Implementing Cancer Survivorship Care Planning Workshop Summary (2007) / Chapter Skim
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2 Suvivorship Care Planning
2 Suvivorship Care Planning
Pages 5-30
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From page 5... ...
Overcoming some of the challenges and barriers to implementation is critical because survivorship care planning is a sentinel project in the drive for quality cancer care. A key message of the report is that the needs and concerns of the large and growing number of cancer survivors cannot be ignored.
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From page 6... ...
In the area of infertility, which is a concern of many cancer survivors, many patients have been told, "You should be happy just to be alive." In this example, potential late effects need to be addressed during treatment planning to help ensure that individuals make informed choices and have an opportunity to lead full, normal lives to the extent possible. Why does cancer care present such a challenge?
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From page 7... ...
None of these strategies is widely available for patients receiving active treatment today. Transition care planning is needed to address issues of coordination of care and quality of care throughout the care trajectory.
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From page 8... ...
The IOM report identified key elements that should be included in the Survivorship Care Plan: · Specific tissue diagnosis and stage; · Initial treatment plan and dates of treatment; · Toxicities during treatment; · Expected short- and long-term effects of therapy; · Late toxicity monitoring needed; · Surveillance for recurrence or second cancer; · Who will take responsibility for survivorship care; · Psychosocial and vocational needs; and · Recommended preventive behaviors/interventions. 1 IOM (Institute of Medicine)
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From page 9... ...
Implementing such comprehensive care planning presents challenges to providers, and some may judge the IOM recommendation premature given the state of the evidence. Evidence is beginning to emerge on the value of this kind of care planning, or guided care, after patients complete their primary treatment.
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From page 10... ...
BlueCross of California conducts regular surveys of primary care physicians, and, in anticipation of the course, a few questions about survivorship care planning were added to the survey. The survey was fielded at about the time of the IOM report's release (November 5, 2005)
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From page 11... ...
The quality of the treatment summaries sent to these primary care physicians was probably somewhat limited, but even so, they did appear to make a difference in how competent primary care physicians felt in terms of following up their survivors. Again, the numbers were small and the physicians participating are not likely to be representative of the population of BlueCross primary care providers in California, but the findings lend some credence to the value of survivorship care plans.
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From page 12... ...
. Handle Manage late health effects transition issues 84% 86% 90% 71% 57% 35% 41% 43% ver ays ver ays Ne Rarely alw Ne Rarely alw Sometimes Sometimes Almost Almost Frequency of receiving summaries FIGURE 2-4 Relationship between confidence of the primary care physicians in managing cancer patients' late effects and receipt of an end-of-treatment summary.
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From page 13... ...
: 7/5/05 10; 8/15/05 3.9 Last CEA 2.0 on 3-10-06 Treatment history (attach relevant treatment summaries) : Surgery Chemotherapy Radiation Other Date(s)
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From page 14... ...
Potential late effects of treatment (e.g., cardiovascular, skeletal) : Surgery: Bowel problems, such as diarrhea, fecal leakage/incontinence, constipa tion, bowel obstruction, hernia, pain, psychological distress Chemo/Biotherapy: fatigue, peripheral neuropathy Patient should report these signs and symptoms if persistent: Diarrhea, constipation, pain with urination, erectile dysfunction, painful intercourse, infertility, numbness or tingling in hands or feet Recommended surveillance for late effects of treatment(s)
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From page 15... ...
What are the barriers to routine generation of treatment summary and survivorship care plans? There are some specialties, for example surgery and radiation oncology, that routinely create an operative note or radiation treatment summary note.
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From page 16... ...
Deborah Schrag An ASCO initiative, "Treatment Plan/Treatment Summary" that is under way is integral to survivorship care planning. The purpose of this
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From page 17... ...
· Burden of documentation reported by oncologists · Patient demand as expressed by the advocacy community · Pay for performance initiatives · Electronic medical record vendor requests · Lessons on fragmentation of care from 2005 hurricanes initiative is to standardize a format for medical oncologists to prepare a treatment plan when patients embark on a new course of therapy. This treatment plan summary would document the diagnosis, purpose of treatment, agent, schedule, anticipated toxicities, and the plan for reevaluation.
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From page 18... ...
Patients in the midst of their cancer treatment were dislocated without any documentation of their diagnosis and treatment. Treatment Summaries The treatment summary is responsive to evidence of problems in three important interrelated domains of quality: 1.
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From page 19... ...
Treatment Plans As a complement to the treatment summary that is prepared at the conclusion of treatment, ASCO is also working on a template for a treatment plan that would be prepared at the onset of chemotherapy and reviewed with patients. This plan would include: · Summary information, such as regimen name and administration plan (e.g., FOLFOX with Bevacizumab every 2 weeks as an outpatient)
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From page 20... ...
Status of Treatment Plans/Treatment Summaries The ASCO group working on the design of the treatment plan and summary recognized the importance of both documents, but in discussing the concept with practicing medical oncologists, realized that it would be difficult to have both documents adopted simultaneously. The ASCO group
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From page 21... ...
Was it more important to first encourage medical oncologists to adopt treatment planning to help ensure patients' informed decision making, or should the completion of treatment summaries be the first priority to improve the survivorship care transition? The ASCO planning group decided to initially focus on the treatment summary with the ultimate goal of having two integrated documents that would span the care trajectory.
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From page 22... ...
It is at these times that having the treatment summary dovetails with survivorship care planning. In oncology, these transitions probably account for nearly 50 percent of all chemotherapy treatment.
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From page 23... ...
initiative that requires providers to wear buttons that say, "Ask me if I have washed my hands." Advocacy organizations have promoted the idea of survivorship care plans, and as patients become informed and start asking for these documents, physicians will be in a position to meet their expectations. Adoption would rapidly occur if health care payers asked for treatment summaries and linked their receipt to reimbursement.
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From page 24... ...
Dr. Lee Newcomer, of the UnitedHealth Group, suggested that the treatment summary and care plan have great potential to save time.
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From page 25... ...
Dr. Ferrell expressed some concern that the ASCO plans for a treatment plan and summary appeared to be reducing survivorship care planning to physical issues and drugs and to also be focused on reimbursement issues.
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From page 26... ...
Starting with a two-dimensional paper template is necessary because the majority of medical oncology practices remain paper based. Estimates are that 30 to 40 percent of medical oncologists do not use a computer for their medical records.
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From page 27... ...
Dr. Schrag agreed and suggested that providers will probably need to have both carrots and sticks to implement survivorship care planning.
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From page 28... ...
Ms. Susan Leigh, a cancer survivorship consultant, indicated that, from an advocacy perspective, survivorship care planning must be viewed as a team effort not limited to doctors.
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From page 29... ...
The Cancer Quality Alliance is therefore a logical place for both development and dissemination activities relating to treatment plans and summaries.
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From page 30... ...
Dr. Loria Pollack of the Centers for Disease Control and Prevention concluded the discussion by pointing out that one of the potential uses of a treatment plan is to assist patients in treatment following a disaster.
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