The day of a confirmed cancer diagnosis is also the first day of survivorship. The good news is that many people are surviving long after treatment has concluded.
In the United States alone there are approximately 13.7 million cancer survivors1; but what does survivorship mean for patients after active treatment ends? Periodic tests and follow-up visits with their oncology team? Continued exams with specialists? Patients are not always certain about next steps after cancer treatment has concluded.
In the last decade, support beyond treatment was identified as a patient need; survivorship care plans (SCPs) were subsequently developed to assist patients in keeping track of their treatment history in order to maintain proper follow-up care. In 2005, the Institute of Medicine (IOM) published a report about patient survivorship and the need for care plans.2 The report highlighted three main objectives for the oncology care team to focus on, which includes:2
- Raise awareness of the medical, functional, and psychosocial consequences of cancer and its treatment.
- Define quality health care for cancer survivors and identify strategies to achieve it.
- Improve the quality of life of cancer survivors through policies to ensure their access to psychosocial services, fair employment practices, and health insurance.
Follow-up Minimizes Risk of Recurrence
Researchers at the University of Pennsylvania looked at how SCPs help patients participate in healthy lifestyle changes and seek follow-up care after active cancer treatment has ended. Of the 8,690 patients studied, 63% reported that the use of the SCP changed their health care participation, and 80% shared or planned to share it with their health care team. Of those survivors who did share their SCP, 80% responded that it improved communication with their health care providers.
More than half of survey respondents (54%) reported that they had made or planned to make a lifestyle change in response to the SCP—the most common changes noted were diet modifications and an increase in exercise. 3
In another study, SCPs were examined for overall patient satisfaction. Researchers polled 48 patients with breast cancer and 10 patients with colorectal cancer about their satisfaction with SCPs. Approximately 80% of patients surveyed reported that they were satisfied with the care plans and 90% agreed that it was useful and easy to understand; however, the care plans did not completely eliminate confusion about the coordination of follow-up care.4
Care plans are especially important for patients at risk for recurrence and increased morbidity and mortality as a result of lack of follow-up care, as observed in a population of African-American patients with breast cancer, specifically. This at-risk population was studied to see whether SCPs helped to keep patients on track following treatment. This small study of 25 survivors and three patient advocates concluded that the IOM’s template for SCPs “lacked adequate content on health history, comorbidity, health promotion, and functioning,” all of which are factors that contribute to underlying clinical, psychosocial, and behavioral risks for poor disease outcomes for black women with breast cancer.5
These studies indicate that SCPs are helpful to many patients, but improvements are required in order to meet the diverse needs of patients. Additionally, this feedback demonstrated existing confusion about care that may help medical teams to ensure that patients understand the next steps following active cancer treatment, such as which health care provider they should visit and when.
1. Cancer Progress Report. AACR. http://cancerprogressreport.org/Pages/CPR2013_release.aspx. Accessed September 30, 2013.
2. From Cancer Patient to Cancer Survivor: Lost in Translation. Inst of Medicine. 2005 http://iom.edu/Reports/2005/From-Cancer-Patient-to-Cancer-Survivor-Lost-in-Transition.aspx. Accessed September 30, 2013.
3. Hill-Kayser CE, Vachani CC, Hampshire MK, et al. Impact of internet-based cancer survivorship care plans on health care and lifestyle behaviors. Cancer. 2013; Aug 6. doi: 10.1002/cncr.28286. [Epub ahead of print]
4. Sprague BL, Dittus KL, Pace CM, et al. Patient satisfaction with breast and colorectal cancer survivorship care plans. Clin J Oncol Nurs. 2013 Jun;17(3):266-72.
5. Ashing-Giwa K, Tapp C, Brown S, et al. Are survivorship care plans responsive to African-American breast cancer survivors?: voices of survivors and advocates. J Cancer Surviv. 2013 Sep;7(3):283-91.