Survivorship Visits Research Articles

Quality improvement scorecards driving innovation and best practice in a large community oncology practice.

417 Background: Lean Six Sigma Visual Management dashboards, or scorecards, are visual tools designed to drive and improve quality patient care, operationalize best practices, and promote a culture of operational excellence. Practice scorecards create a disciplined problem-solving culture where root causes are identified, and systemic process-based improvements are implemented. Scorecards are created to show full practice data transparency, allowing all employees and sites to see each other’s data. Scorecards are designed so that providers can efficiently review the maximum amount of data, following a Green, Yellow, Red visual cue to signify goal adherence. Methods: Phase 1 (2018 – 2019): Clinical scorecards were created and introduced to all staff on a weekly basis focusing on a few key patient metrics (ex: pain scale, pain care plan, ACP, PHQ-9, teaching/consents, patient portal access). Phase 2 (2020 – 2022): Clinical scorecards were expanded with additional patient care initiatives. New nurse navigator scorecards created (ex: patient teaching and survivorship visits). New physician and APP scorecards created with practice-specific provider metrics. Phase 3 (2023 – 2024): Scorecards updated yearly to match practice quality initiatives. New dashboards for non-clinical employees initiated. Physician and APP compensation changed to include quality metric performance tied to financial incentive. Results: Over the course of 5 years, OHC quality scorecard metrics improved from below national averages (red) to exceeding top-tier threshold goals (green). Scorecard utilization increased across all areas of the business, expanding from one scorecard in 2018 to eight in 2024. Scorecards increased overall practice data transparency leading to increase practice quality metric performance. OHC staff utilize scorecards on a weekly, monthly, and quarterly basis to drive quality improvement adherence. Improved outcomes through full data transparency increased staff participation and ownership in quality metrics and led to achieved shared savings in managed care programs. Example of metrics and results: Patient NCCN Staging 36% (2588/7263) to 96% (10299/10749), Teaching/Consents 37% (423/1147) to 97% (3067/3160), and Oral regimen NCCN entry 69% (586/845) to 98% (1037/1055). Conclusions: Visual Management dashboards or practice scorecards are instrumental in driving and supporting practice change. Scorecards allowed OHC staff to efficiently visualize practice-wide actionable data with eye-catching colors to promote optimal clinical performance. As increased data procurement is on the rise, practices can empower their staff to drive change through data utilization. OHC’s scorecards have proven to bridge the gap to goal, facilitate transparent data sharing, and empower providers and staff toward collaboration and embracing operational excellence.

Preference of Young Adult Cancer Survivors for In-Person Versus Telemedicine Cancer Survivorship Visits.

Young adult (YA) cancer survivors face barriers to follow-up care, which can be exacerbated by living in a rural location. Telemedicine may mitigate these barriers, but little is known about the preferences of YA survivors for telemedicine or in-person survivorship visits. We surveyed 57 YA cancer survivors in a rural state to assess their preference for survivorship visits. Forty-six percent of respondents preferred an in-person visit while 16% preferred telemedicine. The remaining 39% reported "it depends" or were undecided. In-person visits were preferred when stratified by rural versus urban location. This work can be used to inform survivorship delivery systems.

OUTC-07. ANALYZING PREDICTORS OF LOSS TO FOLLOW-UP AS SEEN AMONG YOUNG SURVIVORS OF CENTRAL NERVOUS SYSTEM TUMORS FOR QUALITY IMPROVEMENT INTERVENTIONS AT DANA FARBER CANCER INSTITUTE

Abstract At Dana Farber Cancer Institute, children and young adults who have completed treatment for central nervous system tumors visit the Pediatric Neuro-Oncology Outcomes Clinic (“Empower”) for survivorship visits. By attending these long-term clinic visits, survivors can receive multidisciplinary services and undergo monitoring for disease recurrence. We used descriptive statistics and chi-square tests to investigate the relationship between loss to follow-up and sociodemographic factors among Empower patients. We reviewed medical records to gather data on 200 patients who had visited the clinic between 1-1-2015 and 1-1-2020, extracting information about sex, zip code, diagnosis, treatment received, and insurance type (private vs. public). We then indicated whether each patient had been “lost to follow-up,” defined as not returning to the clinic for >1,000 days after the recommended follow-up date. Among the 200 patients reviewed, 46 (23%) were lost to follow-up and 154 (77%) were not lost to follow-up. With respect to race and ethnicity, individuals identifying as Black, Asian, Middle Eastern, Native Hawaiian or Pacific Islander, Hispanic or Latino, or “Other” were more likely to be lost to follow-up than patients who exclusively identified as White (21% versus 39%; p=0.036). Additionally, individuals who were lost to follow-up were more likely to have been treated for low-grade gliomas as opposed to other CNS tumors (30% versus 13.6%; p=.015). Sex, the use of chemotherapy and radiation, and insurance type did not have a significant association with loss to follow-up. An analysis of the relationship between median household income and loss to follow-up is pending. The results imply that there is a significant association between non-white race, Hispanic or Latino ethnicity, a diagnosis of low-grade glioma, and loss to follow-up. The continuation of this study can provide the groundwork for interventions targeted at supporting patients who are at an increased risk of loss to follow-up.

Abstract P6-05-24: Implementing System Solutions for Survivorship Care Plans

Abstract Background: A survivorship care plan (SCP) is a detailed cancer care summary and future care plan that is generally given to a patient upon completion of adjuvant treatment for a cancer diagnosis. The initial goals of SCPs were to educate patients and other health care professionals about the treatments received, make them aware about potential long-term effects of therapy, and emphasize recommendations for future cancer screening and care (1). Due to numerous barriers—scheduling, staffing, and lack of awareness—SCPs are not delivered to all eligible patients. To address this unmet need our multidisciplinary breast clinic (MDBC) established an Advanced Practice Professional (APP) Survivorship Clinic. With the acute impact of the COVID-19 pandemic, survivorship referrals decreased. We, therefore, developed and implemented system solutions to address SCP access. Methods: System solutions include partnering with the Cancer Registry to provide the list of patients potentially in need of survivorship visits, partnering with pharmacy to confirm patient eligibility, creating specifically designated telemedicine survivorship visits in our electronic scheduling system, prospectively scheduling persons identified, engagement of APPs across the MDBC, and establishing a single coordinating point. Numbers of SCPs delivered are tracked monthly and patient satisfaction is assessed through data collected Press Ganey surveys. Results: This presentation will share our process interventions and outcomes as they mature. Our early data demonstrate the efficacy of the workflow and appear promising. Conclusion: We anticipate that system-based solutions will provide more patients with SCPs and demonstrate patient satisfaction. Blaes AH, Adamson PC, Foxhall L, Bhatia S. Survivorship Care Plans and the Commission on Cancer Standards: The Increasing Need for Better Strategies to Improve the Outcome for Survivors of Cancer. JCO Oncol Pract. 2020 Aug;16(8):447-450. doi: 10.1200/JOP.19.00801. Epub 2020 Apr 8. Erratum in: JCO Oncol Pract. 2020 Nov;16(11):774. PMID: 32267803. Gache, K., Leleu, H., Nitenberg, G. et al. Main barriers to effective implementation of stroke care pathways in France: a qualitative study. BMC Health Serv Res 14, 95 (2014). https://doi.org/10.1186/1472-6963-14-95 Citation Format: Dina Alnabulsi, Gloria L. Jackson, AnaMaria Lopez. Implementing System Solutions for Survivorship Care Plans [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-24.

Advanced Practitioner-Led Shared Visits: A Novel Approach to Cancer Survivorship.

The continued increase in the number of cancer survivors is encouraging and credited to better prevention, screening, and treatment. Cancer care authorities call for survivorship follow-up focusing on surveillance, health behaviors, and lingering effects of treatment. Despite the recommendations, cancer centers struggle to provide cost-effective, time efficient, comprehensive programming to address this call. The primary objectives of this quality improvement project were to (1) develop and pilot a shared survivorship visit for breast cancer survivors and (2) evaluate the feasibility and acceptability of the program. The participants in this 4-week pilot project included five female breast cancer survivors, ages 18 and older, diagnosed with stage I, II, or III breast cancer within the past year. Each survivor completed a one-time, 2-hour shared survivorship visit. The shared, interdisciplinary survivorship visit was directed by an advanced practice nurse. A team of nursing and ancillary experts presented information on their specialized area. Upon completion of the visit, the survivor received an individualized survivorship care plan. There were 21 eligible breast cancer survivors and 5 participants. The pilot was successfully implemented, acknowledged the feasibility, and identified the adaptability to other cancer survivors. An evaluation concluded that the APRN-led, shared survivorship visit model was accepted by the patients and the survivorship team. The shared survivorship visits will be implemented into the cancer care program to address the needs of breast cancer survivors. Furthermore, there will be an expansion of the shared survivorship visits to meet the needs of those with other types of cancers.

Oncologist-reported frequency of managing specific long-term and late effects in breast cancer survivors.

193 Background: Breast cancer survivors may experience a broad range of physical and psychosocial long-term and late effects. Although disease-specific guidelines for breast cancer survivorship care are available, systematic approaches remain a challenge in clinical practice. The purpose of this study was to describe variations in how medical oncologists assess and manage specific long-term and late effects in breast cancer survivors. Methods: This study is a secondary analysis of data from a survey of medical oncologists about breast cancer survivorship care in the United States. Using a study-specific list, oncologists were asked to report the “most common” and “most distressing” concerns of breast cancer survivors in their clinical practice, as well as the frequency at which they assess and manage 16 specific long-term and late effects in routine survivorship care. Data was analyzed using descriptive statistics to rank perceived patient concerns and compare practice variations across specific post-treatment issues. Results: Data from 215 surveys were included. Oncologists perceived anxiety, fatigue, neuropathy, and menopausal symptoms as top-ranking common and distressing concerns in breast cancer patients. When asked how often they assess and manage specific long-term and late effects in routine survivorship visits, oncologists reported the highest frequency for neuropathy (55%), bone health (54%), and pain (52%), and the lowest frequency for cognitive impairment (19%), sexual dysfunction (15%), and body image concerns (13%). Cognitive impairment and body image were perceived as the fourth and fifth most distressing issues that breast cancer survivors face, yet oncologists reported routine assessment and management less than 20 percent of the time. Conclusions: Findings from this analysis indicate that oncologists routinely assess and manage certain long-term and late effects, while others remain neglected. Important disconnects between perceived patient concerns and the issues that are routinely addressed in clinical practice were also identified. Standardized approaches that incorporate brief patient-reported assessments across multidimensional issues may facilitate comprehensive, guideline-concordant survivorship care.[Table: see text]

An Analysis of Factors Related to Care Engagement along the Cancer Survivorship Care Continuum for Cancer Survivors in Florida.

This study identifies factors associated with care engagement along the cancer survivorship care continuum for Floridians. We identified patients from the OneFlorida Data Trust with a cancer diagnosis at any age and encounters from 2012-2020. Multivariable logistic regression models produced odds ratios (OR) predicting 1) any outpatient non-acute care visit, 2) cancer-related visit with any provider, 3) cancer-related visit with a cancer provider, and 4) survivorship visit with a cancer provider. Encounter-based independent variables were insurance, Social Deprivation Index quartile, and Rural Urban Continuum Area (adjusted for age, sex, race, ethnicity, and treatment). 662,489 survivors were included in the sample. Those with Medicaid and dual eligible status (Medicare and Medicaid) were more likely to have an outpatient visit (Medicaid OR 2.02, 95%CI 1.93-2.12; dual eligible 3.06, 2.91-3.22) or a cancer-related visit with a cancer provider (Medicaid 1.82, 1.77-1.86; dual eligible 1.32, 1.28-1.35), and less likely to have a survivorship visit (Medicaid 0.27, 0.26-0.28; dual eligible 0.20, 0.19-0.21). Uninsured survivors were less likely to have all visit types, while those with Medicare were more likely. Those from the most socially deprived areas were more likely to have an outpatient visit (1.09, 1.03-1.14) and less likely to have a cancer-related visit with any provider (0.90, 0.88-0.92) or a cancer provider (0.93, 0.91-0.95). Survivors from non-metropolitan areas were more likely to have an outpatient visit (1.38, 1.22-1.56), cancer-related visit (1.22, 1.16-1.28), cancer-related visit with a cancer provider (1.45, 1.39-1.52), and a survivorship visit (1.34, 1.22-1.48). Survivors who have public insurance are more likely to have outpatient visits, and those with Medicaid or dual eligible status are less likely to have survivorship visits. Uninsured status is consistently associated with lack of engagement across the care continuum. Those from areas with higher social deprivation are more likely to have outpatient visits, but less likely to have a cancer-related visit with or without a cancer provider. Survivors from non-metropolitan areas are more likely to engage in all visit types along the care continuum.

Breast Cancer Survivors' Satisfaction and Information Recall of Telehealth Survivorship Care Plan Appointments During the COVID-19 Pandemic.

To examine patient satisfaction and information recall after telehealth breast cancer survivorship visits with a nurse practitioner. Female survivors of breast cancer after their first visit with a nurse practitioner in the outpatient survivorship clinic post-treatment. Participants included female survivors who were originally diagnosed with stage 0-III breast cancer and have since completed an initial telehealth appointment to review the survivorship care plan. Survivors were invited to complete a 20-question electronic survey about their satisfaction and recall of visit information. 62 participants completed the survey and indicated an overall high level of satisfaction with telehealth survivorship appointments. Most recalled key survivorship information from the visit and felt the appropriate amount of information was discussed. Overall satisfaction was significantly correlated with the length and convenience of the appointment, and the personal manner and technical skills of the nurse practitioner. Survivors' age was not associated with significant differences in overall satisfaction. Telehealth for initial survivorship visits demonstrated high satisfaction with telehealth and the overall visit as a low-cost intervention to treat symptoms.

Sleepless and Spent in Survivorship: Fatigue and Insomnia in Breast Cancer Survivors.

It is estimated that there are 3.8 million breast cancer survivors in the United States. Addressing survivors' post-treatment needs is critical to providing quality healthcare. A standardized questionnaire for breast cancer survivors was employed to assess the health status, challenges, and concerns of our breast cancer patients at their survivorship visits, which were conducted 4months after surgery. All patients were seen in the breast center at one community hospital over a 6-year period. Responses to a standardized questionnaire that was administered to 505 consecutive breast cancer patients at their survivorship visits 4months after surgery were evaluated. The most striking finding was that 35% reported symptoms of insomnia, 26% had persistent fatigue, and 19% experienced fatigue that interfered with their usual activities. There was a significant association between symptoms of insomnia and radiation treatment (P = .004), pain (P < .001), hormone therapy (P < .01), and side effects of hormone therapy (P < .0001). There was also a significant association between fatigue and pain (P < .001) as well as side effects from hormone treatment (P = .0036). Over a third (35%) of breast cancer patients suffer from insomnia, while over a quarter (26%) complain of fatigue at their survivorship assessments. Contributing factors include radiation treatment, pain, and hormonal therapy. Careful assessment and treatment of fatigue and symptoms of insomnia in breast cancer patients is needed to improve quality of life for survivors.

Implementing survivorship care planning in two contrasting health systems: lessons learned from a randomized controlled trial.

Survivorship care plans (SCPs) are recommended to promote appropriate follow-up care, but implementation has been limited. We conducted a randomized controlled trial comparing three SCP delivery models in two health systems. We utilize mixed methods to compare the feasibility and participants' perceived value of the three models. Patients completing treatment for stage I-III breast, prostate, or colorectal cancer from one urban-academic and one rural community cancer center were randomized to (1) mailed SCP, (2) SCP delivered during an in-person survivorship visit, or (3) SCP delivered during an in-person survivorship visit plus 6-month follow-up. Clinics had flexibility in intervention implementation. Quantitative data summarize intervention fidelity and protocol deviations. Qualitative interview data provide patients' perspectives on feasibility and intervention value. Of 475 eligible participants approached, 378 (79%) were randomized. Of 345 SCPs delivered, 265 (76.8%) were by protocol. Protocol deviations were more common at the urban-academic center. In post-study qualitative interviews, participants recalled little about the SCP document or visit(s). SCPs were valued for information and care coordination, although their static nature was limiting, and sometimes SCP information differed from that provided elsewhere. Visits were opportunities for care and reassurance, but time and distance to the clinic were barriers. SCP provision was challenging. Patients were interested in SCP, but not necessarily additional survivorship visits, particularly at the urban-academic hospital. These findings suggest that patients value careful consideration of health care needs during the transition out of treatment; SCP documents are one element of this. For many patients, models without additional visits and dynamic SCPs may be preferred.

Addressing cancer survivors’ cardiovascular health using the automated heart health assessment (AH-HA) EHR tool: Initial protocol and modifications to address COVID-19 challenges

BackgroundThe purpose of this paper is to describe the Automated Heart-Health Assessment (AH-HA) study protocol, which demonstrates an agile approach to cancer care delivery research. This study aims to assess the effect of a clinical decision support tool for cancer survivors on cardiovascular health (CVH) discussions, referrals, completed visits with primary care providers and cardiologists, and control of modifiable CVH factors and behaviors. The COVID-19 pandemic has caused widespread disruption to clinical trial accrual and operations. Studies conducted with potentially vulnerable populations, including cancer survivors, must shift towards virtual consent, data collection, and study visits to reduce risk for participants and study staff. Studies examining cancer care delivery innovations may also need to accommodate the increased use of virtual visits. Methods/designThis group-randomized, mixed methods study will recruit 600 cancer survivors from 12 National Cancer Institute Community Oncology Research Program (NCORP) practices. Survivors at intervention sites will use the AH-HA tool with their oncology provider; survivors at usual care sites will complete routine survivorship visits. Outcomes will be measured immediately after the study visit, with follow-up at 6 and 12 months. The study was amended during the COVID-19 pandemic to allow for virtual consent, data collection, and intervention options, with the goal of minimizing participant-staff in-person contact and accommodating virtual survivorship visits. ConclusionsChanges to the study protocol and procedures allow important cancer care delivery research to continue safely during the COVID-19 pandemic and give sites and survivors flexibility to conduct study activities in-person or remotely.

Prevalence and risk factors for vasomotor symptoms in Hispanic female breast cancer survivors, 0-3 years post-treatment: Results of a single-center retrospective analysis.

e24038 Background: Early detection and a growing complement of treatment options have led to improved survival among women with breast cancer in the U.S. Vasomotor symptoms (VMS) such as hot flashes and night sweats are among the most common side effects reported by breast cancer survivors (BCS) following treatment. These symptoms may affect quality of life and increase the risk of non-adherence to anti-hormonal therapies. Hispanics are one of the fastest growing ethnic populations in the U.S. However, research exploring whether Hispanic BCS report VMS at similar rates as their non-Hispanic counterparts remains an important gap in the science. The purpose of this study was to compare the prevalence and risk factors for VMS between Hispanic and non-Hispanic BCS following cancer treatment. Methods: Data for this single-center, retrospective study came from a database of self-reported symptom data collected at survivorship visits. Results: Over a 2.8-year period, 815 female BCS were evaluated for VMS (Hispanic: 63.0% (n=513) vs. Non-Hispanic: 37.0% (n = 302)). Mean age of the sample was 58.4 + 11.7 (range 24.2 - 91.8).Approximately four in ten (42.9%) BCS reported VMS at their initial survivorship visit, 0-3 years post-treatment. Results found virtually no difference in VMS prevalence between Hispanic and non-Hispanic BCS, (42.5% vs 43.7%, p = 0.735). BCS who reported VMS after treatment were 6.5 years younger, on average, than BCS who did not report VMS (54.7 ±11.0 vs. 61.2 ±11.3, p &lt; 0.001). Multivariate logistic regression models using age, race, stage of cancer, chemotherapy, radiation and hormone therapy as predictors showed that only age was associated with reporting VMS. For every one-year increase in age, the odds of reporting VMS fell by approximately 5.3% (OR: 0.947, 95% CI: 0.933-0.963, p &lt; 0.0001). Conclusions: Results found no difference in VMS prevalence between Hispanic and non-Hispanic BCS. VMS were reported by over 40 % of BCS in the study. In addition, symptoms were more prevalent in younger BCS. Given the potential impact of VMS on quality of life and mediation adherence, studies validating these findings as well as exploring the prevalence and risk factors for VMS in Hispanic BCS from distinct nationalities and cultures are needed.

Predictors of receiving survivorship care plans and visits.

12055 Background: While the Commission on Cancer has eliminated strict quotas for accreditation, Survivorship Care Plans (SCPs) and/or Survivorship Care Visits (SCV) at treatment completion are encouraged. However, who receives a SCP or SCV, whether it impacts care, and impact of distress on care is unknown. We examined the provision of survivorship care at the Lifespan Cancer Institute (LCI) to determine (1) clinical and distress thermometer scores (DTS) association with SCPs and SCVs; (2) impact of SCV visits on specialty referrals, and (3) demographic and clinical predictors of receipt of SCP and SCV. Methods: We retrospectively reviewed EMR records on 1,960 patients at LCI between 2014-2017 for SCPs and SCVs and extracted demographics, treatment variables, and distress scores. We used T-test or Wilcoxon rank test and Chi-square tests for evaluating the bivariate associations of SCP and SCV with continuous and categorical factors respectively. We fit logistic regression models to assess the adjusted effect of these factors on receipt of SCP and SCV independently. All analyses were performed in R v4.0.2. Results: The mean age was 63.9 (SD=11.8), 67% were female, 51.2% were married or partnered. Breast (38.8%), lung (17.6%), and prostate (13.7%) were the most common cancers. DTS were recorded in 64% with mean of 3.88(SD=3.05): distress was higher in women (4.36, SD=3.01), breast cancer pts (4.53, SD=3.07), gyn (4.22, SD=3.07), pancreatic (4.12, SD=3.41) and anal cancers (4.52, SD=3.47) and in those with Stage IV disease (5.33, SD=3.43). SCPs were completed in 740 (37.8%) patients and of those 65.9% had a SCV. SCV were associated with more specialty referrals for psychiatry, physical therapy, nutrition, and sexual health but not smoking cessation or fiscal services. DTS were associated with increased referral to psychiatry only. The adjusted models (table) showed odds of receiving a SCP were higher in those younger, and having breast cancer v all other cancers, with prostate having lowest odds. For receipt of SCV, odds were higher in those younger, female, and having breast cancer, with prostate and lung having the lowest odds. Conclusions: Gender, age and type of cancer are significant predictors of receipt of SCP and SCV. SCP and SCV patterns may represent patient preferences, but practice patterns and unconscious biases may also play a part suggesting areas for further research and outreach.[Table: see text]

The Center for Trauma Survivorship: Addressing the great unmet need for posttrauma center care.

Returning patients to preinjury status is the goal of a trauma system. Trauma centers (TCs) provide inpatient care, but postdischarge treatment is fragmented with clinic follow-up rates of <30%. Posttraumatic stress disorder (PTSD) and depression are common, but few patients ever obtain necessary behavioral health services. We postulated that a multidisciplinary Center for Trauma Survivorship (CTS) providing comprehensive care would meet patient's needs, improve postdischarge compliance, deliver behavioral health, and decrease unplanned emergency department (ED) visits and readmissions. Focus groups of trauma survivors were conducted to identify issues following TC discharge. Center for Trauma Survivorship eligible patients are aged 18 to 80 years and have intensive care unit stay of >2 days or have a New Injury Severity Score of ≥16. Center for Trauma Survivorship visits were scheduled by a dedicated navigator and included physical and behavioral health care. Patients were screened for PTSD and depression. Patients screening positive were referred for behavioral health services. Patients were provided 24/7 access to the CTS team. Outcomes include compliance with appointments, mental health visits, unplanned ED visits, and readmissions in the year following discharge from the TC. Patients universally felt abandoned by the TC after discharge. Over 1 year, 107 patients had 386 CTS visits. Average time for each appointment was >1 hour. Center for Trauma Survivorship "no show" rate was 17%. Eighty-six percent screening positive for PTSD/depression successfully received behavioral health services. Postdischarge ED and hospital admissions were most often for infections or unrelated conditions. Emergency department utilization was significantly lower than a similarly injured group of patients 1 year before the inception of the CTS. A CTS fills the vast gaps in care following TC discharge leading to improved compliance with appointments and delivery of physical and behavioral health services. Center for Trauma Survivorship also appears to decrease ED visits in the year following discharge. To achieve optimal long-term recovery from injury, trauma care must continue long after patients leave the TC. Therapeutic, Level III.

Survivorship Data Coordinator: Successful Exemplar of a New Survivorship Care Plan Role.

Survivorship care and survivorship care plans have become integral components of comprehensive cancer care and national accreditation. An academic and community cancer network successfully pilot tested a new non-nursing role to support efficiency in case finding, staffing, and tracking patients throughout care delivery: the survivorship data coordinator (SDC). Key functions of the SDC role include abstracting data into survivorship care plans, scheduling survivorship visits, and tracking the number of completed survivorship care plans shared with patients. This pivotal role improved organizational processes and facilitated achievement of accreditation standards around survivorship care.

Application of Path-Goal and Transformational Leadership Theory to Improve Patient and Provider Satisfaction with APP-Led Survivorship Care: A Quality Improvement Initiative

Introduction A limited number of survivorship models have been implemented following theoretical frameworks to promote patient and provider satisfaction. The purpose of this quality improvement (QI) initiative was to evaluate both parties' satisfaction with a newly implemented advanced practice provider (APP) led survivorship visit and apply theoretical principles of Path-Goal (PG) and Transformational Leadership (TL) to enhance outcomes. Methods We surveyed a convenience sample (n = 11) of adult cancer survivors ages 36-75 undergoing survivorship visits at day 100 (n = 5) and at 1 year (n = 6) post stem cell transplant (SCT) and APP's (n = 7) conducting the visits following an interrupted QI design. Satisfaction scores were obtained from both parties using a modified version of the validated Short Assessment of Patient Satisfaction (SAPS). Scores of > 19 were considered satisfying. Additionally, 10-point Likert scales, binary, and open-ended questions were used to assess satisfaction, self-management, and survivorship care plan (SCP) utility. We analyzed the data using descriptive statistics, reporting median scores and percentages for the most common results. For open-ended questions, qualitative analysis was used to identify themes. Results We found patients were satisfied with the visit (median SAPS 25, range 19-28). Additionally, 100% were very satisfied with the effect of their care, found the SCP useful and reported improved post-visit self-efficacy. Conversely, providers were overall dissatisfied (median SAPS 14, range 6-19). Only 28% were satisfied with care they provided and 42% were dissatisfied with their plans. We also found 42% of providers and 23% of patients were dissatisfied with explanations about post-SCT risks. Furthermore, 29% of providers and 36% of patients were dissatisfied with care planning decisions. Conclusion Our APP-led survivorship model was satisfying for patients. However, provider satisfaction was low. Both parties expressed dissatisfaction with education about post-SCT risks and decisions affecting care planning. Results of a theory based provider intervention to enhance satisfaction will be presented at the 2019 Transplant and Cellular Therapies Meeting in February 2019.

Advanced Practice Providers and Survivorship Care: They Can Deliver.

As the number of cancer survivors grows, new models of survivorship care are being implemented, but there is limited evaluation to date. This retrospective review assesses the concordance of care provided to adult-onset cancer survivors by advanced practice providers (nurse practitioners and physician assistants) with Institute of Medicine guidelines for survivorship care. Records from three survivorship clinics at a single institution were reviewed for frequency of recurrence surveillance, screening for second cancers, symptom management (physical, psychological), health promotion education (alcohol, tobacco, cholesterol, and bone density screenings; diet/exercise discussion), care coordination, and provision of care plan. Data were characterized using descriptive statistics. Over 2 years, 9,052 unique survivorship visits occurred; 210 breast, 208 prostate, and 204 colorectal visits were randomly selected for review. All patients with breast cancer underwent surveillance for recurrence; 99% were screened for new cancers. Discussion of health promotion activities ranged from 83% to 100%; 91% of patients were reviewed for physical symptoms, and 93% were reviewed for psychological symptoms. All patients with prostate cancer underwent recurrence surveillance; 97% were screened for new primaries. Health promotion activities ranged from 70% to 97%, and symptoms were discussed in 89% of visits. All patients with colorectal cancer underwent a surveillance colonoscopy for recurrence; 97% had a carcinoembryonic antigen test. Among women, 97% had mammograms, and 96% had a Papanicolaou test; 83% of men had a prostate-specific antigen test. Health promotion activities ranged from 69% to 100%, and symptoms were discussed in 93% to 97% of visits. Findings suggest that advanced practice providers can provide survivorship care in accordance with Institute of Medicine standards, which provide a normative standard. This assessment is an important step in evaluating survivorship outcomes.

Health after cancer: Early patient experience in a pilot survivorship clinic embedded in primary care.

180 Background: Prior research has identified barriers to provision of quality survivorship care in primary care settings such as lack of expert knowledge and training, primary care burden and insufficient communication with oncologists. We implemented a survivorship clinic at an academic medical center in the primary care division with the goal of defining the elements required for a seamless transition and co-management. Methods: The primary care physician received training in cancer survivorship based on the ASCO Curriculum, shadowing of 3 breast medical oncologists and 1 gynecologic oncologist, attendance at the 2018 Cancer Survivorship Symposium and NCCN’s Cancer Survivorship Advocacy Meeting. Patients with breast and gynecologic cancers were referred by their oncologists or APP (PA or NP) at various points in their cancer trajectory. Clinical characteristics of patients were abstracted from the electronic medical record and in-depth interviews were conducted with 2 patients. Results: 41 patients attended the survivorship clinic. The majority (88%) were breast (63%) or gynecologic (24%) cancer survivors. Patient age was evenly distributed with 8 age &lt; 46, 11 age 46-59, and 7 age &gt; = 60. 23 (56%) patients had stage &lt; 3 at diagnosis. 21 (51%) had been cancer-free for five years + and 4 were referred by their oncologist to help with patient co-management during cancer treatment. Of the 8 breast cancer patients &lt; 46 years old, 6 had a genetic mutation and 7 were interested in fertility. 15/26 breast cancer patients are currently on endocrine therapy. Interviewed patients expressed appreciation for receiving whole-person care and knowing there is bidirectional communication between clinicians. Conclusions: Cancer survivors are open to and interested in a survivorship visit based in a primary care clinic; this includes both patients who have been cancer-free &gt; 5 years as well as those recently treated with curative intent. Greater efforts are needed to train primary care physicians to deliver survivorship visits that are customized to meet the needs of cancer survivors.

Survivorship care visits in a high-risk population of breast cancer survivors.

Breast cancer survivors face numerous challenges after diagnosis and treatment. Several models have been developed to attempt to improve quality of care. Here, we describe characteristics and outcomes of patients who participated in survivorship visits (SV) at Johns Hopkins (JH). We retrospectively reviewed charts of breast cancer patients who participated in an optional SV 1-3months after completing locoregional therapy and initial systemic therapy. We report patient demographics, comorbidities, tumor characteristics, treatments, and responses to symptom questionnaires. We compared the characteristics of SV participants to stage I-III analytical cases in the 2010-2015 JH Cancer Registry (JHCR). We identified 87 women with stage I-III breast cancer who participated in SVs from 2010 to 2016. Compared to patients in the JHCR (n = 2942), SV participants were younger, more likely to be African American and more likely to have a higher TNM stage, hormone receptor-negative disease, and HER2-positive disease. They were more likely to have received chemotherapy and radiation therapy. They also have similar recurrence rates despite the SV cohort's shorter median follow-up time. Among SV participants, the prevalence of comorbidities including peripheral neuropathy, anemia, lymphedema, anxiety, deep vein thrombosis, and depression increased significantly from time of diagnosis to most recent follow-up. Compared to the JHCR cohort, SV participants had higher risk cancers and a high frequency of comorbidities potentially associated with breast cancer and therapy. These high-risk patients may benefit most from specific interventions targeting survivorship care, and their experiences may help improve care delivery models.

Cancer survivorship care plans time and effort.

146 Background: The Lifespan Cancer Institute (LCI) is one program based at three hospitals in the Lifespan healthcare system, a main teaching affiliate of Brown Medical School. All sites are ASCO QOPI certified. In 2017, 1,742 patients from radiation, surgical, and medical oncology were diagnosed and/or treated for cancer. The Commission on Cancer guidelines specify patients with a new diagnosis of cancer treated with curative intent receive a survivorship care plan (SCP) within one year of diagnosis extended to 18 months for those receiving hormone therapy. Methods: The LCI Quality team is a multidisciplinary group comprised of nursing, leadership, physicians, midlevel providers, administrative assistants, and tumor registry staff. Our Quality Improvement Project for 2017 was generation and distribution of survivorship care plans to 50% of eligible patients. Our project underwent 5 plan/do/study/act cycles (PDSA). Prior to the intervention only 271 care plans were prepared and delivered for 2016 diagnoses. Results: For the total 2017 diagnoses, 843 eligible patients were treated within the LCI (medical and radiation oncology). Survivorship Care plans completed by midlevel providers were generated and distributed to 100% of LCI patients during January -April 2018 (244 in total), a 37% increase compared to the same timeframe, one year previous. The electronic medical record provides tools for SCP preparation including auto population of demographics and chemotherapy plan. Staging, radiation, and surgery are manually entered. On average, each SCP required 1 hour to complete for approximately 244 hours of midlevel provider time for January -April 2018. This abstract’s time and effort does not include the time for patient calls, survivorship visits or administrative monitoring. Conclusions: Survivorship care plans provide patients and primary care providers a summary of the treatment plan and recommendations for follow up/survivorship goals in transitions of care. Significant time and effort is required to generate an individual SCP therefore the goal should be to increase electronic efficiencies within the medical record, and focus on the clinically relevant patient population who are most likely to survive 5 years and be impacted by diagnosis and treatment.