ASCO Issues Clinical Expert Statement on Cancer Survivorship Care Planning
Efforts at implementing survivorship care plans have met with limited success in oncology practice, in part due to the time required to complete survivorship care plans, lack of role clarity, and lack of reimbursement for time to complete the documents. In response, ASCO convened a Survivorship Care Planning Workgroup to identify essential survivorship care plan components and develop a revised ASCO survivorship care plan template with the aim of overcoming barriers to implementation. The resultant template and ASCO clinical expert statement was published in the Journal of Oncology Practice by Mayer et al.
The main elements of the ASCO statement are summarized below, consisting of recommendations regarding components of the treatment summary and follow-up care plan that constitute the survivorship care plan. The new survivorship care plan template is available online at jop.ascopubs.org The recommendations focus on elements of survivorship care plans that are “both essential and feasible to collect” and include much less detail than prior ASCO templates, thus addressing barriers associated with time required for completion of survivorship care plans.
The sharper focus of the new recommendations ensures that necessary information is collected and communicated, but also means that the survivorship care plan document alone will not be sufficient to address all concerns and needs of survivors. The authors noted that “ASCO and other organizations could develop resource toolkits for survivors as supplements to the information provided in the [survivorship care plan].”
Key Components of Treatment Summary
- Contact information of the treating institutions and providers
- Specific diagnosis (eg, breast cancer), including histologic subtype (eg, non–small cell lung cancer) when relevant
- Stage of disease at diagnosis (eg, I to III)
- Surgery (yes vs no). If yes: surgical procedure with location on the body; date of surgery (year required, month optional, day not required)
- Chemotherapy (yes vs no). If yes: names of systemic therapy agents administered (listing individual names rather than regimens); end date of chemotherapy treatment (year required, month optional, day not required)
- Radiotherapy (yes vs no). If yes: anatomic area treated with radiation; end date of radiation treatment (year required, month optional, day not required)
- Ongoing toxicity or adverse effects of all treatments received (including those resulting from surgery, systemic therapy, or radiotherapy) at the completion of treatment; any information concerning the likely course of recovery from these toxicities should also be covered.
- For selected cancers, genetic or hereditary risk factors or predisposing conditions and genetic testing results if performed.
Key Components of Follow-up Care Plan
- Oncology team member contacts, with location of the treatment facility (repeat if separate document)
- Need for ongoing adjuvant therapy for cancer including: adjuvant therapy name, planned duration, and expected adverse effects
- Schedule of follow-up–related clinical visits (presented in table format to include who will provide follow-up visits and how often and where visits will take place)
- Cancer surveillance tests for recurrence (presented in table format to include who is responsible for ordering or carrying out the tests, the frequency of testing, and where testing will take place)
- Cancer screening for early detection of new primary malignancies; to be included only if different from the general population (presented in table format to include who is responsible for carrying out tests, frequency of testing, and where testing will take place)
- Other periodic testing and examinations. Rather than outlining specific testing, the expert group suggests inclusion of a general statement to “continue all standard non–cancer-related health care with your primary care provider, with the following exceptions: [if there are any].”
- Possible symptoms of cancer recurrence. Rather than including a list of possible symptoms, the group suggests inclusion of the general statement: “Any new, unusual, and/or persistent symptoms should be brought to the attention of your provider.”
- A list of likely or rare but clinically significant late or long-term effects that a survivor may experience based on his or her individual diagnosis and treatment if known (including symptoms that may indicate the presence of such conditions)
- A list of items (eg, emotional or mental health, parenting, work/employment, financial issues, and insurance) should be covered with standard language stating that survivors have experienced issues in these areas and that the patient should speak with his or her oncologist and/or primary care provider if having related concerns; a list of local and national resources to assist the patient in obtaining proper services should be included.
- A general statement emphasizing the importance of healthy diet, exercise, smoking cessation, and alcohol use reduction may be included; statements may be tailored if particularly pertinent to the individual patient.
Pilot Study of New Survivorship Care Plan Template
In a pilot study of the new survivorship care plan template including 45 completed survivorship care plans at 11 practice sites, the following items were rated on a scale of 1 (strongly disagree) to 5 (strongly agree) by personnel completing the survivorship care plan: survivorship care plan was easy to complete (mean score = 3.5, range = 1–5); time to complete survivorship care plan was reasonable (mean score = 3.5, range = 1–5); clear what information was needed (mean score = 3.9, range = 3–5); easy to obtain information for survivorship care plan (mean score = 4.1, range = 2–5); template includes important elements for survivorship care plan (mean score = 4.5, range = 3–5); information is sufficient for survivorship care plan (mean score = 4.1, range = 3–5); and template will be useful in discussing follow-up care plans (mean score = 4.7, range = 3–5).
The average time to complete the survivorship care plan was 30 minutes (range = 10–75 minutes). Among the 11 sites, the document was completed by a nurse practitioner at 4, nurse at 3, nurse with administrator or clerical personnel at 2, physician at 1, and social worker at 1.
Deborah K. Mayer, PhD, of UNC Lineberger Comprehensive Cancer Center, is the corresponding author for the Journal of Oncology Practice article.
Claire F. Snyder, PhD, reported stock or other ownership with Immunomedics, Meck, Oncolytics, Biotech, and Express Scripts; a consultant or advisory role with Walgreens (institutional); and research funding from Wellpoint (institutional) and Genentech.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
