Transcript Survivorship Care Plans

Survivorship Care Plans
Daniel P. McKellar, MD, FACS
Chair Elect, Commission on Cancer
Survivorship Care Plans
• Introduction to the Commission on Cancer
• Overview of New COC Standard On Survivorship Care Plans
• Who, what, why, and how of care plans
• Sample survivorship care plans and resources
Commission on Cancer: Our Mission
The CoC is a consortium of professional
organizations dedicated to improving survival and
quality of life for cancer patients through
standard-setting, prevention, research, education,
and the monitoring of comprehensive quality care.
Commission on Cancer Membership
49 professional organizations
• Administrative: American College of Oncology Administrators, Association of Cancer
Executives, Association of Community Cancer Centers, American Hospital Association, National
Consortium of Breast Centers
• Advocacy/Patient Based: American Cancer Society, Cancer Support Community,
LIVESTRONG, National Coalition for Cancer Survivorship
• Allied Health: American Academy of Hospice and Palliative Medicine, Academy of Nutrition
and Dietetics, Oncology Nutrition Dietetic Practice Group, American Psychosocial Oncology Society,
Association of Oncology Social Work, National Society of Genetic Counselors, Oncology Nursing
Society,
• Clinical: American Academy of Pediatrics, American College of Obstetricians & Gynecologists,
American College of Physicians, American College of Radiology, American College of Surgeons
Oncology Group, American College of Surgeons Resident & Associate Society, American College of
Surgeons Young Fellows Association, American Head & Neck Society, American Pediatric Surgical
Association, American Radium Society, American Society of Breast Surgeons, American Society of
Clinical Oncology, American Society of Colon & Rectal Surgeons, American Society of Radiation
Oncology, American Urological Association, College of American Pathologists, Society of
Gynecologic Oncologists, Society of Nuclear Medicine, Society of Surgical Oncology, Society of
Thoracic Surgeons
Commission on Cancer Membership
49 professional organizations
• Government: Centers for Disease Control & Prevention, Department of Defense,
Department of Veterans Affairs, National Cancer Institute, Applied Research Program, National
Cancer Institute SEER Program
• Registry: National Cancer Registrars Association, North American Association of Central
Cancer Registries
• Research/Education: American Association for Cancer Education, The Institute for
Palliative Medicine at San Diego Hospice, American Joint Committee on Cancer, Association of
American Cancer Institutes, National Comprehensive Cancer Network, National Surgical Adjuvant
Breast & Bowel Project
CoC Objectives
• Establish standards to ensure quality, multidisciplinary, and
comprehensive cancer care delivery in healthcare settings
• Conduct surveys in healthcare settings to assess compliance
with those standards
• Collect and use data to monitor treatment patterns and
outcomes and enhance cancer control and clinical surveillance
activities
• Provide access to data for cancer programs to use for quality
improvement, administrative purposes, and for research
• Provide resources to cancer programs and provide effective
educational interventions to improve cancer prevention, early
detection, care delivery, and outcomes in healthcare settings
Historical Timeline of the COC
• 1930 – Standards for cancer clinics developed
• 1933 – Initial group of 140 facilities accredited
• 2012 – Currently accredit over 1500 facilities in all 50 states
1600
1509
1429
1400
1405
1200
1995
2001
2011
Cancer Programs in U.S. Hospitals
Hospitals
with
accredited
programs
30%
Treated
elsewhere
29%
Hospitals
without
accredited
programs
70%
General medical/surgical facilities
Including Puerto Rico=~5000
*Cancer Facts and Figures, American Cancer Society
Diagnosed
and treated in
accredited
programs
71%
Estimated new cancer patients in 2011: 1,596,670*
2012 New Cancer Program Standards
The Future of Quality Cancer Care
Survivorship Care Plan
• Why do we need this new standard?
– 12 Million Americans “Living” with cancer
– 1 in 10 American Households have at least one
person who has been diagnosed with cancer in the
last 5 years
– Cancer is a lifelong diagnosis with lasting effects
• Often emotional, physical, psychosocial effects
Why do we need survivorship care plans and treatment summaries?
Why do we need survivorship care plans and treatment summaries?
Why do we need survivorship care plans and treatment summaries?
Why do we need survivorship care plans and treatment summaries?
How comfortable the primary
care physician is managing
late health effects and
transition issues
How often the primary
care physician received
treatment summaries of
their patients with cancer
Survivorship Care Plans
“The challenge in overcoming cancer is not
only to find therapies that will prevent or arrest
the disease quickly, but also to map the middle
ground of survivorship and minimize its medical
and social hazards”
Fitzhugh Mullan, MD
Cancer Survivor
Mullan F.”Reflections of a cancer survivor”,
New England Journal of Medicine, 1985;313:270-273
Patient’s Perspective
• Right to have a record and understand treatment
received
• Right to know what happens after treatment
• Follow-up recommendations
• Potential late effects of treatment
• Right to know what life will be like after treatment
– How to stay healthy, symptom recognition
– Medical, psychosocial and financial issues
– Available resources
Why do we need survivorship care plans and treatment summaries?
http://iom.edu/Reports/2005/From-Cancer-Patient-to-Cancer-Survivor-Lost-in-Transition/From-Cancer-Patient-to-CancerSurvivor-Lost-In-Transition.aspx
Survivorship Care Plan
2006 IOM Report
“From Cancer Patient to Survivor-Lost in Transition”
– Identified specific needs for patients completing treatment
– Survivors ‘lost in transition’ due to lack of awareness of
survivor needs
– Fragmented and poorly coordinated care between providers
Survivorship Care Plan
• IOM report called for written summaries of care
that should include:
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Expected course of recovery from treatment
Schedule of recommended follow-up screenings
Information on possible signs of recurrence
List of recommendations for psychosocial support and
behavioral interventions for health promotion and
disease prevention
Survivorship Care Plan
• S 3.3: “The cancer committee develops and
implements a process to disseminate a
comprehensive care summary and follow-up
plan to patients with cancer who are
completing cancer treatment. The process is
monitored, evaluated, and presented at least
annually to the cancer committee and
documented in the minutes.”
3.3 - Survivorship Care Plan
• Process Requirements
– Plan is provided by principal provider(s) who
coordinated treatment, with input from other care
providers
– Plan is given to patient upon completion of
treatment
– Plan contains record of care received to include:
• Disease characteristics
• Follow up care plan including recognized evidencebased standards of care
• Minimum standards included in IOM fact sheet
Survivorship Care Plans
Barriers to Care Plans
• Lack of awareness of need for care plans
• Lack of time to complete
• Lack of reimbursement
• Not required
Problems with current approach to care plans
• Not standardized
• Focus only on cancer surveillance
• Lack of research/validation
Survivorship Care Plans
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Important elements of care plans
Specific tissue diagnosis and stage
Initial treatment plan and dates of treatment
Toxicities during treatment
Expected short/long-term effects of therapy
Late toxicity monitoring needs
Surveillance for recurrence or 2nd cancers
Who is responsible for survivorship care?
Psychosocial and vocational needs
Recommended preventive behaviors and
interventions
http://www.cancer.org/Treatment/SurvivorshipDuringandAfterTreatment/SurvivorshipCarePlans/index
Sample Care Plans
Journey Forward
• www.journeyforward.org
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National Coalition for Cancer Survivorship
UCLA Cancer Survivorship Center
Wellpoint,Inc.
Genetec
Prescription for Living
• www.nursingcenter.com/library/static.asp?pageid=721732
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American Cancer Society
Oncology Nursing Society
National Coalition for Cancer Survivorship
American Journal of Nursing
University of Pennsylvania School of Nursing
American Society of Clinical Oncology (ASCO) treatment summaries
• www.cancer.net/patient/survivorship/
Lance Armstrong Livestrong Survivor Care Program
• www.livestrongcareplan.org
The Journey Forward – Plan Builder
ASCO Cancer.Net
http://www.cancer.net/patient/Survivorship
ASCO Cancer.Net
Lance Armstrong Livestrong Survivor Care Program
Lance Armstrong Livestrong Survivor Care Program
www.facs.org/cancer
WWW.facs.org/cancer
OTHER RESOURCES ON SURVIVORSHIP
IOM Cancer Survivorship Care Planning Fact Sheet http://www.canceradvocacy.org/take-action/nccs-policy/background-materials/iomfact-sheet-on-cancer-care.pdf
American Society of Clinical Oncology –
http://www.cancer.net/patient/Survivorship/ASCO+Cancer+Treatment+Summaries/
ASCO+Cancer+Treatment+Summaries
Fred Hutchinson Cancer Research Center http://www.fhcrc.org/patient/support/survivorship
LIVESTRONG – www.livestrongcareplan.org
National Coalition for Cancer Survivorship – www.journeyforward.org
Cure Search (Children’s Oncology Group) – http://www.survivorshipguidelines.org
Cancer Support Community - http://cancersupportcommunity.org
SUMMARY
• Addressing cancer patient survivors’ needs is an essential
part of providing high quality, modern oncology care
• Survivors need and want treatment care plans and
summaries
• Many resources are available for survivorship care plans
but the key is getting these implemented by cancer
programs and into the hands of cancer survivors
• The new COC standard 3.3 on survivorship care plans
will assure that all accredited cancer programs begin
to implement care plans
Any Questions or Comments?