Summing it up: an integrative review of studies of cancer survivorship care plans (2006-2013)

Building Personalized Cancer Follow-up Care Pathways in the United States: Lessons Learned From Implementation in England, Northern Ireland, and Australia

There is a global need to transform cancer follow-up care to address the needs of cancer survivors while efficiently using the health care system to limit the effects of provider shortages, gaps in provider knowledge, and already overburdened clinics; improve the mental health of clinicians; and limit costs to health care systems and patients. England, Northern Ireland, and Australia are implementing an approach that triages patients to personalized follow-up care pathways depending on the types and levels of resources needed for patients' long-term care that has been shown to meet patients' needs, more efficiently use the health care system, and reduce costs. This article discusses lessons learned from these implementation efforts, identifying the necessary components of these care models and barriers and facilitators to implementation of this care. Specifically, the United States and other countries looking to transform follow-up care should consider how to develop six key principles of this care: algorithms to triage patients to pathways; methods to assess patient issues to guide care; remote monitoring systems; methods to support patients in self-management; ways to coordinate care and information exchange between oncology, primary care, specialists, and patients; and methods to engage all stakeholders and secure their ongoing buy-in. Next steps to advance this work in the United States are discussed.

Impact of lymphoma survivorship clinic visit on patient-centered outcomes

PURPOSE

Cancer survivors may experience physical, social, and emotional effects of cancer and its treatments. National Comprehensive Cancer Network (NCCN) guidelines recommend the development of a survivorship care plan (SCP) for cancer patients following completion of treatment with curative intent. Our institution developed a lymphoma survivorship clinic (SC) to assess patient needs, provide education, and create and deliver SCPs. This study analyzed the impact of a SC visit on patient-centered outcomes.

METHODS

Surveys were sent to lymphoma patients at Mayo Clinic Rochester within 4 weeks of their post-treatment visit to the SC that queried patient-reported outcomes, including experience of care, quality of life (QOL), and distress. We compared survey responses between those who attended the SC and those who were eligible but did not attend.

RESULTS

From November 2013 to May 2015, 236 lymphoma patients were surveyed, 96 of whom had a SC visit and 140 of who were eligible but did not attend. Those who attended the SC were more likely to "definitely" recall discussion on improving health, preventing illness, and making changes in habits/lifestyle, diet, and exercise. There were no differences in QOL or distress. Adjusted analyses revealed that SC attendance was associated with better self-reported overall health among younger patients and better physical well-being in Hodgkin lymphoma patients compared to those with other subtypes of lymphoma.

CONCLUSIONS

Participation in the lymphoma SC improved patient education on survivorship issues, particularly health behaviors. There may be a particular benefit in younger patients. However, there were no differences in QOL or distress. Further study is needed to determine if improved survivorship education and SCP delivery leads to long-term health benefits in cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Our study evaluates the clinical impact of a SC in patients treated for lymphoma. We demonstrate that a SC visit improves patient education regarding health behaviors.

Transition to survivorship: can there be improvement?

PURPOSE OF REVIEW

The transition from primary cancer treatment to posttreatment follow-up care is seen as critical to the long-term health of survivors. However, relatively little attention has been paid to understanding this pivotal period. This review will offer a brief outline of the significant work surrounding this pivotal time published in the past year.

RECENT FINDINGS

The growing number of cancer survivors has stimulated an emphasis on finding new models of care, whereby responsibility for survivorship follow-up is transitioned to primary care providers. A variety of models and tools have emerged for follow-up care. Survivorship care plans are heralded as a key component of survivorship care and a vehicle for supporting transition. Uptake of survivorship care plans and implementation of evidence-based models of survivorship care has been slow, hindered by a range of barriers.

SUMMARY

Evaluation is needed regarding survivorship models in terms of feasibility, survivor friendliness, cost effectiveness, and achievement of sustainable outcomes. How, and when, to introduce plans for transition to the patient and determine transition readiness are important considerations but need to be informed by evidence. Additional study is needed to identify best practice for the introduction and application of survivorship care plans.

Survivorship care plan experiences among childhood acute lymphoblastic leukemia patients and their families

BACKGROUND

As survivorship care plan (SCP) use among childhood cancer survivors and their families has not been extensively researched, we report on their experiences with receiving an SCP after the completion of therapy.

METHODS

Eligible patients had acute lymphoblastic leukemia, completed therapy, and had no evidence of disease at enrollment. Patients aged 7 or older (N = 13) and at least one parent (N = 23 for 20 total patients) were surveyed and completed assessments at enrollment (Time 1, T1), SCP delivery (Time 2, T2), and follow-up (Time 3, T3) (retention 90.9%). Surveys assessed the delivery process and SCP format. McNemar tests were used to assess change from T2-T3.

RESULTS

Satisfaction with the SCP was generally high among parents. At T1 the majority of parents (69.6%) thought the SCP should be delivered after treatment but by T3 most preferred the plan to be delivered before the end of treatment (60.9%). While 95.7% of parents intended to share their child's SCP with another provider, family, or school at T2, only 60.9% had done so by T3 (P < 0.01). At both T2 and T3, 100% of parents agreed that the SCP would help make decisions about their child's future health care. Most patients at T3 (83.3%) felt they had learned something new from their SCP.

CONCLUSIONS

Pediatric oncology patients and families feel SCPs are useful and will help them make decisions about health care in the future.

Determinants of quality prostate cancer survivorship care across the primary and specialty care interface: Lessons from the Veterans Health Administration

Background

With over 3 million US prostate cancer survivors, ensuring high‐quality, coordinated cancer survivorship care is important. However, implementation of recommended team‐based cancer care has lagged, and determinants of quality care across primary and specialty care remain unclear. Guided by the theoretical domains framework (TDF), we explored multidisciplinary determinants of quality survivorship care in an integrated delivery system.

Methods

We conducted semistructured interviews with primary (4) and specialty (7) care providers across 6 Veterans Health Administration clinic sites. Using template analysis, we coded interview transcripts into the TDF, mapping statements to specific constructs within each domain. We assessed whether each construct was perceived a barrier or facilitator, examining results for both primary care providers (PCPs) and prostate cancer specialists.

Results

Cancer specialists and PCPs identified 2 primary TDF domains impacting their prostate cancer survivorship care: Knowledge and Environmental context and resources. Both groups noted knowledge (about survivorship care) and procedural knowledge (about how to deliver survivorship care) as positive determinants or facilitators, whereas resources/material resources (to deliver survivorship care) was noted as a negative determinant or barrier to care. Additional domains more commonly referenced by cancer specialists included Social/professional role and identity and Goals, while PCPs reported the domain Beliefs about capabilities as relevant.

Conclusions

We used the TDF to identify several behavioral domains acting as determinants of high‐quality, team‐based prostate cancer survivorship care. These results can inform prostate cancer survivorship care plan content, and may guide tailored, multidisciplinary implementation strategies to improve survivorship care across the primary and specialty care interface.

Cancer Survivorship Care Plan Utilization and Impact on Clinical Decision-Making at Point-of-Care Visits with Primary Care: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health

Every cancer survivor and his/her primary care provider should receive an individualized survivorship care plan (SCP) following curative treatment. Little is known regarding point-of-care utilization at primary care visits. We assessed SCP utilization in the clinical context of primary care visits. Primary care physicians and advanced practice providers (APPs) who had seen survivors following provision of an SCP were identified. Eligible primary care physicians and APPs were sent an online survey, evaluating SCP utilization and influence on decision-making at the point-of-care, accompanied by copies of the survivor's SCP and the clinic note. Eighty-eight primary care physicians and APPs were surveyed November 2016, with 40 (45%) responding. Most respondents (60%) reported discussing cancer or related issues during the visit. Information needed included treatment (66%) and follow-up visits, and the cancer team was responsible for (58%) vs primary care (58%). Respondents acquired this information by asking the patient (79%), checking oncology notes (75%), the SCP (17%), or online resources (8%). Barriers to SCP use included being unaware of the SCP (73%), difficulty locating it (30%), and finding needed information faster via another mechanism (15%). Despite largely not using the SCP for the visit (90%), most respondents (61%) believed one would be quite or very helpful for future visits. Most primary care visits included discussion of cancer or cancer-related issues. SCPs may provide the information necessary to deliver optimal survivor care but efforts are needed to reduce barriers and design SCPs for primary care use.

Survivor and Clinician Assessment of Survivorship Care Plans for Hematopoietic Stem Cell Transplantation Patients: An Engineering, Primary Care, and Oncology Collaborative for Survivorship Health

The long-term care of hematopoietic stem cell transplantation (HSCT) survivors poses special challenges owing to a myriad of possible chronic and/or late complications. Survivorship care plans (SCPs) have been proposed as tools to communicate information on the late effects of treatment and recommended follow-up care to clinicians and survivors. The primary aims of this study were to determine SCP content and format, as well as to assess the preferred timing of SCP provision following HSCT. HSCT survivors and nontransplantation clinicians (oncologists and primary care physicians) were invited to participate in a survey evaluating the usefulness and utility of a sample HSCT-specific SCP with a treatment summary generated by autopopulation from an electronic health record (EHR). All participating HSCT survivors (n = 29) and clinicians (n = 18) indicated a desire to receive an SCP. More than 85% of the participants perceived information about treatments received, recommended follow-up and health maintenance including vaccinations, survivor and clinician resources, and graft-versus-host disease and other late/chronic side effects to be useful. The majority of survivors also believed that care team contact information was useful. In addition, >85% of survivors and clinicians agreed that the SCP increased their understanding of treatments and chronic/late side effects, improved health care provided, and were satisfied with the SCP and found it understandable and easy to use. The majority of survivors indicated that additional information should be added to the SCP, whereas some clinicians deemed the SCP too long. Survivors preferred to receive the SCP as a paper document at the end of a regular follow-up visit and review it with a cancer clinician, whereas clinicians preferred to receive the SCP through the EHR. These findings will help improve the design of future SCPs for use by HSCT survivors and clinicians. Future work will include leveraging the EHR to ease the burden of creating user-centered documents.

Adopting patient-centred tools in cancer care: role of evidence and other factors

Background

Randomized controlled trials (rcts) provide limited evidence to support the use of survivorship care plans (scps), but they provide strong evidence for patient decision aids (ptdas). Despite that evidence, the uptake of ptdas has been limited, but scps are being endorsed and implemented in many cancer programs across Canada. The objective of the present study was to illuminate the decision-making processes involved in the adoption of scps and ptdas.

Methods

Informed by the principles of grounded theory, in-depth semi-structured interviews were conducted with clinicians, managers, and administrators who work in cancer care programs across Canada (n = 21). Data were collected and analyzed concurrently, using a constant comparative analysis approach. Data collection ended when theoretical saturation was reached.

Results

For these types of patient-centred tools, participants noted that high-quality research evidence is often unnecessary for adoption decisions. Six key factors contribute to adoption or non-adoption decisions for scps and ptdas:■ Alignment of research evidence with other evidence■ Perceived clinician benefit■ Endorsement by organizations and professional bodies■ Existence of local champions■ Adaptability to local contexts■ Ability to routinize and reach a large patient population.

Conclusions

High-level evidence is not always the main consideration when adopting new tools into practice. And yet, understanding how clinicians and health system decision-makers decide whether and how to adopt new tools is important to optimizing the use of new tools and practices that are supported by research evidence.

Evaluation of a survivorship needs assessment planning tool for head and neck cancer survivor-caregiver dyads

PURPOSE

The objectives of this study were to test the acceptability and feasibility of a survivorship needs assessment planning (SNAP) tool for head and neck cancer (HNC) survivors and caregivers, evaluate short-term changes in psychosocial outcomes after completing the SNAP session, and develop strategies for system refinement.

METHODS

We used a prospective one-group design and mixed methods with HNC survivors and caregivers (N = 25 dyads). Participants completed baseline and 6-week surveys before and after completing a SNAP clinic visit to assess psychosocial outcomes and acceptability. Intervention sessions included tablet-based needs assessments driving tailored care plans. Dyads' open-ended feedback and clinician interviews (N = 12) evaluated acceptability and feasibility.

RESULTS

SNAP data collection time burden and technology challenges were minimal, and care plans included messages (M = 19), educational materials (M = 13), and referrals (M = 4.5; 86% behavioral medicine, 77% nutrition, 65% physical therapy). Participants reported high satisfaction with the session and care plan, highlighting the key strengths of pulling complex medical information together and the focus on caregiver well-being, with multiple suggestions to facilitate clinic workflow. Depression and unmet needs decreased and survivorship knowledge increased significantly in survivors and caregivers (p < .05) over the 6-week period.

CONCLUSIONS

The SNAP tool is an innovative technology-based survivor-centered strategy to assess and manage needs in HNC survivors and caregivers. Results support its acceptability and ability to address dyads' needs; the tool merits further testing in a clinical trial.

IMPLICATIONS FOR CANCER SURVIVORS

Technology-enabled care planning may be a productive way to assess and address HNC dyads' dynamic needs after treatment.

Do Breast Cancer Survivorship Care Plans Improve Health Outcomes?

Although they have been widely studied, important questions remain about the impact of breast cancer survivorship care plans on improving health outcomes. The goal of this article was to review published studies on the impact of cancer survivorship care plans on health outcomes and health care delivery among breast cancer survivors. A total of 111 article citations were identified in PubMed and non-duplicates in CINAHL. After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, 7 studies met the eligibility criteria. All of the studies had a randomized controlled design. Early trials of the efficacy of breast cancer survivorship care plans generally showed little or no improvement in health outcomes. The positive findings of recent studies suggest that survivorship care interventions that empower and activate patients to self-manage their follow-up care and improve patient-provider communication may be especially promising.

Survivorship care planning and implementation in neuro-oncology

Survivorship has become a significant topic within oncologic care. The tools and means by which the provision of survivorship care can be implemented and delivered are in development and are the focus of significant research oncology-wide. These tools and methods include innovations of survivorship care delivery, survivorship care plans, and improving communication among all stakeholders in an individual patient's care as the means to elevate health-related quality of life. The merits of these survivorship care provisions in the field of neuro-oncology and its patients' exigent need for more patient-centric care focused on living with their illness are discussed. Since 2014 there has been a mandate within the United States for adult cancer patients treated with curative intent to receive survivorship care plans, comprising a treatment summary and a follow-up plan, intended to facilitate patients' care after initial diagnosis and upfront treatment. Several cancer-specific survivorship care plans have been developed and endorsed by health care professional organizations and patient advocacy groups. A survivorship care plan specific for neuro-oncology has been collaboratively developed by a multidisciplinary and interprofessional committee; it is endorsed by the Society for Neuro-Oncology Guidelines Committee. It is available as open access for download from the Society for Neuro-Oncology website under "Resources": https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx. Survivorship care offers an opportunity to begin directly addressing the range of issues patients navigate throughout their illness trajectory, an oncology initiative to which neuro-oncology patients both need and deserve equitable access.

Survivorship care planning in gynecologic oncology-perspectives from patients, caregivers, and health care providers

Purpose

This qualitative study sought to describe the challenges following treatment and the preferences regarding survivorship care among patients treated for gynecological cancer, their caregivers, and health care providers.

Methods

Between July and August 2017, in-depth semi-structured interviews regarding survivorship were conducted at a large academic hospital in the USA among patients who recently completed treatment (< 12 months) for a gynecological cancer (ovarian, endometrial, cervical, and vulvar) and their primary caregivers. A focus group was conducted among health care providers (oncologists, nurses, and fellows). Main themes were identified using descriptive content analysis.

Results

A total of 30 individuals participated in this study (13 patients, 9 caregivers, 8 health care providers). Almost all participants reported a desire for more information on how to address survivorship needs, specifically as they related to side effects, follow-up schedule, and psychological assistance. Despite this uniformly identified need for more information, preferences for survivorship care planning differed across cancer types and individuals, with respect to content, timing, and mode of delivery. Health care providers expressed challenges in communicating with patients about survivorship, a desire to shift post-treatment conversations to the goal of improving quality of life as opposed to focusing on disease recurrence, and an unmet need for disease specific and individualized survivorship care planning.

Conclusions

Patients, caregivers, and health care providers each expressed a need for gynecologic cancer-tailored survivorship care resources.

Implications for Cancer Survivors

The variation of disease types and patient and caregiver needs may require multi-faceted, individualized survivorship care planning.

Electronic supplementary material

The online version of this article (10.1007/s11764-018-0713-9) contains supplementary material, which is available to authorized users.

What do primary care providers think about implementing breast cancer survivorship care?

Purpose

As cancer centres move forward with earlier discharge of stable survivors of early-stage breast cancer (bca) to primary care follow-up, it is important to address known knowledge and practice gaps among primary care providers (pcps). In the present qualitative descriptive study, we examined the practice context that influences implementation of existing clinical practice guidelines for providing such care. The purpose was to determine the challenges, strengths, and opportunities related to implementing comprehensive evidence-based bca survivorship care guidelines by pcps in southeastern Ontario.

Methods

Semi-structured interviews were conducted with 19 pcps: 10 physicians and 9 nurse practitioners.

Results

Thematic analysis revealed 6 themes within the broad categories of knowledge, attitudes, and resources. Participants highlighted 3 major challenges related to providing bca survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden. They also described 3 major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles.

Conclusions

We identified several important challenges to implementation of comprehensive evidence-based survivorship care for bca survivors, as well as several strengths and opportunities that could be built upon to address those challenges. Findings from our research could inform targeted knowledge translation interventions to provide support and education for pcps and bca survivors.

Development of the Cancer Survivor Profile-Breast Cancer (CSPro-BC) app: patient and nurse perspectives on a new navigation tool

PURPOSE

Despite advancements in care, cancer survivors continue to report unmet needs following active cancer treatment. The Cancer Survivor Profile-Breast Cancer (CSPro-BC) application (app) was developed to help address these needs, using breast cancer survivors (BCS) as a pilot group. This paper describes the app development, BCS and nurse perceptions of the app, and changes made based on this feedback.

METHODS

The CSPro-BC app was developed for use on an iPad and includes (1) administration of a 15-20-min survey assessing 18 needs, (2) generation of a profile of needs, relative to a reference group of BCS (median 2 years post-treatment), and (3) provision of problem-specific online resources. Perceptions of the app were evaluated using both quantitative and qualitative approaches. Feedback was elicited from nurse navigators and BCS. BCS were recruited until the point of saturation.

RESULTS

BCS (N = 11) were middle-aged and a median of 2.4 months post active treatment. Structured questionnaires indicated the following: survey covered meaningful problem areas, profile display was clear, and nurse's involvement was helpful. Follow-up interviews (2 weeks later) revealed that BCS shared their profile with others, but most BCS did not use the resources and those who did thought there were too many. Nurses (N = 3) said the app increased appointment time, but prompted them to discuss areas often not covered in typical BCS follow-up.

CONCLUSIONS

Feedback by end users directly informed revision of the app.

IMPLICATIONS FOR CANCER SURVIVORS

The CSPro-BC app has been optimized based on BCS feedback.

Alberta CancerBridges development of a care plan evaluation measure

Background

No standardized measures specifically assess cancer survivors' and healthcare providers' experience of Survivor Care Plans (scps). We sought to develop two care plan evaluation (cpe) measures, one for survivors (cpe-s) and one for healthcare providers (cpe-p), examine initial psychometric qualities in Alberta, and assess generalizability in Manitoba, Canada.

Methods

We developed the initial measures using convenience samples of breast (n = 35) and head and neck (n = 18) survivors who received scps at the end of active cancer-centre treatment. After assessing Alberta's scp concordance with Institute of Medicine (iom) recommendations using a published coding scheme, we examined psychometric qualities for the cpe-s and cpe-p. We examined generalizability in Manitoba, Canada, with colorectal survivors discharged to primary care providers for follow-up (n = 75).

Results

We demonstrated acceptable internal consistency for the cpe-s and cpe-p subscales and total score after eliminating one item per subscale for cpe-s, two for cpe-p, resulting in revised scales with four 7-item and 6-item subscales, respectively. Subscale scores correlated highly indicating that for each measure the total score may be the most reliable and valid. We provide initial cpe-s discriminant, convergent, and predictive validity using the total score. Using the Manitoba sample, initial psychometrics similarly indicated good generalizability across differences in tumour groups, scp, and location.

Conclusions

We recommend the revised cpe-s and cpe-p for further use and development. Studies documenting the creation and standardization of scp evaluations are few, and we recommend further development of patient experience measures to improve both clinical practice and the specificity of research questions.

Survivorship care plans have a negative impact on long-term quality of life and anxiety through more threatening illness perceptions in gynecological cancer patients: the ROGY care trial

Purpose

Prior results from the registration system oncological gynecology (ROGY) care trial showed that survivorship care plans (SCPs) increased threatening illness perceptions in gynecological cancer survivors, but it remained unclear whether this would result in poorer physical and psychosocial outcomes. The aim of the current study is to assess the direct and indirect effects of SCPs on health-related quality of life (HRQoL) and anxiety and depression, through illness perceptions.

Methods

Twelve hospitals in the South of the Netherlands were randomized to providing ‘SCP care’ or ‘usual care.’ Newly diagnosed endometrial and ovarian cancer patients completed questionnaires after initial treatment (endometrial, 221 [75%]; ovarian, 174 [71%]) and after 6, 12, and 24 months. SCPs were automatically generated after initial treatment by the oncology providers through the web-based ROGY. Illness perceptions were measured after initial treatment and HRQoL and anxiety and depression after 6, 12, and 24 months.

Results

Structural equation models showed that endometrial cancer patients who experienced more symptoms or concern due to the SCP reported worse social functioning (β = − 0.82; p = 0.01) and more fatigue, insomnia, pain, and anxiety (β = 0.58–0.86, p < 0.05) within 12 months after treatment. Ovarian cancer patients who had lower trust that the treatment would cure their disease due to the SCP reported worse emotional functioning 6 months after treatment (β = 0.27, p = 0.02).

Conclusions

Current results show that SCPs may have negative effects on HRQoL and anxiety in patients who experience more threatening illness perceptions due to the SCP. We should be aware of the potential negative consequences of SCPs.

Trial Registration clinicaltrials.gov Identifier: NCT01185626.

Patient-reported experiences on supportive care strategies following the introduction of the first Swedish national cancer strategy and in accordance with the new patient act

INTRODUCTION

Several supportive care strategies are described in Swedish legislation and policy documents, such as the National Cancer Strategy and the Patient act. No previous systematic evaluation from a patient perspective has been performed. The aim of this study was to evaluate how these supportive care strategies are experienced by patients treated for cancer in the Stockholm-Gotland region.

MATERIAL AND METHODS

In this cross-sectional study, we identified patients (diagnosed with gynaecological, haematological, upper gastrointestinal and head and neck cancer during 2014) from the Swedish Cancer Register. The European Organization of Research and Treatment of Cancer, EORTC, Quality of Life Questionnaires, QLQ-C30, Information QLQ-INFO25 and a study-specific questionnaire was used to collect data during follow-up after cancer treatment. We collected data on 869 cancer patients' perception of availability and access to supportive care strategies and how they were experienced.

RESULTS

Among the supportive care strategies suggested in the legislation and policy documents, just over half of the patients (n = 393, 53%) reported that they had access to a contact nurse, while 43% (n = 312) had received an individual written care plan and 16% (n= 137) had been referred to palliative care. Only 29% (n = 218) of the patients reported that they had received information about patient advocacy groups and 8% (n= 62) on medical second opinions from their cancer care team.

DISCUSSION

The supportive care strategies suggested in Swedish legislation and policy documents may be useful but are only available for some patients. The implementation goals for the National Cancer Strategy and the Swedish Patient act have not been reached.

Enhancing Survivorship Care Planning for Patients With Localized Prostate Cancer Using a Couple-Focused mHealth Symptom Self-Management Program: Protocol for a Feasibility Study

BACKGROUND

This project explores a new model of care that enhances survivorship care planning and promotes health for men with localized prostate cancer transitioning to posttreatment self-management. Survivorship care planning is important for patients with prostate cancer because of its high incidence rate in the United States, the frequent occurrence of treatment-related side effects, and reduced quality of life (QOL) for both men and their partners. A key component of comprehensive survivorship care planning is survivorship care plans (SCPs), documents that summarize cancer diagnosis, treatment, and plans for follow-up care. However, research concerning the effectiveness of SCPs on patient outcomes or health service use has thus far been inconclusive. SCPs that are tailored to individual patients' needs for information and care may improve effectiveness.

OBJECTIVE

This study aims to examine the feasibility of an enhanced survivorship care plan (ESCP) that integrates a symptom self-management mHealth program called Prostate Cancer Education and Resources for Couples (PERC) into the existing standardized SCP. The specific aims are to (1) examine the feasibility of delivering ESCPs and (2) to estimate the magnitude of benefit of ESCPs.

METHODS

We will use a two-group randomized controlled pretest-posttest design and collect data at baseline (T1) and 4 months later (T2) among 50 patients completing initial treatment for localized prostate cancer and their partners. First, we will assess the feasibility of ESCP by recruitment, enrollment, and retention rates; program satisfaction with the ESCP; and perceived ease of use of the ESCP. To achieve the secondary aim, we will compare the ESCP users with the standardized SCP users and assess their primary outcomes of QOL (overall, physical, emotional, and social QOL); secondary outcomes (reduction in negative appraisals and improvement in self-efficacy, social support, and health behaviors to manage symptoms); and number of visits to posttreatment care services between T1 and T2. We will assess the primary and secondary outcomes using measurements with sound psychometrical properties. We will use a qualitative and quantitative mixed methods approach to achieve the research aims.

RESULTS

This project is ongoing and will be completed by the end of 2018.

CONCLUSIONS

The results from this study will help design a definitive randomized trial to test the efficacy of the ESCPs, a potentially scalable program, to enhance supportive care for prostate cancer patients and their families.

Survivorship care plan outcomes for primary care physicians, cancer survivors, and systems: a scoping review

PURPOSE

With the focus on survivorship care-coordination between oncology and primary care providers (PCPs), there is a need to assess the research regarding the use of survivorship care plans (SCPs) and determine emerging research areas. We sought to find out how primary care physicians have been involved in the use of SCPs and determine SCP's effectiveness in improving care for cancer survivors. In this scoping review, we aimed to identify gaps in the current research and reveal opportunities for further research.

METHODS

We followed the methodology for scoping studies which consists of identifying the research question, locating relevant studies, selecting studies, charting the data, and collating, summarizing, and reporting the results.

RESULTS

Out of 5375 original articles identified in the literature search, 25 met the inclusion/exclusion criteria. Eight articles examined PCP-only related outcomes, eight examined survivor-only related outcomes, eight examined mixed outcomes between both groups, and one examined system-based outcomes. Findings highlighted several areas where SCPs may provide benefits, including increased confidence among PCPs in managing the care of survivors and increased quality of life and well-being for survivors. This research also highlighted the need for careful consideration of SCP mode of delivery and content in order to maximize their utility to patients and providers.

CONCLUSIONS

Based on the findings of this review, SCPs may benefit providers and health care systems, but the benefits to patients remain unclear. Further research on the potential benefits of SCPs to particular patient populations is warranted.

IMPLICATIONS FOR CANCER SURVIVORS

SCPs appear to be beneficial to PCPs in improving overall quality of care. However, more work needs to be done to understand the direct impact on cancer survivors.

Survivorship care planning in neuro-oncology

Cancer patient survivorship has become a significant topic within oncology care for both adult and pediatric patients. Starting in 2005, the Institute of Medicine recommended the use of survivorship care plans to assist patients transitioning from active treatment to the posttreatment phase of their cancer care, a critical time for many patients. Since 2014 there has been a mandate within the United States for adult cancer patients treated with curative intent to receive survivorship care plans comprised of a treatment summary and a follow-up plan to facilitate a better understanding among patients of what to expect after treatment. In addition to a general oncology survivorship care plan, specific care plans have been created for breast, lung, prostate, and colon cancers, as well as lymphoma. A survivorship care plan specific to adult neuro-oncology has been developed by a multidisciplinary and interprofessional committee, with approval from the Society for Neuro-Oncology Guidelines Committee. It has been published in compendium with this review of survivorship care planning and available as a fillable PDF on the Society of Neuro-Oncology Guidelines Endorsement web page (https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx). Implementation of this survivorship care plan provides a unique opportunity to begin addressing the range of survivorship issues our neuro-oncology patients navigate from diagnosis to end of life.

Integrated Care Planning for Cancer Patients: A Scoping Review

Introduction

There has been a growing emphasis on the use of integrated care plans to deliver cancer care. However little is known about how integrated care plans for cancer patients are developed including featured core activities, facilitators for uptake and indicators for assessing impact.

Methods

Given limited consensus around what constitutes an integrated care plan for cancer patients, a scoping review was conducted to explore the components of integrated care plans and contextual factors that influence design and uptake.

Results

Five types of integrated care plans based on the stage of cancer care: surgical, systemic, survivorship, palliative and comprehensive (involving a transition between stages) are described in current literature. Breast, esophageal and colorectal cancers were common disease sites. Multi-disciplinary teams, patient needs assessment and transitional planning emerged as key features. Provider buy-in and training alongside informational technology support served as important facilitators for plan uptake. Provider-level measurement was considerably less robust compared to patient and system-level indicators.

Conclusions

Similarities in design features, components and facilitators across the various types of integrated care plans indicates opportunities to leverage shared features and enable a management lens that spans the trajectory of a patient's journey rather than a phase-specific silo approach to care.

Care Coordination and Transitions of Care

Care coordination and effective transitions of care are essential for high-quality care in cancer survivors. Aspects of care that require coordination include cancer surveillance, managing the effects of cancer and its treatment, and preventive care, including screening for new cancers, with the clinician responsible for each aspect of care clearly defined. There are many barriers to transitioning and coordinating care across cancer specialists and primary care physicians; possible solutions include survivorship care plans and certain care models. Improving these areas, along with survivorship care training and education, may lead to more effective care coordination and transitions in the future.

Unmet needs for information and psychosocial support in relation to quality of life and emotional distress: A comparison between gynecological and breast cancer patients

OBJECTIVE

We compared gynecological and breast cancer patients regarding their needs for information and psychosocial support, quality of life (QoL), and emotional distress and the relationship among these constructs.

METHODS

In a multicenter, cross-sectional study in Germany, we evaluated 1214 female cancer patients (317 with gynecological cancer, 897 with breast cancer). We obtained self-reports of unmet needs, using a self-developed measure. We measured QoL with the EORTC QLQ-C30, symptoms of depression with the Patient Health Questionnaire (PHQ-9), and symptoms of anxiety with the Generalized Anxiety Disorder Scale (GAD-7).

RESULTS

Compared to breast cancer patients, gynecological cancer patients felt less informed about several aspects of their disease, particularly regarding psychological support (p<0.001), tended to have more unmet information needs, and reported lower QoL levels. Lower emotional functioning, but higher physical functioning were independent correlates of the level of unmet information needs. Depressive symptoms and higher physical functioning (only in breast cancer) were independent correlates of higher needs for psychosocial support.

CONCLUSION

Compared to breast cancer, gynecological cancer patients were less satisfied with the information received and reported lower levels of QoL.

PRACTICE IMPLICATIONS

Both clinicians and policy makers should take efforts to address the higher needs of gynecological cancer patients.

A mixed-methods study to explore the supportive care needs of breast cancer survivors

OBJECTIVE

Needs assessment is the essence of quality cancer survivorship care. The aim of this study was to explore the supportive care needs of breast cancer survivors (BCS) in the first 5 years post treatment.

METHODS

A mixed-methods approach was employed. A quantitative study included a Supportive Care Needs Survey, which was completed by 250 BCS to identify the level of their needs for help. The quantitative data informed semistructured qualitative interviews undertaken with 60 BCS to explore in detail their posttreatment needs and experiences.

RESULTS

32.4% and 16.8% reported 1 to 5 and greater than or equal to 6 needs for help, respectively. The regression analyses revealed that women within 2 years posttreatment and with higher educational level had higher levels of Psychological and Health Care System/Information needs. The qualitative data revealed "continuity of care" and "lifestyle advice and self-management" as prominent survivorship concerns. It was shown that determination to continue normal life, social support, and feeling overwhelmed by information were all experienced as important influences on survivors' need for help.

CONCLUSIONS

Posttreatment needs vary with BCS characteristics and to the domains concerned. The approach to posttreatment care needs to be personalized and viable.

Age and Cancer Treatment Are Related to Receiving Treatment Summaries and Survivorship Care Plans in Female Young Adult Cancer Survivors

The study determined factors associated with patient-reported receipt of survivorship care plans and/or treatment summaries (SCP/TS). Two hundred forty female young adult cancer survivors ages 18-44 completed a web-based survey that included self-report on receiving SCP/TS. Mean age was 32.8 (standard deviation 5.8) years; 20% were diagnosed with cancer at age <21. Only 47% reported receipt of SCP/TS. Age <21 at diagnosis (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.0-3.9), chemotherapy (OR 2.3, 95% CI 1.2-4.6), central nervous system radiation (OR 2.5, 95% CI 1.1-5.6), and bone marrow transplantation (OR 7.2, 95% CI 1.5-33.3) were significantly associated with higher odds of SCP/TS receipt. Improved integration of TS and SCP into cancer survivorship care is needed.

The Impact of Survivorship Care Planning on Patients, General Practitioners, and Hospital-Based Staff

BACKGROUND

In 2005, the Institute of Medicine recommended that all cancer patients receive a survivorship care plan (SCP). Despite widespread support, few centers have routinely implemented them. Understanding of their impact is limited.

OBJECTIVES

The aims of this study were to examine the impact of SCP delivery on patients and healthcare professionals at an Australian comprehensive cancer center and determine enablers and barriers to implementation.

METHODS

Six groups were surveyed: (1) patients who had received SCPs; (2) nurse coordinators using SCPs, (3) general practitioners (primary care, GPs) of patients who had received SCPs, (4) clinical service chairs, (5) heads of allied health, and (6) nurse coordinators not using SCPs (nonengaged nurse coordinators). Groups 1 to 3 completed written questionnaires. Groups 4 to 6 participated in semistructured interviews.

RESULTS

Fifty patients, 7 nurse coordinators, 18 GPs, 7 clinical service chairs, 4 heads of allied health, and 8 nonengaged nurse coordinators participated. Eighty-seven percent of patients considered the SCP to be very or somewhat useful; 50% felt it helped them understand their cancer experience. All engaged nurse coordinators reported SCPs to be very or somewhat useful, and 86% believed SCPs improved communication with GPs. General practitioners felt SCPs were very or somewhat useful (67%) and wished to receive SCPs for future patients (83%). Organizational and clinical leadership, multidisciplinary engagement, resourcing, and timing of SCP delivery were considered critical enablers.

CONCLUSION

Patients and healthcare professionals support the use of SCPs; however, they are resource intensive and require significant organizational support.

IMPLICATIONS FOR PRACTICE

Nurses are instrumental to SCP implementation. Attention to enablers and barriers is important for successful implementation.

Empowering survivors after colorectal and lung cancer treatment: Pilot study of a Self-Management Survivorship Care Planning intervention

PURPOSE

This study evaluates the feasibility and acceptability of a Self-Management Survivorship Care Planning (SM-SCP) intervention in colorectal and lung cancer survivors.

METHODS

This is a single-group, pre- and post-mixed methods study of an advance practice nurse-driven survivorship care intervention that integrates a survivorship care plan with self-management skills coaching. Colorectal and lung cancer survivors with stage I-III disease were enrolled at 3-6 months after completing treatments, and the intervention was administered in one in-person or telephone session. Survivor outcome measures included depression, anxiety, self-efficacy, QOL, and satisfaction. Paired t-tests were used for exploratory evaluations of pre-to post-intervention score changes. Content analysis was conducted to analyze the qualitative data to describe survivors' experience with the intervention.

RESULTS

Thirty participants (15 colorectal, 15 lung) enrolled and completed the study (73% retention). It took an average of 40 min to complete the TS/CP and 34.2 min to deliver the intervention. Exploratory analysis revealed significant differences from baseline to post-intervention in depression, anxiety, self-efficacy, physical functioning, role limitations-physical, pain, general health, health transition, physical health summary, and total QOL. Three qualitative themes emerged: 1) Feeling empowered about having a plan; 2) Struggling with psychosocial concerns; and 3) Suggestions for intervention content and delivery.

CONCLUSIONS

The SM-SCP intervention was feasible and acceptable for colorectal and lung cancer survivors after treatment completion. Survivorship care interventions have potential to fulfill the unmet needs of colorectal and lung cancer survivors. Their effectiveness might be greater by integrating conceptually-based models of care, such as self-management skills building.

Provision of integrated psychosocial services for cancer survivors post-treatment

Meeting the psychosocial needs of patients with cancer has been recognised as a priority within oncology care for several decades. Many approaches that address these needs have been developed and described; however, until recently much of this work had focused on patients during treatment and end-of-life care. With continued improvement in therapies, the population of cancer survivors who can expect to live for 5 or more years after cancer diagnosis has increased dramatically, as have associated concerns about how to meet their medical, psychosocial, and health behaviour needs after treatment. Guidelines and models for general survivorship care routinely address psychosocial needs, and similar guidelines for psychosocial care of patients with cancer are being extended to address the needs of survivors. In this Series paper, we summarise the existing recommendations for the provision of routine psychosocial care to survivors, as well as the challenges present in providing this care. We make specific recommendations for the integration of psychosocial services into survivorship care.

The impact of cancer survivorship care plans on patient and health care provider outcomes: a current perspective

BACKGROUND

To help the growing number of cancer survivors deal with the challenges of cancer survivorship, survivorship care plans (SCPs) were recommended by the Institute of Medicine (IOM) in 2006. The SCP is a formal document that contains both a tailored treatment summary and a follow-up care plan. Since the IOM recommendation 10 years ago, the implementation in daily clinical practice is minimal. Several studies have investigated the effects of SCPs on patient-reported outcomes and oncology and primary care providers (PCPs), but the quantity and quality of these studies are limited.

RESULTS

The first four randomized trials comparing SCP delivery with usual care failed to show a positive effect on satisfaction with information provision, satisfaction with care, distress or quality of life. SCPs did improve the amount of information provided and communication of PCPs with medical specialists and patients. A recent small trial that changed the focus from SCP as primarily an information delivery intervention to a behavioral intervention did observe positive effects on self-reported health, lower social role limitations and a trend towards greater self-efficacy. Gaps in knowledge about SCPs include uncertainty about content and length of the SCP; whether it should be delivered online or on paper; the timing and frequency of delivery; which health care provide should deliver SCP care. Finally, cost-effectiveness of SCP interventions has received limited attention.

CONCLUSION

Currently, there is not enough evidence to warrant large-scale implementation of SCPs, or to abandon SCPs altogether. Emphasis on the SCP process and survivor engagement, supporting self-management may be an important way forward in SCP delivery. Whether this is beneficial and cost-effective on the long term and among different groups of cancer survivors needs further investigation.

How will cancer survivors use survivorship care plans?

BACKGROUND

Survivorship care plans (SCPs) are internationally endorsed as an important tool to enhance post-treatment survivorship care. To support broad implementation of SCPs, we investigated survivors' preferences regarding SCPs.

MATERIAL AND METHODS

The study was conducted at a comprehensive cancer center. Eligible patients from 10 clinical services, generally up to 12 months following end of treatment (EOT) were approached in clinics or via telephone. A purpose-designed survey assessed survivors' intended use of a SCP and preferences regarding format and content. Intended minimum sample size of 200.

RESULTS

Two hundred and thirty surveys were returned (response rate 68%). Of the 230 participants, over 55% had completed treatment within six months, 35% between six and 12 months, and 10% were receiving ongoing treatments. Most (82%) had not received a SCP and more than one third (42%) reported receiving no information resources at EOT. Almost all (98%) desired further information. Most common information elements desired in a SCP: 'list of symptoms to watch out for and report' (76%), 'summary of treatment received' (70%) and 'things I can do to look after myself' (67%). Most common suggested uses were as: 'a record of cancer treatment' (63%), 'a reminder of things to do to look after myself ' (57%) and 'to help me understand my cancer experience' (56%). Over half (52%) would share the information with their general practitioner. Most indicated preference for paper-based SCPs (91%). There was support for both brief (36%) and detailed versions (42%). Over half requested the information be delivered in a face-to-face discussion with a health professional. Regular telephone support from the treating health care team was most commonly suggested as an additional service to support survivors after EOT.

CONCLUSIONS

Although similar to international findings, results suggest alternate ways of providing the information that survivors desire. Most desired SCP elements have been defined. A flexible approach to SCP interventions is justified.

Prostate cancer survivorship: Implementation of survivorship care plans to meet the mandate and enhance urologic practice through collaborative care

Prostate cancer is the most common malignancy among the male survivorship population in the United States, representing 44% of approximately 7 million survivors. In the era of modern medicine and value-based care, successfully treating only the cancer is not sufficient. The cancer survivor represents an individual in need of restoration and protection against future events. A well-designed and well-supported survivorship program not only meets a mandate for accreditation, it logically translates into better patient care. This review summarizes the history of the survivorship movement, outlines some key elements of a survivorship program, and highlights the opportunity to apply these principles to improve cancer-related care, develop relationships with colleagues that may allow increased identification of men at risk, and expand both the experience and outcomes of individual specialists within men's health.

Using Technology to Improve Cancer Care: Social Media, Wearables, and Electronic Health Records

Digital engagement has become pervasive in the delivery of cancer care. Internet- and cellular phone-based tools and systems are allowing large groups of people to engage with each other and share information. Health systems and individual health professionals are adapting to this revolution in consumer and patient behavior by developing ways to incorporate the benefits of technology for the purpose of improving the quality of medical care. One example is the use of social media platforms by oncologists to foster interaction with each other and to participate with the lay public in dialogue about science, medicine, and cancer care. In addition, consumer devices and sensors (wearables) have provided a new, growing dimension of digital engagement and another layer of patient-generated health data to foster better care and research. Finally, electronic health records have become the new standard for oncology care delivery, bringing new opportunities to measure quality in real time and follow practice patterns, as well as new challenges as providers and patients seek ways to integrate this technology along with other forms of digital engagement to produce more satisfaction in the process of care along with measurably better outcomes.

Issues in Breast Cancer Survivorship: Optimal Care, Bone Health, and Lifestyle Modifications

There are an estimated 3.1 million survivors of breast cancer in the United States. The predominant reasons for this substantially large population are that breast cancer is the most common noncutaneous malignancy among women and that 5-year survival rates after breast cancer treatment are approximately 90%. These patients have many medical considerations, including the need to monitor for disease recurrence and to manage complications of their previous cancer treatments. Most patients remain at risk indefinitely for local and systemic recurrences of their breast cancers and have an increased risk of developing contralateral new primary breast cancers. Therefore, optimizing care for this patient population is critical to the overall health care landscape in the United States. Here, we summarize survivorship care delivery and its challenges, the optimization of bone health in breast cancer survivors, and opportunities for risk reduction through lifestyle modifications.

Cancer survivors as activated patients: Exploring the relationship between cancer history and patient activation

Many cancer survivors experience long-term physical and psychosocial sequalae. As such, there is a need for survivors to be activated and participate in their own health care. Our study explores the relationship between cancer history and patient activation. We used data from the 2013 Health Information National Trends Survey (N = 3185, response rate = 35.19%). Survivors had approximately 70% higher odds of being highly activated compared to those with no cancer history. Level of activation did not vary across time since diagnosis. Future research should examine mechanisms for increased activation in survivors and ways to encourage more activation behaviors.

Web based survivorship interventions for women with breast cancer: An integrative review

PURPOSE

Breast cancer survivors' experience a range of negative sequelae post-treatment including depression, anxiety, physical side effects from treatment, sexuality concerns and decreased quality of life. Survivorship care is recommended by the IOM to meet the post treatment needs of survivors but implementation is variable and barriers to delivery such as time and resource restraints have been identified. Web-based interventions may be a way to overcome some barriers to providing quality survivorship care that is efficacious, cost efficient and convenient. The purpose of this integrative review is to summarize and synthesize the current research on web-based interventions for breast cancer survivorship care and evaluate the data to determine potential implications for practice.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide this integrative review. Key search terms included breast cancer, survivor, intervention, web, internet and technology. Articles evaluating web-based survivorship interventions (n = 405) for early stage breast cancer patients who completed active therapy were included.

RESULTS

Fifteen studies met inclusion criteria: six randomized controlled trials, six survey based studies, one qualitative study, one retrospective chart review and one mixed methods study. Studies evaluating cognitive behavioral therapy provided the strongest data. Other studies evaluated exercise and lifestyle interventions, symptom management programs and pilot/exploratory work. Findings suggest that web-based survivorship interventions are feasible and acceptable to breast cancer survivors.

CONCLUSIONS

Web-based survivorship interventions have the potential to meet the needs of breast cancer survivors while possibly overcoming some of the documented barriers to survivorship care implementation.

The Polaris Oncology Survivorship Transition (POST) System: A Patient- and Provider-Driven Cancer Survivorship Planning Program

BACKGROUND

It is strongly recommended that individuals ending treatment for cancer have a "survivorship plan," and new standards require survivorship planning for accreditation, However, a comprehensive plan is often neglected.

OBJECTIVE

To present the development and field test results of a web-based, breast cancer survivorship care planning system.

METHODS

The Polaris Oncology Survivorship Transition (POST) blends input from the electronic health record (EHR), oncology care providers (OCPs), and patients to create a survivorship care plan (SCP). The content of the POST program was created with the assistance of end-user input (patients, oncologists, and primary care providers (PCPs)) and the full program was piloted on women ending treatment for breast cancer. This paper presents the pilot study that field-tested the POST In a clinical setting. Patients were recruited from outpatient care clinics and chemotherapy units in a comprehensive care center. The study included 25 women ending treatment for breast cancer in the past year, 4 OCPs, and PCPs. Patients received the POST computeπzed assessment and a tailored SCP.

RESULTS

The POST assists providers in crafting efficient and comprehensive SCPs and was rated highly satisfactory by all end-users.

DISCUSSION

The POST program can be used as a cancer survivorship planning program to assist OCPs in care planning for their patients ending treatment for breast cancer.

CONCLUSION

This study provides support for Incorporating computerized SCP programs into clinical practice. Use of the POST in clinical practice has the potential to improve survivorship planning.