Survivorship Care Planning: Just Do It

It has been six years since the publication of the Institute of Medicine's (IOM) report "From Cancer Patient to Cancer Survivor: Lost In Transition."¹ While this report heightened awareness about a long-ignored phase of the cancer trajectory (particularly for adults), it has not significantly changed the way we care for cancer survivors.

Numerous reasons for this have been cited, including the absence of evidence-based guidelines within the domains of surveillance and the management of long-term and late effects, lack of enumeration for survivorship care planning, inadequate staffing to undertake this initiative, and a paucity of outcomes that offer testimony to positive outcomes associated with survivorship efforts.

Another reason has been cited as feeling overwhelmed by the comprehensive nature of the recommendations within the report that has left many within the ranks of the primary cancer team feeling impotent to enact any measure of the proposed actions.²

To this end, in 2011, the Lance Armstrong Foundation (Livestrong) convened a two-day meeting in Washington, D.C., of a diverse group of 150 stakeholders to delineate essential elements of survivorship care planning. Eighty-one elements of survivorship care delivery were identified by the group.³

Through the use of Delphi exercise methodology, these items were then ranked into three tiers. Tier 1 was identified as having the highest priority or essential items. Tier 2 was composed of high-need items, and tier 3 was made of those items to strive for.

Tier 1 contains consensus recommendations that serve as the minimum set of requirements or standard goal for the delivery of survivorship care. It is stated that all medical settings must provide direct access to or referral to the following elements of care:

• Survivorship care plan, psychosocial care plan, and treatment summary
• Screening for new cancers and surveillance for recurrence
• Care coordination strategy that addresses care coordination with primary care providers and primary oncologists
• Health promotion education
• Symptom management and palliative care

Thus, while compartmentalizing the IOM report into smaller, more manageable sections was completed with this evaluative endeavor, it remains that even tackling those items within Tier 1 is a challenge to many busy oncology practices.

Earle and Ganz² remind the readers that tools currently exist on the web and Internet to help with survivorship care planning. This is a place to start. They also suggest that patients partner with the oncology team in efforts to chronicle their history and identify future needs. Online resources on smoking cessation, exercise, nutrition, weight control, and stress reduction can be identified for survivors. Literature on recurrence anxiety and coping can be shared. What is important is to make an initial effort -- not a perfect one -- at survivorship planning inclusive of education, support, and creating key linkages with primary care providers. Just do it.

References:

1. Hewitt M, Greenfield S, Stovall E (Eds.) (2006). From Cancer Patient to Cancer Survivor: Lost In Transition. Institute of Medicine and National Research Council of the National Academies, National Academies Press: Washington D.C.
2. Earle CC & Ganz PA (2012). Cancer survivorship care: Don't let the perfect be the enemy of the good. Journal of Clinical Oncology, 30(30): 3764-3768.
3. Lance Armstrong Foundation (LIVESTRONG). Rechis R, BeckjordEB et.al. The Essential Elements of Survivorship Care: A LIVESTRONG Brief. http://livestrong.org/pdfs/3-0/EssentialElementsBrief.