Nuts and Bolts of Survivorship Care Plan Explored

Globally, there are 20 million cancer survivors, and the number of survivors is expected to grow because people are living longer as a result of newer and better therapies. Many survivors have little or no understanding of the physical, psychosocial, and economic issues that face them for the rest of their lives. Nurses can play a major role in planning survivorship care to help survivors negotiate the next stages of their lives and enjoy a good quality of life.

At the recent meeting of the Oncology Nursing Society Institute of Learning meeting, Stacie Corcoran, RN, MS, AOCNS, Nurse Leader of the Survivorship Program at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City, discussed the definition of survivorship, the components of a treatment summary and care plan, and how to set up a survivorship program.

To give some idea of the scope of survivorship issues, a 2005 poll by the Lance Armstrong Foundation (LIVESTRONG POLL) found that 53% of about 1000 cancer survivors reported secondary health problems (including pain, sexual dysfunction, relationship problems, fertility issues, fear of recurrence, depression, and financial concerns), and 49% reported that their nonmedical cancer needs were not being met. Seventy percent reported that oncologists failed to offer support for health problems secondary to cancer, and only 30% reported that oncologists were willing to discuss these problems.

To bridge this gap, support has been growing among different agencies (including the American Cancer Society, CDC, and Institute of Medicine) for planning survivorship care.

“We know that cancer and its treatments have a potential wide range of effects, and there is limited information and lack of guidelines for assessment, prevention, and management,” Ms Corcoran said. “The survivorship period offers many opportunities to improve health and quality of life in the domains of physical, social, psychological, and spiritual well-being.”

Survivors can experience long-term psychological and physical sequelae that include late and long-term effects such as fatigue, pain, weight gain, early menopause, anxiety, and depression. Specific issues are associated with different cancer types and treatments; for example, prostate cancer survivors may experience sexual dysfunction, urinary incontinence, and radiation proctitis. Lung cancer survivors may deal with reduced lung function, renal impairment, pain, neuropathy, and cognitive loss.

Essential components of a survivorship care program include screening for new cancers, surveillance for recurrence, identification and interventions for consequences of cancer and treatment, health promotion strategies, and last but not least, coordination of care between specialists and primary care providers.

There are several models for survivorship care, but having a nurse practitioner as provider for the posttreatment follow-up offers some advantages. This facilitates shared care and coordinates transition from acute curative therapy to short- and long-term follow-up. A nurse practitioner can coordinate care and ensure continuity by communicating a plan of care to the patient’s primary care provider.

Centers such as MSKCC are in a better position to offer survivors expanded patient services that may not be available at smaller and/or more rural centers. But other resources in communities may offer support, such as local chapters of the American Cancer Society and CancerCare, support groups for specific cancers, and even the local health club.

There is no “one prescription fits all” for survivorship care, and different centers handle it differently. But in general, after primary cancer treatment, patients should be provided with a comprehensive summary and follow-up care plan that is made clear to them. The survivorship care plan should be written by the principal providers of oncology treatment and be reimbursable by third-party payers of healthcare.

The particulars of the plan should include tumor type and characteristics, treatments received, and contact information for the care provider and institution. Guidelines for surveillance can be found on several American Society of Clinical Oncology (ASCO) Web sites for specific tumor types. ASCO provides templates for survivorship care in practice, and other organizations have similar templates/models (ie, LiveStrong care plan (http://livestrongcareplan.org).

MSKCC offers a range of video presentations by experts that address physical, social, practical, and personal concerns of cancer survivors, Ms Corcoran said. These videos are available free of charge on MSKCC’s Living Beyond Cancer Web site, the MSKCC Survivorship YouTube Channel, and the iTunes MSKCC Survivorship Podcast station.