Revised Survivorship Care Plan Template Reduces Time and Resource Commitments

A revised survivorship care plan template addresses obstacles that have limited the use of survivorship plans in clinical practice, suggested an American Society of Clinical Oncology (ASCO) expert panel headed by Deborah K. Mayer, PhD, MSN, RN, Professor of Nursing and Director of Survivorship Care, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill.

“For the most part, we think the revised template addresses the major barriers that have limited use of survivorship care plans in oncology practice,” Dr Mayer told Value-Based Cancer Care (VBCC). “We’re encouraged by the feedback we received from the study participants, and we plan to monitor use of the template and possibly make other modifications that we might identify.”

In its 2005 report, “From Cancer Patient to Cancer Survivor: Lost in Transition,” the Institute of Medicine (IOM) outlined the key components of survivorship care in the United States. The IOM also called for the development and routine use of a survivorship plan as part of cancer care, consisting of a treatment summary and a plan for follow-up care.

The revised plan was evaluated in a pilot study of oncology experts who reviewed the template and provided feedback to the expert panel. A summary of the revised template and the responses from pilot participants was recently published (Mayer DK, et al. J Oncol Pract. 2014;10:345-351).

The pilot study considered the utility of implementing a survivorship care plan at 11 sites, which included a total of 45 plans. On average, the revised template required approximately 30 minutes to implement a survivorship plan in a clinical setting. The study participants gave the new template high marks for incorporating information that is easy to obtain, while covering the essentials of a survivorship plan.

Essentials of a Survivorship Care Plan

The survivorship care plan includes 2 parts, a treatment summary and a care plan, which promote communication between the patient, cancer providers, primary care providers, and any other potential provider.

The expert panel outlined the essential components of a survivorship treatment plan, which include:

1. Contact information for institutions and providers
2. Specific diagnosis, including relevant subtypes
3. Stage of disease
4. Date of surgery, surgical procedure, and location on the body
5. Names of chemotherapy agents administered and end date of treatment
6. Area treated with radiation and end date of treatment
7. Ongoing toxicity or adverse effects of all treatments and likely course of ­recovery
8. Genetic or hereditary risk factors, predisposing conditions, and genetic testing results.

In addition, the panel incorporated the key elements of a follow-up care plan, which is meant to help monitor the care of cancer survivors on an ongoing basis. These key elements include:

1. Contact information for oncology team and treatment facility
2. Name, duration, and potential adverse effects of adjuvant therapy
3. Schedule of follow-up visits
4. Tests for recurrence
5. Early detection screening if different from the general population
6. Other tests and examinations
7. Possible symptoms of cancer recurrence
8. List of long-term effects based on treatment
9. General health promotion.

The oncology expert panel concluded that limiting the template to these essential elements would reduce the time and resource commitments, thereby indirectly addressing the lack of reimbursement for the development and preparation of such a plan.

The panel members also agreed that the essential elements are insufficient, but could be supplemented with resource tool kits for survivors, such as ones developed by ASCO and other organizations.

Care Coordination

The appropriate coordination between oncology and primary care providers will require systemwide commitment and buy-in, the authors noted. Systems and processes must be put in place to handle relevant data from the multiple providers who are involved in the care of patients with cancer.

Those responsible for the survivorship care plan must be clearly defined. The education of primary care providers is essential to their acceptance of these plans. In addition, programs for patients with cancer should establish relationships with primary care providers to refer patients who do not have primary care providers.

Reimbursement

The panel did not specifically address reimbursement, but attempted to address the other barriers in its review of the treatment summary and follow-up care plan.

“By focusing on essential elements and reducing the time burden, the lack of reimbursement for the services may be addressed indirectly,” Dr Mayer told VBCC. “We also have been encouraged by electronic health record vendors’ efforts to facilitate the survivorship care plan process, and we’re hopeful that the functionality will continue to increase.”