In the next 7 years, the US population of cancer survivors is expected to reach 18 million people.1 However, a decade after a pivotal Institute of Medicine (IOM) report called for better implementation of cancer survivorship care plans (SCPs), the evidence base for SCPs’ benefits remains immature and implementation of the IOM report’s recommendations has been inconsistent. The American Society of Clinical Oncology (ASCO) has released newly streamlined SCP templates—an important step toward implementation. But more has yet to be done, and oncology nurses will be at the forefront of those efforts during what one expert calls the coming tsunami of baby boomer cancer survivors.
Survivorship care plans help patients and their primary care providers understand the posttreatment late effects that might occur and what surveillance and monitoring should be undertaken for early detection and management. ASCO released updated SCP templates in Spring 2015, including a generic template and cancer-specific templates for patients completing treatment for breast, colorectal, and prostate cancers; non-small cell lung cancer; small cell lung cancer; and diffuse large B-cell lymphoma. The ASCO survivorship care planning templates include a component for documenting whether or not a patient received radiation therapy, which is associated with ongoing chronic toxicity risks after treatment is complete and late effects that can emerge months or years after therapy.
“This cleaner, simpler form will help health care professionals get survivorship care plans into the hands of patients,” says ASCO Survivorship Care Plan Working Group Chair Deborah K. Mayer, PhD, RN, AOCN®, FAAN, an advanced practice oncology nurse who is a professor of nursing and the director of Cancer Survivorship at the University of North Carolina-Chapel Hill’s Lineberger Comprehensive Cancer Center, in Chapel Hill, North Carolina. “At the end of their treatment, patients should expect to receive a survivorship care plan, but if they don’t get one, they should ask their doctor or nurse for one.”
Many patients do not realize that their cancer care should not end with primary treatment, experts say. The initial written patient treatment plan is the first bookend of care, Mayer says. “The SCP should be the other bookend to the treatment plan.”
The IOM’s 2005 pivotal report From Cancer Patient to Cancer Survivor: Lost in Transition identified four elements for posttreatment care planning2:
- Prevention of recurrent or new cancers
- Surveillance for detection of recurrent or new cancers
- Treatments for the late effects of cancer and cancer treatments
- Coordination between primary care providers and specialists
Unfortunately, several barriers and challenges have complicated and slowed implementation of the IOM report’s deceptively simple goals in the decade since its release, experts tell Oncology Nurse Advisor. The evidence base is still immature, making it unclear which models or approaches might ultimately work best. In a recent review of survivorship care plans, Mayer and coauthors found only four randomized controlled trials “that avoided many biases associated with observational studies.”3
It is too soon to know whether there are patient populations that are more—or less—likely to benefit from SCP, Mayer notes. “We need more outcome data.”