ASCO Clinical Expert Statement on Cancer Survivorship Care Planning

By Matthew Stenger
December 15, 2014

Efforts at implementing survivorship care plans have met with limited success in oncology practice, in part due to the time required to complete them, the lack of role clarity, and the lack of reimbursement for time to complete the documents. In response, ASCO convened a Survivorship Care Planning Workgroup to identify essential components of survivorship care plans and develop a revised ASCO template with the aim of overcoming barriers to their implementation. The resultant “ASCO Clinical Expert Statement on Cancer Survivorship Care Planning” is reported in the Journal of Oncology Practice by Mayer and colleagues.¹ Deborah K. Mayer, PhD, of UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, is the corresponding author for the JOP article.

The main elements of the ASCO statement are summarized here, 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 at asco.org/practice-research/asco-­cancer-survivorship-compendium.

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 the time required for their completion. The sharper focus of the new recommendations not only 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, “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

• Contact information of the treating institutions and providers
• Specific diagnosis, including histologic subtype when relevant
• Stage of disease at diagnosis
• 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 at the completion of treatment. 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

• Oncology team member contacts, with location of the treatment facility
• Need for ongoing adjuvant therapy for cancer, including adjuvant therapy name, planned duration, and expected adverse effects
• Schedule of follow-up–related clinical visits
• Surveillance tests for cancer recurrence
• Cancer screening for early detection of new primary malignancies (if different from the general population)
• Other periodic testing and examinations. Rather than outlining specific testing, the expert group suggested 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 suggested 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 effects that a survivor may experience based on his or her individual diagnosis and treatment if known
• A list of items (eg, emotional or mental health, parenting, employment, financial issues, and insurance) should be covered, with standard language stating that survivors have experienced issues in these areas and that patients should speak with their oncologist and/or primary care provider if having related concerns. A list of local and national resources to assist patients in obtaining proper services should be included.
• A general statement emphasizing the importance of a healthy diet, exercise, smoking cessation, and alcohol use reduction may be included. Statements may be tailored if particularly pertinent to individual patients.

Pilot Study

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; Time to complete survivorship care plan was reasonable—3.5; Clear what information was needed—3.9; Easy to obtain information for survivorship care plan—4.1; Template includes important elements for survivorship care plan—4.5; Information is sufficient for survivorship care plan—4.1; and Template will be useful in discussing follow-up care plans—4.7.

The average time to complete the survivorship care plan was 30 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. ■

Disclosure: For full disclosures of the study authors, visit jop.ascopubs.org.

Reference

1. Mayer DK, et al: American Society of Clinical Oncology clinical expert statement on cancer survivorship care planning. J Oncol Pract 10:345-351, 2014.

See commentary by Mary McCabe, RN, MS, here.

 

---

Related Articles