Cancer Survivorship: Cancer Survivorship: A New BeginningA New Beginning

Arlene O’Rourke APRN

Core Components of a Core Components of a Survivorship Care PlanSurvivorship Care Plan

• Treatment Summary

• Follow-up Plan of Care

Treatment SummaryTreatment Summary

• Demographics/Contact information

Care providers, treatment location, contact information of facility

• Disease specifics

Diagnosis, Pathology, Stage of disease

Treatment SummaryTreatment Summary

• Treatment specifics• Surgery: date, procedure, persistent and/or possible late

effects• Chemotherapy/biotherapy: dates, regimen, clinical trials,

agents, doses, supportive care, persistent or possible late effects

• Hormonal therapy: dates, agents, doses, persistent and possible late effects

• Radiation: dates, sites, type, dose, persistent or possible late effects

• Symptoms to report

Follow-Up Care PlanFollow-Up Care Plan

• Cancer surveillance visit and test schedule• Acute/long term toxicity/expected course of

recovery• Actual and potential late effects and screening

recommendations• Subspecialty referrals including psychosocial• General health promotion• Cancer related resources

GuidelinesGuidelines

• ASCO-www.asco.org

• NCCN-www.nccn.org/professionals/physician.gls/f.guidelines.asp

• Livestrong-www.livestrongcareplan.org

• Journey Forward- www.journeyforward.org

The Survivorship VisitThe Survivorship Visit

• Comprehensive-medical/surgical/family history, psychosocial status, ROS, PE, current health behaviors

• Evaluate• Educate• Intervene for potential and actual late effects,

disease prevention and health promotion

Models of CareModels of Care

• Shared Model

• Risk Based follow-up

• Disease specific clinics

• Institution-based programs

Barriers to Survivorship CareBarriers to Survivorship Care

• Finances• Educated and dedicated personnel• Lack of acceptance and/or integration with disease-

based or general oncology programs or practice• Space• Complexity of survivorship care• Lack of clear, evidenced-based guidelines on proper

management• Limited knowledge of evolving management of co-

morbidities

Issues to ConsiderIssues to Consider

• The ideal model for survivorship care does not exist at this time

• Models may be different in academic medical centers where care is often diseased-based and community cancer programs where 80-85% of patients receive care

• Care plans must eliminate redundant and unnecessary care

• Must assure excellent cancer follow up care and general primary care- outcome improvement

Why Cancer Survivor Clinics?Why Cancer Survivor Clinics?

• Increasing numbers of cancer survivors• Complex care required by cancer survivors• The need for the oncology community to

educate patients and providers about survivorship issues to adequately transition cancer survivors back to their PCPs

• Supply and demand

Future DirectionsFuture Directions• Improve the quality of life for patients and their

families with a diagnosis of cancer• Develop community based interdisciplinary cancer

survivorship program to support and care for the patient and family.

• Alleviate the burden of cancer care in long-term survivors to reflect the decreasing supply of oncologists and primary care providers

• Perform research that demonstrates improvement in outcomes associated with cancer survivorship clinic care