Variations in recommended surveillance in colorectal cancer survivorship care plans.

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]

Download Full-text

Views of family physicians about survivorship care plans to provide breast cancer follow-up care: exploration of results from a randomized controlled trial

Current Oncology ◽

10.3747/co.22.2368 ◽

2015 ◽

Vol 22 (4) ◽

pp. 252 ◽

Cited By ~ 13

Author(s):

M.A. O'Brien ◽

E. Grunfeld ◽

J. Sussman ◽

G. Porter ◽

M. Hammond Mobilio

Keyword(s):

Breast Cancer ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Family Physicians ◽

Survivorship Care Plan ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Care Plans ◽

Randomized Controlled

Background The U.S. Institute of Medicine recommends that cancer patients receive survivorship care plans, but evaluations to date have found little evidence of the effectiveness of such plans. We conducted a qualitative follow-on study to a randomized controlled trial (rct) to understand the experiences of family physicians using survivorship care plans to support the follow-up of breast cancer patients.MethodsA subset of family physicians whose patients were enrolled in the parent rct in Ontario and Nova Scotia were eligible for this study. In interviews, the physicians discussed survivorship care plans (intervention) or usual discharge letters (control), and their confidence in providing follow-up cancer care.Results Of 123 eligible family physicians, 18 (10 intervention, 8 control) were interviewed. In general, physicians receiving a survivorship care plan found only the 1-page care record to be useful. Physicians who received only a discharge letter had variable views about the letter’s usefulness; several indicated that it lacked information about potential cancer- or treatment-related problems. Most physicians were comfortable providing care 3–5 years after diagnosis, but desired timely and informative communication with oncologists. Conclusions Although family physicians did not find extensive survivorship care plans useful, discharge letters might not be sufficiently comprehensive for follow-up breast cancer care. Effective strategies for two-way communication between family physicians and oncologists are still lacking.

Download Full-text

Survivorship and the chronic cancer patient: Patterns in treatment-related effects, follow-up care, and use of survivorship care plans

Cancer ◽

10.1002/cncr.30862 ◽

2017 ◽

Vol 123 (21) ◽

pp. 4268-4276 ◽

Cited By ~ 10

Author(s):

Melissa A. Frick ◽

Carolyn C. Vachani ◽

Christina Bach ◽

Margaret K. Hampshire ◽

Karen Arnold-Korzeniowski ◽

...

Keyword(s):

Cancer Patient ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Care Plans ◽

Follow Up Care

Download Full-text

Patient and Provider Preferences for Survivorship Care Plans

Journal of Oncology Practice ◽

10.1200/jop.2011.000401 ◽

2012 ◽

Vol 8 (4) ◽

pp. e80-e86 ◽

Cited By ~ 60

Author(s):

Deborah K. Mayer ◽

Adrian Gerstel ◽

Ashley N. Leak ◽

Sophia K. Smith

Keyword(s):

Care Coordination ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Care Plans ◽

Follow Up Care

If used alone, survivorship care plans are insufficient to ease the transition to follow-up care. Improved communication and care coordination are important for survivorship care that goes beyond what the plan might provide.

Download Full-text

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

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.77 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 77-77 ◽

Cited By ~ 1

Author(s):

Pamela Kim Washington ◽

Heather Tews ◽

Dan-Thanh Nguyen ◽

Leeina Wade ◽

Trang Phan ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Lessons Learned ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Breast Cancer Patients ◽

Kaiser Permanente ◽

Care Plans ◽

Follow Up Care

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

Download Full-text

Provision and Discussion of Survivorship Care Plans Among Cancer Survivors: Results of a Nationally Representative Survey of Oncologists and Primary Care Physicians

Journal of Clinical Oncology ◽

10.1200/jco.2013.51.7540 ◽

2014 ◽

Vol 32 (15) ◽

pp. 1578-1585 ◽

Cited By ~ 104

Author(s):

Danielle Blanch-Hartigan ◽

Laura P. Forsythe ◽

Catherine M. Alfano ◽

Tenbroeck Smith ◽

Larissa Nekhlyudov ◽

...

Keyword(s):

Cancer Survivors ◽

Primary Care Physicians ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Factors Associated ◽

Care Plans ◽

Follow Up Care ◽

Nationally Representative ◽

Survivorship Care Planning

Purpose Survivorship care planning should involve discussions between providers and cancer survivors to address survivors' needs and optimize adherence. We examined the frequency and factors associated with oncologists' and primary care physicians' (PCPs) reports of provision of written survivorship care plans (SCPs) and discussion of survivorship care recommendations with survivors. Methods A nationally representative sample of 1,130 oncologists and 1,020 PCPs was surveyed about survivorship care practices with survivors. Logistic regression models predicted multilevel factors associated with providing SCPs or discussing recommendations with survivors. Results Although a majority of oncologists (64%) reported always/almost always discussing survivorship care recommendations with survivors, fewer also discussed who survivors should see for cancer-related and other follow-up care (32%); fewer still also provided a written SCP to the survivor (< 5%). Survivorship care recommendations and provider responsibility were not regularly discussed by PCPs and survivors (12%). Oncologists who reported detailed training about late and long-term effects of cancer were more likely to provide written SCPs (odds ratio [OR], 1.73; 95% CI, 1.22 to 2.44) and discuss survivorship care planning with survivors (OR, 2.02; 95% CI, 1.51 to 2.70). PCPs who received SCPs from oncologists were 9× more likely (95% CI, 5.74 to 14.82) to report survivorship discussions with survivors. Conclusion A minority of both PCPs and oncologists reported consistently discussing and providing SCPs to cancer survivors. Training and knowledge specific to survivorship care and coordinated care between PCPs and oncologists were associated with increased survivorship discussions with survivors. These nationally representative data provide a useful benchmark to assess implementation of new efforts to improve the follow-up care of survivors.

Download Full-text

Patient Satisfaction With Breast and Colorectal Cancer Survivorship Care Plans

Clinical Journal of Oncology Nursing ◽

10.1188/13.cjon.17-03ap ◽

2013 ◽

Vol 17 (3) ◽

pp. 266-272 ◽

Cited By ~ 22

Author(s):

Brian L. Sprague ◽

Kim L. Dittus ◽

Claire M. Pace ◽

Dorothy Dulko ◽

Lori A. Pollack ◽

...

Keyword(s):

Colorectal Cancer ◽

Patient Satisfaction ◽

Cancer Survivorship ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Care Plans

Download Full-text

Who is receiving survivorship care plans? Findings from the 2012 Livestrong survey.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9608 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9608-9608

Author(s):

Ruth Rechis ◽

Carla Bann ◽

Stephanie Nutt ◽

Linda Squiers ◽

Naveen Rao

Keyword(s):

Medical Center ◽

Care Plan ◽

Cancer Center ◽

Survivorship Care Plans ◽

Institute Of Medicine ◽

Survivorship Care ◽

Long Term Effects ◽

Care Plans ◽

Key Stakeholders

9608 Background: There are more than 14 million cancer survivors in the US – a number that is on the rise. Care coordination resources will be essential to provide support to this growing population. Key stakeholders, including the Commission on Cancer (CoC) and the Institute of Medicine, have proposed survivorship care plans (SCPs) as a way to extend support. However, limited research has been conducted to date on SCPs. Methods: In 2012, the LIVESTRONG Foundation (LIVESTRONG) administered a survey to understand the role of a treatment summary (TS) and SCPs and how they fit into survivors’ care. Logistic regression models were conducted to identify factors associated with receiving SCPs or TS. Results: 5,303 survivors responded to these questions (Table). While 92% of these respondents received information about where to return to for cancer check-ups, only 51% reported receiving a TS and 17% reported receiving a SCP. Survivors who were more likely to receive SCPs if they had a navigator (p<.001) and if they were male, Black, had finished treatment within the past year, or received care at a university-based medical center or community cancer center (p < 0.05). Also, those receiving a SCP were significantly more likely to have had a detailed discussion with a provider regarding long-term side effects, emotional needs, and lifestyle recommendations. Specifically, 60% of those with a SCP discussed long-term effects compared to 39% who did not. Conclusions: Results here indicate that few survivors receive SCPs but survivors reported benefits from receiving them. Currently many workflow barriers impede delivering SCPs, and LIVESTRONG is working with key stakeholders including the CoC to automate the LIVESTRONG Care Plan powered by Penn Medicine’s OncoLink through a registry and EMR system to understand how to address this issue. [Table: see text]

Download Full-text

Use of Survivorship Care Plans and Analysis of Patient-Reported Outcomes in Multinational Patients With Lung Cancer

Journal of Oncology Practice ◽

10.1200/jop.2015.008904 ◽

2016 ◽

Vol 12 (5) ◽

pp. e527-e535 ◽

Cited By ~ 4

Author(s):

Abigail T. Berman ◽

Cristina M. DeCesaris ◽

Charles B. Simone ◽

Carolyn Vachani ◽

Gloria DiLullo ◽

...

Keyword(s):

Lung Cancer ◽

Patient Reported Outcomes ◽

Primary Lung Cancer ◽

The United States ◽

Cancer Center ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Cognitive Changes ◽

Care Plans ◽

Patient Reported

Purpose: Lung cancer is the leading cause of cancer death and is a significant source of morbidity. Patient-reported outcomes (PROs) have been shown to be prognostic for survival. We have analyzed emerging patterns of longitudinal PROs collected in the development of survivorship care plans (SCPs). Methods: OncoLife and the LIVESTRONG Care Plans are Internet-based programs designed to generate unique SCPs. We selected SCPs from patients identifying as survivors of primary lung cancer. Patient-reported demographics and treatment and toxicity data were examined. Effects were categorized by the physiologic system that they affected. Results: Six hundred eighty-nine plans were created for users self-identifying as survivors of primary lung cancer. Average time from diagnosis to reporting was 1.68 years (range, 0 to 24 years). Most were white (85.9%), well educated (61.1% “some college” or higher), and lived in the United States (90.7%). Patients underwent chemotherapy (75.8%), radiotherapy (54.7%), and surgery (54.4%). Neurocognitive symptoms (eg, fatigue, cognitive changes) were the most common (48.8%), especially among those receiving chemotherapy, followed by musculoskeletal/dermatologic symptoms (14.1%) and thoracic symptoms (13.5%). Only 11.2% were initially offered an SCP. Of those offered SCPs, 54.5% were offered by their health care provider, and most often were at a non–university-based cancer center (66.2%). Conclusion: For patients with lung cancer worldwide, it is feasible to obtain PROs and to create SCPs through an Internet-based program. As patients with lung cancer achieve improved survival, further attention should be paid to PROs. Surprisingly, neurocognitive symptoms seem to be the most common issues and therefore the most important to address. Increased effort should be made to provide SCPs, particularly in urban and university cancer center settings.

Download Full-text