents intended to improve care for cancer survivors who have completed active treatment-are required, yet implementation is poor. We sought to understand SCP implementation in cancer programs in the USA with the objective of identifying opportunities for improvement. We recruited cancer care providers in the USA via several cancer care networks to participate in a survey regarding SCP implementation. We used descriptive statistics to analyze the data. Three hundred ninety-five providers from diverse cancer programs in 47 states and Washington, DC responded to the survey. The timing of SCP implementation varied across and within cancer programs, with approximately 40% of respondents reporting developing SCPs more than 3months after primary treatment or adjuvant therapy completion. Nurse navigators were responsible for 48-58% of each stage of SCP implementation. Processes that could have been automated often occurred in-person or via phone and vice versa. Respondents reported spending more than 2h per SCP to complete all stages of implementation, of which less than a third was reimbursed by third-party payers. We identified several opportunities for improving SCP implementation, including broadening the base of responsibility, optimizing modes of communication, decreasing the time required and increasing the funding available, and limiting variation in SCP implementation across and within cancer programs. Future work should assess the influence of approaches to SCP implementation on desired outcomes.

Implementation of survivorship care plans in the pediatric oncology clinic.

55 Background: Quality survivorship care and follow up have been well described in the pediatric oncology population to improve overall health of cancer survivors. Typically, a key component is the delivery of a survivorship care plan (SCP) in a dedicated survivorship program. Creation of an SCP in the immediate post-treatment period has not been commonly adopted. To address the Commission on Cancer's (CoC) requirement to provide SCPs within six months of ending therapy, our pediatric oncology clinic has used quality improvement (QI) methods to incorporate SCPs into clinic workflow with subsequent survivorship program referral. Our aim is to meet the CoC’s benchmark of 50% of eligible patients receiving SCPs by December 31, 2017. Our secondary goal is to improve the timeliness of delivery to patients, families, and primary care providers (PCP). Methods: Registry data from our cancer center was utilized to identify eligible patients. Upcoming appointments were then identified for a panel of eligible patients using the electronic medical record (EMR). Providers use a standardized SCP template which includes the components required by the CoC. The SCP is then reviewed with families, electronically sent to the PCP, and saved in the EMR. Evaluation of the process included subjective feedback from providers and Plan-Do-Study-Act cycles. Based on this feedback and cycles, iterations of the template have been progressively streamlined and the EMR panel has been updated. Results: Care plan creation and delivery is ongoing. At baseline, 28% of eligible patients had SCPs previously created in the survivorship program. After implementation of our QI methods, to date, we have increased the proportion of eligible patients with an SCP to 40.3%, approaching our goal of 50% by December 31, 2017. We have also decreased the time from end of therapy to delivery of a care plan from 22.9 months to 14 months. This is expected to further improve as the process continues. Conclusions: The QI process has been successful in implementing a new standard of care for delivery of SCPs. Ongoing use of QI methods will increase compliance with the CoC standards and result in improved survivorship care.

Enhancing provider engagement and accountability: A strategy for survivorship care plan implementation within a large hospital network.

56 Background: Challenges to Survivorship Care Plan (SCP) implementation persist and guidelines to facilitate provider engagement and accountability are needed. In 2014, Levine Cancer Institute (LCI), part of one of the largest Commission on Cancer (COC) hospital networks, instituted a SCP delivery model. The patient’s LCI or LCI-affiliated physician or advanced care provider (ACP) is responsible to create and deliver the SCP. This presentation updates and extends prior work presented at the 2017 ASCO Cancer Survivorship Symposium to demonstrate the utility of enhanced provider engagement and accountability in SCP program expansion at LCI. Methods: The Survivorship Section partnered with the Cancer Committee to develop a system to enhance provider engagement and accountability. Strategies to improve engagement included: emailed SCP metrics (monthly goals and volume reports) and poster presentations to demonstrate SCP value to Tumor Site Section Leaders (TSSLs), administrators and providers. Strategies to promote accountability included: (1) partnered with TSSLs to clarify SCP eligibility criteria, set monthly goals and identify methods to optimize delivery; (2) discussed SCP metrics within each TSSL to highlight participation rates of providers or clinics; (3) presented Section- and clinic-specific SCP performance at quarterly Cancer Committee, National Accreditation Program for Breast Cancer leadership and Operational meetings; and (4) required all newly hired outpatient ACPs to receive SCP training and included SCP delivery in yearly ACP goals. Results: Since 2014, the total number of SCPs, participating providers, clinics and cancer types has grown 25-, 17-, 7- and 22-fold, respectively. Conclusions: LCI developed a multilayer partnership strategy that enhanced engagement and accountability at the leadership and provider level. This partnership significantly increased numbers of SCPs delivered over four years and allowed us to meet COC goals. [Table: see text]

Survivorship care plans in safety net: Bridging the barriers.

68 Background: Survivorship care plans (SCPs) are considered an important tool in survivorship care. SCP should include treatment summaries and follow up care plans and are intended to improve survivorship care. Despite the institute of medicine (IOM) recommendation regarding SCPs, the uptake has been low in community cancer centers. The safety net hospitals face additional challenges to SCPs including patient who may have low health literacy and limited English proficiency. In addition, resources and personnel constraints can be important barriers for implementation of SCPs. Methods: Zuckerberg San Francisco General Hospital is a safety net hospital in the City and County of San Francisco. We created SCPs for breast cancer survivors, as it is our largest group of cancer survivors. Patients, who were within 5 years of completion of treatment with curative intent for breast cancer were candidates for receiving SCPs. We used ASCO survivorship template to create a survivorship care plan. ASCO breast cancer SCP was discussed in the focus groups and modified to match the needs of our patients. SCP committee and patient advisory board evaluated the SCP prior to a pilot of the SCPs in the clinic. We piloted the SCPs initially in English and Spanish to assess feedback from clinic providers. After requested modifications SCP was then translated in to simplified Chinese. The SCP delivery was embedded in the clinic flow and was done at time of routine clinic visit to reduce the burden of additional visits. Results: 104/175 eligible patients have already received the SCP over one year period. All providers in the clinic participated in delivery of SCPs. Conclusions: SCP in multiple languages can be implemented successfully in safety net setting in a patient population with low health literacy and limited English proficiency. Availability in multiple languages, provider buy–in and embedding SCPs in clinic flow appears to be important factors in implementation. We are evaluating the optimal process of SCP delivery with an ongoing randomized pilot study of SCPs with and without navigation with breast cancer related quality of life and self-efficacy measures. We are also evaluating the usefulness of SCPs in meeting the informational needs of primary care providers.