Oncologists now have a tool for helping the growing numbers of cancer survivors in the United States. The American Society for Radiation Oncology (ASTRO) published a new template that standardizes and streamlines the creation of patient-focused plans for long-term cancer survivor care following radiation therapy.1
“Fortunately, the number of cancer survivors are increasing, which is why these templates are such an important resource for oncologists,” said ASTRO chair Bruce Minsky, MD, who is a professor of radiation oncology at The University of Texas MD Anderson Cancer Center, Houston, TX.
Dr Minsky said earlier detection of cancer, increasingly effective treatment options, and an aging population are 3 leading factors contributing to a growing number of cancer survivors. He said these patients now more than ever need to be educated and empowered. Dr Minsky said the new template should lead to better coordination of post-treatment care for cancer survivors, including greater clarity in the dialogue between radiation oncologists and primary care providers (PCPs) for managing the less common side effects that may appear well after treatment is complete.
“As the cancer paradigm starts to evolve from ‘die of’ to ‘live with’ we need to be actively involved in our patient’s long-term care and needs,” Dr Minsky told Cancer Therapy Advisor.
New Accreditation Requirements
Many oncologists are now scrambling to meet new accreditation requirements set by the American College of Surgeons Commission on Cancer (CoC). It issued a mandate that cancer programs provide survivorship care plans (SCPs) for all curative cancer patients by 2019 to maintain accreditation.
The new CoC requirement may necessitate changes for most radiation oncology programs. A March 2014 survey of ASTRO members found that only 40% of respondents used SCPs for curative patients and 19% of respondents used SCPs for palliative patients.2
Primary barriers to implementation included cost and the lack of a standardized, comprehensive SCP framework suited to patients who received radiation therapy. Nearly 80% of the radiation therapy providers reported using SCPs that relied on a framework developed internally within their practices. Subsequently, different patients may receive different types of information depending on where they receive treatment.
“The majority of cancer patients, roughly 60%, receive radiation treatment as part of their care. This new SCP template is designed specifically for use by radiation oncologists. Radiation oncologists have a long tradition of documenting a treatment summary for each patient. New requirements for SCPs mean that radiation oncologists would need to create 2 separate documents at the end of treatment for each patient, adding significant burden, which is one of the biggest barriers to widespread SCP adoption,” said Ronald Chen, MD, MPH, an associate professor in the Department of Radiation Oncology at the University of North Carolina at Chapel Hill and lead author on the manuscript that included the template.
Dr Chen was the chair of ASTRO’s Clinical, Translational and Basic Science Advisory Committee, the group that examined current adoption levels of SCPs and developed the template to standardize them in the future. He said radiation oncologists always provide their patients with follow-up materials, contacts for ancillary services such as financial or nutritional counseling, and information on potential late treatment effects.
However, the SCP template coordinated these components in a central, plain language document. The template included both elements required by CoC in SCPs (a summary of past treatment and directions for future care). The treatment summary outlined the survivor’s diagnosis and stage information. The treatment summary also included details such as the site, dosage, and schedule of RT.
The plan for follow-up care covered anticipated toxicities from radiation therapy, expected course of recovery from treatment-related toxicities, and possible functional and/or social limitations. It also included recommendations for preventive measures and behaviors, cancer information resources, and referrals to supportive care providers.
“This SCP template is unique in that it is designed to significantly reduce the burden on radiation oncologists in creating these documents, and it allows them to meet Commission on Cancer requirements for SCPs. There continues to be debate on whether SCPs actually improve the outcomes of cancer survivors, and there are ongoing research efforts which will address this controversy,” Dr Chen told Cancer Therapy Advisor.
- Chen, RC, Hoffman KE, Sher DJ, et al. Development of a standard survivorship care plan template for radiation oncologists [published online ahead of print October 6, 2015]. Practical Radiation Oncology. doi: 10.1016/j.prro.2015.10.001.
- Koontz BF, Benda R, De Los Santos J, et al. US radiation oncology practice patterns for post-treatment survivor care [published online ahead of print October 6, 2015]. Practical Radiation Oncology. doi: 10.1016/j.prro.2015.10.002.