Survivorship Care Plan Template Research Articles

Abstract A033: The iCCARE Consortium for Prostate Cancer in Black men: Creating a survivorship care plan for Black prostate cancer survivors

Abstract Background: Globally, Black men suffer the greatest prostate cancer (CaP) burden. Blacks are diagnosed more at advanced stages of CaP, greater morbidity and mortality and poorer survivorship outcomes. Blacks are exposed to adverse, discriminatory societal determinants. How these determinants impact the CaP disparities, in particular survivorship and health related quality of life inequities are understudied. Studies examining patient-reported outcomes of Black CaP survivors reveal heightened negative HRQOL sequelae, and depression, family, work and living situation instability due to cancer treatment and societal determinants of health (SDOH). SDOH is used mostly in Public Health to predict population health risk and outcomes, but rarely integrated into HRQOL research and practice. This project is novel by incorporating SDOH into the assessment and relief of HRQOL threats. Despite the Black CaP disparities in survivorship, there remains unacceptable lack of focus and prioritization to provide comprehensive relief. Methods: In response to this noticeable scientific gap, our requisite multidisciplinary investigatory team including Survivor-Advocate Investigators joins forces to achieve the study goal. We are employing community engaged research practice to create a CaP survivorship care plan (SCP) template targeted to Blacks. Our SCP will provide a comprehensive best-practice roadmap to document medical information with treatment history and status, along with relevant resources and health advisories to provide relief for unfavorable sequalae due to cancer and its treatments as well as improve quality of life for CaP survivors. We are building upon the Science of Survivorship, and Contextual Socioecological and the Behavioral Precision Medicine Models with full survivor-advocate partnership to create the SCP. This project to develop a SCP template employs an informative consensus panel to inform the initial SCP. Results: Based on advocate-survivor input and guidance, the SCP will include resources and tools focused on SDOH, treatment adherence, treatment side effects and symptom relief, co-occurring chronic conditions, cardio-protective strategies, and physical, emotional and social wellbeing towards improving in patient outcomes and HRQOL in Black CaP survivors. Data from the Engagement Core and Survivor-Advocate Community Advisory Board, and the preliminary SCP CaP for Black men will be presented at the meeting. Conclusion: Our Consortium builds upon the work of the multidisciplinary PIs, and provide team science approach with robust scientific methods to better understand and address the HRQOL needs of Black CaP survivors. Importantly, this research will make available a patient-centered SCP for CaP survivors, focused on Black men. The iCCaRE Consortium will use this SCP_CaP to inform the development of Artificial Intelligence interventions addressing medical, follow-up care, surveillance, social and emotional support, SDOH and health advisories that will be deployed on popular mobile platforms for greater reach and on-demand use. Citation Format: Kimlin T. Ashing, Folakemi T. Odedina, Cassandra N. Moore, Che Ngufor, Getachew A. Dagne, Fornati Bedell, Diana Londoño, John McCall, Arnold Merriweather, JoAnne S. Oliver, Rotimi Rotimi Oladapo. The iCCARE Consortium for Prostate Cancer in Black men: Creating a survivorship care plan for Black prostate cancer survivors [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A033.

The PanCareFollowUp Care Intervention: A European harmonised approach to person-centred guideline-based survivorship care after childhood, adolescent and young adult cancer

BackgroundLong-term follow-up (LTFU) care, although endorsed, is not available for the majority of adult survivors of childhood, adolescence and young adult (CAYA) cancer. Barriers to implementation include lack of time, knowledge, personnel and funding. Sustainable solutions are urgently needed to address the needs of CAYA cancer survivors to improve the quality of life and reduce the burden of late effects on survivors, health care systems and society. The European Union–funded PanCareFollowUp project, initiated by the Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer, was established to facilitate the implementation of person-centred survivorship care across Europe. Patients and methodsThe PanCareFollowUp Care Intervention was co-developed with survivors as part of the PanCareFollowUp project. It is a person-centred approach to survivorship care, supported by guidelines and with flexibility to adapt to local health care settings. The Care Intervention consists of three steps: (1) previsit completion of a Survivor Questionnaire (by the survivor) and Treatment Summary (by the health care provider [HCP]), (2) a clinic visit including shared decision-making, and (3) a follow-up call to finalise the individualised Survivorship Care Plan. ResultsWe developed the key components of the PanCareFollowUp Care Intervention: a PanCareFollowUp Survivor Questionnaire, Treatment Summary template, Survivorship Care Plan template, and educational materials for HCPs and survivors. Wide implementation of the PanCareFollowUp Care Intervention will be supported with a freely distributed Replication Manual on completion of the PanCareFollowUp project. ConclusionsThe PanCareFollowUp Care Intervention will support the implementation of person-centred, guideline-based LTFU care in different health care settings across Europe to improve survivors’ health and well-being.

Genetic testing documentation in survivorship care plans in patients with breast cancer.

e24110 Background: Genetic testing results for germline mutations impact care of cancer survivors, thus are important to include in a survivorship care plan (SCP). In 2014, the Commission on Cancer adopted the American Society of Clinical Oncology’s SCP template and included a section on cancer genetic testing and results. However, data on its implementation is scant. We assessed documentation of genetic testing results in SCPs in various genetic test result groups and by primary oncology treatment team (PT) and consulting survivorship team (ST). Methods: We conducted a retrospective chart review of breast cancer patients who had a survivorship visit at our institution from February 2015 to January 2020, were seen by a genetic counselor (GC), and had genetic testing for germline mutations for hereditary predisposition to cancer (GGT). We compared the extent of documentation of GGT between the PT and ST’s SCPs, and among result categories (positive, negative, and variant of uncertain significance (VUS)) for occurrence of genetic testing, name of panel tested, GC recommendations, GC name/contact information, and name of gene involved and site of mutation (when applicable). Results: Among 398 women with breast cancer (DCIS 3%, Stage I 47%, Stage II 40%, Stage III 10%), median age was 49 years (range 27-77 years); 91% were non-Hispanic white, 4.7% black, 2.7% Asian, and 1% were Hispanic. GGT was documented in 93.7% of SCPs overall. GGT results were positive in 12.8%, negative in 65.8%, and VUS in 21.4%. The ST (75% SCPs) more often included GGT documentation in SCP as compared to PT (95.7% vs 87.9%, p = 0.006). There was no difference in GGT documentation by result category (positive 96.1%, negative 92.4%, VUS 96.5%, p = 0.3). GGT documentation was more detailed by ST as compared to PT, with name of panel tested included in 97% vs 92% of SCPs (p < 0.001). Of those with positive or VUS results, the name of the involved gene was included in 95% vs 77% (p = 0.003), and the site of mutation in 82% vs 48% (p < 0.001) of SCPs (ST vs PT). Only 56% of SCPs in the positive results group included all GC’s screening and follow up recommendations, while 84.7% in the VUS and 92% in the negative results group included them (p < 0.001). GC name/contact information were more often documented in ST’s SCPs (66% vs 8%; p < 0.001), with overall reporting being low in all result categories (positive 49%, negative 54%, VUS 48%). Conclusions: Overall, SCPs were likely to have documentation of GGT occurrence, name of tested panel and involved genes, but less frequently included the specific mutation identified, GC contact information, or GC recommendations for those with positive results. Documentation tended to be more complete for SCPs performed by ST rather than by PT. The causes of this discrepancy are unclear and may be related to different levels of comfort with and knowledge of GGT. Further study is needed to identify knowledge gaps and processes to improve documentation of GGT in SCPs.

Dashboard directed decision support to increase cancer survivorship care plan adherence.

e24043 Background: Oncology practices face multiple challenges when trying to implement the Commission on Cancer (CoC) Survivorship Care Plan (SCP) documentation standard. First, it is difficult to systematically identify patients who qualify for a SCP from the electronic medical record (EMR). Second, SCP documentation must be completed within a specific timeframe that does not always align with clinical encounters for routine care. Finally, as practices participate in more regulatory programs, such as the Oncology Care Model (OCM), the burden of meeting the unique but often overlapping documentation standards becomes burdensome. Our goal was to improve adherence to SCP documentation through enhanced clinical documentation workflows and clinical decision support. Methods: To meet CoC SCP standards, SCP templates were built into the EPIC EMR at a single multi-centered institution. These templates allowed the user to indicate on the problem list if the SCP was needed. Likewise, Institute of Medicine (IOM) care plan documentation templates and reminders were built to meet OCM standards. Population dashboards were developed in Tableau to track SCP documentation adherence and provide support regarding eligible patients who required SCP documentation. Patients were eligible who had a cancer diagnosis codes on the problem list, and MC in the EMR. Patients greater than 12 months from being marked curative were considered eligible to complete SCP. Results: Between 2015-2019, 2763 cancer patients were MC by 31 providers, where 806 (30%) were OCM patients. Overall, 1372 (70%) non-OCM patients required an SCP, where 563 (41%) were completed. When examining the OCM patients, 689 (85%) required a SCP, where 552 (80%) were completed. For patients MC in 2018, 163/439 (37%) and 137/190 (72%) of patients received a SCP for the non-OCM and OCM group respectively. For patient MC in 2019 after implementation of the decision support dashboard, 115/145 (79%) and 144/148 (97%) of eligible patients had completed SCP for the non-OCM and OCM group respectively (Table). Conclusions: During the study period, adherence to SCP documentation doubled concordant with CoC standards at that time. Integration of IOM and SCP documentation improved adherence among OMC compared to non-OCM patients. The decision support dashboard helped prioritize cases for SCP documentation for care teams. This is an example of a decision support framework that could be used for other standards driven documentation requirements in cancer.

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.

Models of childhood cancer survivorship care in Australia and New Zealand: Strengths and challenges.

Childhood cancer survivors remain at risk of developing life-altering and/or life-threatening health conditions following the completion of curative treatment. However, no uniform model of care for childhood cancer survivors exists in Australia and New Zealand (ANZ). This study reports on current childhood cancer survivorship care in ANZ, highlighting the challenges childhood cancer survivor long-term follow-up (LTFU) clinics face. We conducted semistructured, telephone interviews with the pediatric medical director and clinical nurse consultant from all 11 LTFU clinics at tertiary referral pediatric oncology units across ANZ (n = 19; 100% response rate). Data were analyzed using NVivo10. Participants unanimously identified limited options for transitioning older survivors out of pediatrics and inadequate funding as central challenges to the provision of best-practice LTFU care. There is duplication of resource development between clinics (e.g. survivorship care plan templates and clinic systems). Although participants recognized an overly prescriptive model of LTFU care as potentially unfeasible, the majority endorsed a national, or even bi-national, model of care that could be tailored to meet the needs of their local environment. The lack of an accepted model of optimal childhood cancer survivorship care across ANZ prevents the synergistic development of survivorship guidelines, survivorship care plans, transition pathways, information technology solutions, funding streams and late effects data consortiums. Sufficient resources to facilitate growth may be difficult to secure if approached by individual centers rather than via a national, cooperative effort. Improved solutions are urgently needed for transitioning survivors to appropriate care beyond the pediatric age.

Growing a cancer survivorship care plan program.

58 Background: More than 15.5 million cancer survivors live in the United States. This number is expected to be over 20 million by 2026. Cancer survivors have increased risk of morbidity; therefore, preventive and on-going medical treatment requires close monitoring and coordination. The Institute of Medicine’s (IOM) 2005 report, Cancer Patient to Cancer Survivor: Lost in Transition, recommended health providers raise awareness of cancer survivors’ needs and establish cancer survivorship as a distinct phase of care. The IOM also recommended patients who complete primary treatment are provided a comprehensive summary and plan that is effectively explained. A survivorship care plan maps out and improves care related to accessibility of past diagnosis and treatment history, surveillance guidelines, and potential long term side effects. In 2012, the Commission on Cancer (CoC) added Standard 3.3 Survivorship Care Planto the program standards. This met the IOM’s objective of addressing potential patients that get “lost” as they transition from care they received during treatment through phases of their life or disease. Methods: The Cancer Committee within a CoC certified organization developed multiple strategies to address the IOM and CoC standards. Strategies included a process to disseminate a comprehensive care summary for cancer patients who are completing primary treatment, adoption of the American Society of Clinical Oncology’s Treatment Summary and Survivorship Care Plan template, and adding a survivorship nurse navigator to the interprofessional treatment team. The survivorship nurse navigator monitors and reviews survivorship care plans with patients, advises when to seek treatment for symptoms, discusses surveillance guidelines, navigates patients through therapies, and educates on prevention and screening. Results: Evaluation for quality of life and compliance with individualized surveillance guidelines is ongoing. Conclusions: The oncology nurse navigator role is uniquely positioned to lead care coordination and improve outcomes through the continuum of care. Providing patients with a summary of their treatment and a plan moving forward may decrease stress related to the transition from active treatment to survivorship.

Survivorship care plan: Use of the ‘Oncology History’ (OncHx) feature of the Epic electronic health record (EHR).

51 Background: Survivorship care plans, including a cancer treatment summary, are a standard of cancer survivorship care. At Stanford Health Care (SHC), OncHx, a component of the Beacon module in Epic version 2012, became available May 2, 2013. The OncHx, linked to the problem list and visible to all SHC users, can be inserted in all encounter documentation and provides a chronological treatment summary. OncHx can be updated at any time. Events are categorized as: diagnosis, surgery, chemotherapy, radiation, blood and marrow transplant, anti-hormone therapy, clinical research, disease status, procedures, hospital admissions and adverse reactions. Each event is auto-sorted by date. We measured OncHx use at SHC between 5/1/13-5/1/16. Aim: Our objective is to measure the frequency OncHx is populated as a treatment summary. Methods: Our cohort was unique cancer diagnosis in the problem list and >1 visit to SHC during the analytical period. Cohort patients with >1 event recorded in OncHx at analytic period end was counted as having a populated OncHx. Results: The number of documented cancer diagnoses in the problem list increased over time. The frequency of populated OncHx increased from 5.6 to 16.5% reached a steady state of 15%. Five survivorship APPs populated 12% of all OncHx (#653). Nurses have edit privileges and populated < 1% of all OncHx events. Conclusions: The OncHx contains an organized, date ordered and refreshable treatment summary and is useful in generation of the survivorship care plan. Initial adoption by SHC advanced practice providers (APPs) and physicians has been slow, except Survivorship APPs. Use increased after more providers were given edit privileges in May, 2014. Near future enhancements are auto-population of chemotherapy administered and report of OncHx usage in Epic generated survivorship care plan template. There is an opportunity for nurses to populate OncHx and use it for their documentation.

Abstract P1-10-15: Breast cancer survivorship support services: Evaluation findings of the thriving again survivorship program

Abstract Background. While a breast cancer diagnosis can be daunting for women of any age, studies have shown that young breast cancer survivors exhibit more emotional and psychological distress because of their relatively young age and life stage at diagnosis. In September 2011, the Centers for Disease Control and Prevention funded seven organizations, including Sharsheret, a national not-for-profit organization supporting young Jewish women and their families facing breast cancer, to develop support services and educational awareness activities for young breast cancer survivors. With this funding, Sharsheret developed the Thriving Again® (TA) survivorship program, which provides support services and resources, including a tailored survivorship kit with a survivorship care plan template, exercise DVD and healthy living cookbook. Participants were asked to complete an evaluation of services received to further enhance the program. Methods. Breast cancer survivors who received a TA survivorship kit were asked to complete an online or paper survey evaluating Sharsheret's survivorship support services. Among 972 women who received the TA survivorship kit and were invited to complete an evaluation, 164 women returned the evaluation survey and 85 completed it in its entirety. Descriptive statistics on demographics and factors related to utilizing the survivorship care plan template and Sharsheret's services were calculated and analyzed. The small sample size limited additional analyses. Results. Of the 85 women who completed the survey, 46% were <45 years of age and 43% were of Jewish descent. 62% of respondents reported that they received the kit and care plan template at the time they needed it most in their survivorship journey. These women more often reported completing their survivorship care plan template either themselves or with a member of their medical team. Care plan completion was also high among women considering themselves as "survivors" (89%). The vast majority of women participating in the Genetics for Life® program (76%) had spoken with a Sharsheret clinical team member at the time they ordered their TA kit. Other factors, such as stage at diagnosis and age, were unrelated to use of the care plan and Sharsheret's programs. Conclusion. Although breast cancer survivors may identify themselves as "survivors" at any point post-diagnosis, women responding to the survey who were satisfied with the timing of receiving the TA kit during their survivorship journey and who self-identified as a "survivor" were more likely to complete the care plan template. Women who reviewed the kit and learned more about TA with a member of Sharsheret's support team were more likely to engage in other Sharsheret programs, most notably, Genetics for Life®. Although the sample size was small, the findings from this evaluation may be helpful to other survivorship programs. Most notably, other programs may need to be aware of how patients perceive themselves as survivors and offer care plans and resources when patients feel they most need them, even if patients have not yet completed treatment. The findings in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Citation Format: Silber E, Stahl S, Fleischmann AK. Breast cancer survivorship support services: Evaluation findings of the thriving again survivorship program. [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 P1-10-15.

Improving patient participation in a breast cancer survivorship program at a safety net hospital.

60 Background: To provide comprehensive services and meet Commission on Cancer (CoC) accreditation requirements, we developed and evaluated a customized breast cancer SCP template and delivery model. Objective: To implement and pilot test survivorship care plan (SCP) delivery for breast cancer survivors. Methods: Clinicians at a safety net hospital partnered with investigators at an academic institution to start a breast cancer survivorship care program. We developed an SCP template that is CoC-complaint and responsive to input gathered in 2 focus groups with breast cancer survivors (n = 12) and interviews with staff (n = 8). Oncologists and nurses identified and referred English-speaking women who had completed breast cancer treatment. Participants completed baseline measures prior to receiving individualized SCPs in a survivorship consultation visit with a dedicated APN. In response to high no-show rates, we expanded clinic scheduling to harmonize with participants' other medical appointments. Interim feasibility results for our ongoing study are presented here. Results: A total of 154 patients were screened to reach target enrollment (n= 80) within 20 months. Participant median age was 60 ± 11; 71% were African American, 14% Hispanic; 11% Non-Hispanic White and 92% had household incomes < $20,000. Average times were: 30 ± 13.4 minutes for abstracting patient clinical information in preparation for the survivorship visit; 25 ± 16 minutes for completing individual SCPs; 22±7.65 minutes to review / deliver the SCPs with patients. The difference in no-show rate between first 3-month recruitment period (clinic limited to one day/week) and next 17 months (clinic appointment expanded to accommodate patients' schedule) was statistically significant, p = 0.028. Conclusions: Tailoring SCP templates and delivery models to the needs of a safety net hospital aided the sustainability of a new survivorship clinic. Patient non-adherence to scheduled visits was significantly improved by expanding clinic hours. Significant clinician time was spent preparing SCPs and a level 4 visit (25 minutes) does not adequately reflect this effort. This study is funded by the American Cancer Society, Illinois Division (Grant# 254698).

Implementing provider and patient initiated survivorship care planning: Lessons from baseline.

65 Background: It is recommended that cancer patients completing treatment receive a Survivorship Care Plan (SCP). Most SCP templates are designed for provider initiation and completion. Barriers to SCP provision include time and resource restrictions in the oncology clinic. Patient-initiated SCPs are one alternative. We conducted a pilot trial describing and comparing implementation of a provider-initiated versus patient-initiated tool. We present clinician and patient baseline data. Methods: We recruited oncologists from two community-based academically affiliated hospitals and conducted qualitative interviews exploring perceptions of patients’ needs and SCP value. To determine feasibility of oncologists identifying patients for an SCP, participating oncologists were to refer adult patients completing active treatment for non-metastatic cancer to the study team. Enrolled patients completed the Cancer Survivors’ Unmet Needs (CaSUN) and Preparing for Life as a New Survivor (PLANS) surveys. Results: Of 58 invited clinicians, 13 agreed to participate, 5 referred patients. Participating clinicians were not currently providing SCPs. Opinions were mixed about SCP value for improving care; most saw value for communication and care coordination. The study team worked with nurses to identify eligible patients, given challenges with identification as part of routine practice. We recruited 41 patients (aged 44-90 years, 68% female, 81% White, 53% reporting excellent or very good health) from 71 approached. At baseline, patients reported an average of 13.8 informational and support needs; 9.3 of which were met and 4.5 were unmet. The most common unmet needs were recurrence concerns (37%), case management to identify services (30%), adjusting to changes in quality of life (22%), and coordination among providers (21%). In terms of understanding follow-up care, 24% reported not feeling prepared for what to expect and not knowing about follow-up tests; 22% reported providers not communicating well with each other. Conclusions: Need exists for robust systems to identify eligible patients. Enrolled patients’ needs were relatively modest, with recurrence concerns and inter-professional coordination being key. Clinical trial information: NCT02405819.

Implementing survivorship care planning in a large integrated cancer program.

69 Background: Aurora Health Care is comprised of 15 hospitals and 22 oncology clinics. Aurora Cancer Care (ACC), a Commission on Cancer (CoC) accredited program, diagnoses and treats 7,000 adult cancer patients annually, more than any other healthcare system in Wisconsin. The CoC’s Survivorship Standard 3.3 requires accredited cancer programs to provide cancer patients with survivorship counseling and a written care plan. ACC was challenged to develop a consistent model of survivorship care that can work at multiple sites across the system. Methods: Workflow planning and education began at all oncology clinics in fourth quarter of 2014. Thirteen disease specific survivorship care plan templates were built into the EMR with some-auto population functionality. A system wide delivery plan was launched in first quarter of 2015 with the goal of targeting 10% of eligible patients. Initial focus was on breast cancer patients with some sites also including other cancers. The model of survivorship care is an “embedded consultation” in medical or surgical oncology with an advanced practice provider (APP) completing the care plan and meeting with the patient at the end of first line treatment. Results: Initial required volumes were estimated based on 2013 registry data with a goal of completing approximately 700 care plans in 2015 to meet the 10% CoC standard. During Q1 & Q2 of 2015, 444 care plans were generated and given to patients, mostly for breast cancer survivors. The most significant barrier surrounded retrieving data from the EMR. Conclusions: Data from the first half of 2015 demonstrates success with the approach. Aurora Cancer Care will exceed the benchmark of 700 care plans. There has been a high level of engagement with the APPs who have taken ownership of survivorship care planning, contributing to the success of the program thus far. Because of difficulty retrieving data from the EMR, manual tracking was still required. Future modifications will address this and other barriers.

PCSM-02SURVIVORSHIP CARE PLANNING IN THE NEURO-ONCOLOGY CLINIC

A 2006 Institute of Medicine report recommended that cancer survivorship care planning be implemented into comprehensive care of the patient with cancer. Survivorship care planning is a planned approach to addressing 1) prevention of late effects, 2) surveillance for cancer progression or late effects, 3) intervention for symptoms arising from the cancer or its treatment, and 4) coordination of care amongst healthcare providers. In response to the recommendations, we developed a cancer survivor component of care that was added to the current clinical program and delivered by advanced practice nurses. Survivorship care planning was implemented at completion of the concomitant phase of treatment, upon completion of the adjuvant phase of treatment, and at any time treatment changed. A survivorship care plan template was developed as part of the electronic medical record (EMR) and used to guide survivor discussions. The care plan addressed the four key aspects above with recommendations for interventions related to each aspect. Inclusion of the care plan in the EMR allowed all neuro-oncology team members to provide input into and be able to view the plan collectively; the plan was also shared electronically with the primary provider. Ongoing symptoms were identified using patient self-report data to supplement the examination, and addressed on an individual basis with additional referral to a web-based self-management program. Research about program efficacy is ongoing. Challenges were encountered in identifying reimbursement options and program adaptation to a wide variety of tumor types. A multidisciplinary approach was found to be most helpful in implementing survivorship care planning into comprehensive care for the person with a brain tumor.

Development of a standard survivorship care plan template for radiation oncologists

PurposeIn response to a need expressed by members of the American Society for Radiation Oncology (ASTRO), the ASTRO Board of Directors approved an initiative to create a radiation oncology-specific survivorship care plan (SCP) template. Methods and MaterialsMembers of the ASTRO Health Services Research Committee (which was subsequently renamed the Clinical, Translational, and Basic Science Advisory Committee) were charged with this task. Creation of the ASTRO SCP template was informed by existing SCP templates published by other organizations and modified to add radiation treatment details felt to be important by committee members. An emphasis was placed on describing diagnostic and treatment details in ways that patients and referring physicians can understand. The resulting template subsequently underwent ASTRO committee review, public comment, and was ultimately approved by the ASTRO Board of Directors. ResultsThe standardized template includes 2 components: the first 2 pages represent an SCP that is to be given to the patient and referring physicians, whereas page 3 includes additional technical radiation therapy details which are usually included in a traditional radiation treatment summary. That is, the template serves two purposes—obviating the need for radiation oncologists to create an SCP for patients and a separate treatment completion note. ConclusionsThe standardized ASTRO SCP template serves an immediate need of practicing radiation oncologists to have a template that is radiation-specific and meets current requirements for SCP and radiation treatment summary. Potential future work may include development of disease-specific templates that will include more granular details regarding expected toxicities and follow-up care recommendations and working with electronic medical record system vendors to facilitate autocreation of SCP documents to reduce the burden on physicians and other staff. These future developments can make this intervention more helpful to patients, and further reduce the burden of creating SCPs.

The Survivorship Care Model at MSKCC

The Survivorship Care Model at MSKCC

Are survivorship care plans responsive to African-American breast cancer survivors?: voices of survivors and advocates

African-American breast cancer survivors (AABCS) suffer the greatest from cancer recurrence, morbidity, and mortality in part due to the lack of cancer follow-up care and surveillance. To improve survival and survivorship, the Institute of Medicine advises that cancer survivors be provided a survivorship care plan (SCP). The current study investigated AABCS' understanding of SCP and gathered preliminary feedback on infusing cultural and socioecological responsiveness. The study embraced a community-based participatory research framework. Three facilitated, structured, consensus meetings were conducted with AABCS (N = 25) and advocates (N = 3) to provide information towards identifying the content domains of an SCP that are culturally responsive to AABCS. AABCS recommended inclusion of patient-centered information on the purpose and use of the SCP. They raised concerns that higher mortality in AABCS may be due to greater comorbidities and inadequate surveillance and follow-up care. Participants recommended that the SCP document all comorbidities and medications, regardless of relationship to cancer; referrals for cancer-related providers; and culturally informed health advisories. Study findings indicate that the available SCP template lacked adequate content on health history, comorbidity, health promotion, and functioning. These factors constitute the underlying clinical, psychosocial, and behavioral risks for poor disease outcomes that may be exacerbated in AABCS. SCPs are intended to educate and activate patients to join their oncology care team as informed partners. However, the emerging science and implementation of SCPs seem void of patient input. Our investigation suggests a practical approach for survivor engagement in the SCP discourse to increase their cultural responsiveness and patient-centeredness.

Developing a cultural and socioecological patient-centered survivorship care plan template for African American survivors.

40 Background: Cancer and its treatments bring added health and life challenges. Cancer survivors require ongoing surveillance and medical care. To facilitate best practice in follow-up care, the Institute of Medicine, the American Society of Clinical Oncology and advocacy organizations advise that cancer survivors be provided with treatment summaries and Survivorship Care Plan (SCP). African-American breast cancer survivors (AABCS) have poorer outcomes characterized by greater morbidity and mortality, hence warranting their careful surveillance and follow-up medical care. SCP investigations are urgently needed to improve follow-up care and cancer outcomes in AABCS. Methods: The study embraced a community-based participatory research framework, building upon a series of research projects conducted by the African American Cancer Coalition, a partnership of scientific researchers and community-based advocates. Three informative focus groups were conducted with AABCS (N=25) and advocates (N=3) to obtain input on cultural and socio-ecological SCP contents to increase patient responsiveness. Results: AABCS believed that increased mortality may be due to comorbidities and inadequate surveillance and follow-up care. Participants recommended that the SCP attend to and document all comorbidities and medications; allow for participation of primary care providers; referrals for providers especially surgeons who are familiar with treating AABCS to the reduce keloid, and health advisories on nutrition, exercise and stress management. Quality-of-life related components and community referrals should be included because they are important for overall health. AABCS noted the importance of spirituality in life, and the disproportionately high levels of socioecological stress in the community. Conclusions: Participants infused cultural and socioecologic relevance towards the development of a patient centered SCP template to increase acceptability and utilization among AABCS. Participants underscored that developing the SCP responsive to AABCS and facilitating adherence to SCP recommendations, are areas warranting increased intervention and research.