A new survivorship model for adolescents and young adults (AYA).

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 43-43
Author(s):  
Erin Marie Barthel ◽  
Sabrina Karim ◽  
Elizabeth Kiernan ◽  
Katherine Spencer ◽  
Rachel Murphy-Banks ◽  
...  
Keyword(s):  
Mental Health ◽  
Active Treatment ◽  
Hematologic Malignancy ◽  
Life Assessment ◽  
Survivorship Care ◽  
Active Therapy ◽  
Care Plans ◽  
Age Related ◽  
Lost To Follow Up

43 Background: The AYA population is a growing group of cancer survivors, currently exceeding 600,000 in the US, with 70,000 new diagnoses each year. These survivors experience deficits in general health, mental health, and functional status. Unfortunately, many are lost to follow-up after the completion of active therapy. They lack clarity about where to go for care and why such care is needed. To further complicate this, many have not established a primary care provider (PCP). Methods: We present a model of survivorship care tailored to the AYA population. Our clinic has dedicated physical space and is staffed by pediatric- and adult-trained oncologists. Survivors are paired with age-matched peer navigators to guide them through the logistics of follow-up care and assist with age- related transitions in education, housing, and insurance. Additionally, we have established a new model of survivorship care, introduced immediately at the end of active therapy, utilizing a staged curriculum, survivorship care plans, and point-of-care health-related quality of life assessment. Results: Fifty-five unique patients seen in 182 visits provided data for this report. The median age was 26 years (range 18-40). Twenty-nine (53%) of the patients were female. The majority of patients (58%) had been treated for a hematologic malignancy. One third of patients had completed college (31%). Most were employed (71%), but a majority still lived with their parents (64%). The majority of patients had more than one late effect (62%). Twenty-three (43%) reported mental health symptoms, including anxiety, mood swings, or sleep problems. Conclusions: A survivorship clinic with tailored programs for AYAs is feasible and necessary. In our sample, many AYA survivors have late effects and almost half reported psychosocial distress. Clinicians need to monitor this age group closely to ensure that patients are not lost to follow-up as they transition from active treatment to survivorship care and from pediatric to adult-based care. Our clinic provides an integrated medical home for the AYA survivor that continues to care for them when active treatment comes to completion and provides ongoing care coordination with PCPs and subspecialists to co-manage their complex health issues.

Use of survivorship care plans to re-engineer breast cancer follow-up.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 162-162
Author(s):  
Grace Makari-Judson ◽  
Sandra Hubbard ◽  
Tamara Wrenn
Keyword(s):  
Breast Cancer ◽  
Nurse Practitioners ◽  
Active Treatment ◽  
Wait Times ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans ◽  
Medical Oncologists ◽  
Before And After

162 Background: Use of survivorship care plans (SCPs) was recommended by the IOM in 2005, but benefits are a subject of ongoing debate. ASCO’s Cost of Cancer Care Task Force cited use of unnecessary imaging and tumor markers in breast cancer follow up amongst the “top five” list to improve quality. Communication with breast cancer survivors about guideline based post-treatment follow-up may be improved with SCPs, however few studies have addressed measurable outcomes. We describe use of SCPs to coordinate follow-up care in a multidisciplinary practice. Methods: In 2009, our breast surgeons, medical oncologists, and nurse practitioners agreed upon guidelines for follow up of breast cancer patients, developed a Survivorship Care Program to follow active treatment and implemented use of SCPs. Prior to 2009, follow up was partly determined at physician discretion and partly patient-driven, often with both medical and surgical providers seeing patients within short spans of time. To improve access to two part-time breast surgeons, guidelines were established to shift follow-up to medical oncologists and nurse practitioners. After diagnosis, patients were given comprehensive SCPs, which included recommended follow-up visits and testing. Wait times and numbers of new surgical patients were measured before and after use of SCPs. Results: Implementation of SCPs occurred during 2009; data from time periods two years before and after SCPs is listed below. Wait times were measured from call to first appointment. New patients included both benign and malignant breast disease. Conclusions: SCPs were useful in re-engineering follow-up habits of clinicians, adding value to each visit and gaining acceptance from established patients regarding recommended surveillance. Patients expressed that uncertainty experienced at the end of active treatment is mitigated by remaining in an environment that can be easily transitioned back to other clinical services. SCPs contributed to reduced wait times and increase in volume of new patients seen by breast surgeons. Future studies should assess contribution of SCPs to reducing unnecessary tests and improving compliance with ASCO guidelines. [Table: see text]

Survivorship care: Improving delivery of care plans for hematology patients at the Washington Cancer Institute (WCI).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6605-6605
Author(s):  
Hira Latif ◽  
Maya Beplat ◽  
Prabhjyot Singh ◽  
Asma Ali Dilawari
Keyword(s):  
Care Delivery ◽  
Hematologic Malignancy ◽  
Survivorship Care ◽  
Future Health ◽  
Waiting Room ◽  
Curative Intent ◽  
Delivery Of Care ◽  
Treatment Summaries ◽  
Care Plans ◽  
Tumor Types

6605 Background: Cancer and long-term sequalae of its treatment impact the future health and psychosocial wellness of these survivors. ASCO guidelines recommend providing survivorship care to cancer patients who have completed treatment with curative intent. The Commission on Cancer (COC) recommends that survivorship care including treatment summaries be delivered to 50% of eligible patients. In our ASCO Quality Training Program project, we aimed to achieve this COC goal of 50% for the year 2018. Methods: Baseline data collected from Jan 1, 2016 to June 30, 2018 indicated that 33% of hematologic malignancy survivors at WCI received treatment summaries and survivorship care. For the year 2018, there were 11 survivors of hematologic malignancy, and 4 of them (36%) had received survivorship care prior to initiation of the project. We surveyed 12 providers to obtain data for perceived challenges to deliver survivorship care. Large volume of patients, lack of resources, no standardized process and high no-show rates were identified as the most important barriers. A bi-monthly survivorship clinic run by hematology/oncology fellows was initiated in September 2018 to address some of these barriers. Patient referral forms were mounted in the clinic work rooms to assist providers with identifying patients that qualify for survivorship; a pathway for referrals to the survivorship clinic was created and providers were informed about the clinic. Information flyers regarding survivorship care and the clinic were placed in the waiting room to increase awareness amongst patients. Results: By November 30, 2018, 63% of hematological cancer survivors received survivorship care and treatment summaries. Compared to the average from the preceding two years, survivorship care delivery increased by 30%. Conclusions: Our institution was able to meet the COC requirement by delivering survivorship care to 63% of survivors of hematological malignancies through the intervention from this quality improvement study. We intend to extend this process to other tumor types to increase the delivery of consolidated survivorship care at the WCI.

Patient-reported survivorship care practices and late effects after treatment of Hodgkin (HL) and non-Hodgkin lymphoma (NHL).

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 119-119
Author(s):  
Melissa Frick ◽  
Carolyn Vachani ◽  
Margaret K. Hampshire ◽  
Christina Bach ◽  
Karen Arnold-Korzeniowski ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cognitive Change ◽  
Transitions Of Care ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Convenience Sample ◽  
Care Plans ◽  
Patient Reported ◽  
Care Practices

119 Background: Multimodal treatment of HL and NHL yields excellent outcomes, however, survivors are at risk for developing myriad late- and long-term effects (LLTEs). We describe survivorship care practices and LLTEs reported by HL/ NHL survivors. Methods: From a convenience sample of 964 HL (37%) and NHL (63%) cancer survivors using a publicly available Internet-based survivorship care plan (SCP) tool between 2011-2016, we examined cancer care and toxicity profile data. Results: Of all survivors, 67% were female and 84% were Caucasian; median age of diagnosis was 28y for HL and 49y for NHL survivors with median fu of 5y and 2y, respectively. 88% were free of cancer, 9% with recurrent or secondary malignancy, and 3% with metastatic disease. Chemotherapy was delivered to 89% of HL and 94% of NHL survivors, and radiation (RT) to 64% and 28%, respectively. Of those receiving RT, 96% (n = 217) HL and 61% (n = 106) NHL survivors received chest/mantle RT. Few reported receipt of previous SCP (13%) or treatment summary (4%). Most reported continued care from an oncologist (49%) or in combination with a PCP (19%). A shift to PCP management alone was observed, increasing from 2% of survivors if < 2y fu to 30% once ≥2y fu. Survivors who received chest RT reported: hyper- or hypothyroidism (35%), thyroid nodules (8%), speaking/swallowing changes (20%), heart disease (14%), pulmonary fibrosis/pneumonitis (12%), and skin cancers within the RT field (9%). 6 of 321 (2%) who received chest RT reported secondary breast cancers, compared to zero in the group not receiving chest RT with median time to breast cancer 20.5y (R 6-32 years). Receipt of chemotherapy was associated with: chronic fatigue (56%), cognitive change (56%), peripheral neuropathy (35%), sexual changes (15% of males, 35% of females), and heart disease (10%). Conclusions: While this population achieves excellent disease outcomes, survivors report a substantial burden of LLTEs, suboptimal delivery of survivorship information, and transitions of care in follow-up. Multiple opportunities thus exist through which SCPs may be used to improve awareness regarding survivorship/ LLTEs and communicate follow-up care plans between survivors and treatment teams.

Variations in recommended surveillance in colorectal cancer survivorship care plans.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 13-13
Author(s):  
Alaina Chodoff ◽  
Katherine Clegg Smith ◽  
Aishwarya Shukla ◽  
Amanda L. Blackford ◽  
Nita Ahuja ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Risk ◽  
Controlled Trial ◽  
Center Frequency ◽  
Cancer Center ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans ◽  
Follow Up Care

13 Background: Survivorship care plans (SCPs) outline pertinent information about a cancer survivor’s treatment and follow-up care. We describe the content of colorectal cancer (CRC) SCPs, completed as part of a randomized controlled trial of SCPs, and evaluate whether follow-up recommendations are guideline concordant. Methods: We analyzed 74 CRC SCPs from an academic and community cancer center. Frequency distributions and descriptive statistics were calculated for the entire cohort and separately by recruiting site. Follow-up recommendations were compared to American Cancer Society (ACS), American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines (Table). Results: Content routinely provided in SCPs (>80%) included patient demographics, cancer diagnosis, treatment details (surgery, chemotherapy, radiation therapy) as well as treatment-related side effects. SCP content specified less frequently included cancer stage, cancer risk (predisposing conditions), and recommendations for genetic counseling/testing and health promotion. Nearly all SCPs from the community site provided uniform, guideline-concordant follow-up. At the academic site, on average, more than 15 follow-up recommendations were listed for each surveillance modality, except colonoscopy. Among the SCPs that specified the frequency of follow-up care, the rate of guideline-concordant recommendations was 15/42 (36%) for follow-up visits, 29/43 (67%) for imaging, 12/45 (27%) for laboratory and 39/39 (100%) for colonoscopy. Conclusions: SCPs consistently provided information about CRC diagnosis and treatment, but often omitted information about cancer risk, staging and prognosis. There was considerable variation between cancer centers in the follow-up recommendations suggested for CRC survivors. Future work to improve the consistency of SCP follow-up recommendations with guidelines may be needed. Clinical trial information: NCT03035773 . [Table: see text]

Effects of Survivorship Care Plans on patient reported outcomes in ovarian cancer during 2-year follow-up – The ROGY care trial

2017 ◽  
Vol 145 (2) ◽  
pp. 319-328 ◽  
Author(s):  
Belle H. de Rooij ◽  
Nicole P.M. Ezendam ◽  
Kim A.H. Nicolaije ◽  
M. Caroline Vos ◽  
Johanna M.A. Pijnenborg ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Patient Reported Outcomes ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans ◽  
Patient Reported

scholarly journals Exploring Interactive Survivorship Care Plans to Support Breast Cancer Survivors: Protocol for a Randomized Controlled Trial

10.2196/23414 ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. e23414
Author(s):  
Akshat Kapoor ◽  
Priya Nambisan
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Self Management ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Breast Cancer Survivorship ◽  
Care Plans ◽  
The Impact

Background Breast cancer is the most common form of cancer among American women, accounting for 23% of all cancer survivors nationally. Yet, the availability of adequate resources and tools for supporting breast cancer survivors has not kept up with the rapid advancement in treatment options, resulting in unmet supportive care needs, particularly among low-income and minority populations. This study explores an alternative means of delivering breast cancer survivorship care plans (SCPs), with the aim of improving survivor morbidity, patient knowledge, and self-management of treatment-related symptoms, as well as addressing inconsistencies in follow-up care visits. Objective The overall goal of this study is to improve the uptake of SCP recommendations via an educational intervention for breast cancer survivors, to improve treatment-related morbidity, patient knowledge, self-management, and adherence to follow-up visits. The specific aims of the study are to (1) evaluate the feasibility of the online SCP, and (2) assess the impact of the online SCP on survivorship outcomes. Methods We will enroll 50 breast cancer survivors who have completed initial breast cancer treatment into a 2-armed, randomized, waitlist-controlled pilot trial, and collect data at baseline and 6 months. For the first aim, we will use mixed methods, including surveys and personal interviews among the intervention group, to determine the feasibility of providing an online, interactive SCP (called ACESO) based on the survivors’ online user experience and their short-term adoption. For the secondary aim, we will compare the 2 groups to assess the primary outcomes of survivor knowledge, self-efficacy for self-management, perceived peer support, and adherence to SCP-recommended posttreatment follow-up visits to oncology and primary care; and the secondary outcomes of treatment-related morbidity (body weight, fatigue, depression, anxiety, sexual function, distress, and sleep quality). We assess these outcomes by using measurements from validated instruments with robust psychometric properties. Results We have developed and refined the online breast cancer survivorship plan, ACESO, with consultation from breast cancer oncologists, nurses, and survivors. Approval for the study protocol has been obtained from the Institutional Review Board. An advisory board has also been established to provide oversight and recommendations on the conduct of the study. The study will be completed over a period of 2 years. Conclusions The results of this pilot study will inform the feasibility and design of a larger-scale pragmatic trial to evaluate the impact of an online breast cancer SCP on treatment-related morbidity and self-efficacy for self-management. International Registered Report Identifier (IRRID) PRR1-10.2196/23414

scholarly journals Integration of survivorship care plans into standard care: A quality improvement project.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 70-70
Author(s):  
Patricia Deslauriers ◽  
Shanmuga Subbiah ◽  
Jane M. Fall-Dickson
Keyword(s):  
Quality Of Life ◽  
Standard Care ◽  
Patient Knowledge ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Improvement Project ◽  
Care Plans ◽  
Sf 36

70 Background: American College of Surgeons’ Commission on Cancer accredited programs are required to provide Survivorship Care Plans (SCPs) to cancer survivors after initial cancer treatment. A critical need exists to evaluate SCP patient outcomes. The primary purpose of this quality improvement project was to integrate SCP into standard care for adult stage I, II, and III breast and colon cancer patients. Secondary aims were to examine the hypothesis that the SCP will improve participants’ knowledge base regarding their cancer, health promotion and disease prevention, satisfaction with delivery of health care, quality of life, and adherence to follow-up and surveillance testing. Methods: The IRB approved study was conducted at a hospital-based Medical Oncology Clinic (MOC) in the Western US. A pre/post design was used. Sociodemographic, Medical Outcomes Study Form-36 (MOS-SF-36), Patient Satisfaction Questionnaire Short Form-PSQ-18 (PSQ-SF-18), and Patient Knowledge of Disease Questionnaire (PKDQ) data were collected pre/post SCP. At the follow-up visit, MOS-SF-36, PSQ-SF-18, PKDQ, and open-ended evaluative questionnaire (OEEQ) data were collected. Results: Forty-two subjects were enrolled. The sample is primarily female (n = 36; 86%), Caucasian (n = 41; 97.6%), Hispanic (n = 36; 85.7%), non-high school graduates (n = 26; 61%), and unemployed/retired (n = 32; 78%). Annual incomes were primarily less than $20K (n = 32; 78%). Paticipants were post-treatment for breast cancer (n = 36) or colon cancer (n = 6). 100% of the participants returned for follow-up visits with only 2 (4.8%) delayed. There were significant increases in knowledge (p < 0.001). There were no statistically significant changes in the MOS-SF-36 ant the PSQ-SF-18. Themes in the OEEQ captured satisfaction with the provision of the SCP, changes in health promotion and disease prevention habits. Conclusions: This pilot study supports the hypothesis that SCPs improve adherence to follow-up and patient knowledge, especially in a unique setting of a low socio-economic, ethnically diverse population. A larger study is needed to show statistically significant improvements in health-related quality of life and satisfaction with delivery of health care.

The views of bowel cancer survivors and health care professionals regarding survivorship care plans and post treatment follow up

2009 ◽  
Vol 3 (2) ◽  
pp. 99-108 ◽  
Author(s):  
Carl Baravelli ◽  
Meinir Krishnasamy ◽  
Carmel Pezaro ◽  
Penelope Schofield ◽  
Kerryann Lotfi-Jam ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Survivors ◽  
Health Care Professionals ◽  
Bowel Cancer ◽  
Post Treatment ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans

Barriers in providing breast and colorectal cancer survivorship care: Perceptions of U.S. primary care physicians (PCPs) and medical oncologists (MOs).

2011 ◽  
Vol 29 (18_suppl) ◽  
pp. CRA9006-CRA9006 ◽  
Author(s):  
K. S. Virgo ◽  
C. C. Lerro ◽  
C. N. Klabunde ◽  
C. Earle ◽  
P. A. Ganz
Keyword(s):  
Colorectal Cancer ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Preventive Care ◽  
Regression Models ◽  
Preventive Health Care ◽  
Physician Attitudes ◽  
Survivorship Care ◽  
Care Plans

CRA9006 Background: Increased coordination among clinicians in cancer survivorship care is needed yet the literature suggests barriers remain due to a fragmented healthcare system. This is the first nationwide study of barriers PCPs and MOs perceive regarding breast and colorectal cancer survivorship care. Methods: The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) was mailed to a nationally representative stratified sample (N=5,275) of eligible American Medical Association member PCPs and MOs (N=3,596) providing care to cancer survivors, to permit comparisons of views regarding follow-up testing, roles, knowledge self-confidence, and perceived barriers. We analyzed physician-based barriers using weighted multinomial logistic regression models adjusted for physician demographics, reimbursement, training, and practice characteristics. Results: 2,202 physicians (1,072 PCPs and 1,130 MOs) responded (57.6% response rate; 65.1% cooperation rate). In weighted univariate analyses, PCPs were significantly more likely to report often/always ordering tests or treatments as malpractice protection, being concerned about missed care, and lacking adequate training to manage patient problems. MOs were more likely to report (often/always and sometimes) concerns about duplicated care and about which physician provides general preventive health care. In multivariate regression models, physician specialty remained significant for 3 of 5 physician-based barriers. MOs were less likely to report inadequate training (OR: 0.33, 95% CI: 0.22-0.49), less likely to often/always order extra tests due to malpractice concerns (OR: 0.53, 95% CI: 0.34-0.84), and more likely to report being often/always (OR: 1.97, 95% CI: 1.13-3.43) and sometimes (OR: 2.16, 95% CI: 1.60-2.93) uncertain who is providing general preventive care, compared to PCPs. Conclusions: MOs perceived different physician-based barriers as problematic in cancer follow-up care compared to PCPs. Alleviation of inadequate training, malpractice-driven test ordering, and preventive care delivery barriers may require education and provision of survivorship care plans.

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