As the saying goes, “Timing is everything.” And so it is with the recently released ASCO Clinical Expert Statement on survivorship care planning.1 Although there has been extensive discussion and debate about the use of survivorship care plans since the publication of the 2005 Institute of Medicine report “From Cancer Patient to Cancer Survivor,” there have been few data, or even little consensus, about how best to proceed with implementing these documents.
The published information that does exist focuses on the many barriers to development and use of this communication tool. The list is long and includes a variety of issues—the time-consuming process of preparing a survivorship care plan, the lack of clarity about whose responsibility it is to maintain the document, the lack of consensus about what should be in it, the lack of reimbursement for its preparation, and the lack of compatibility of existing templates with electronic health records. And so the list goes, but we are at a point in time when a number of these obstacles can be addressed, and the ASCO expert statement—reviewed in this issue of The ASCO Post—allows us to reset our thinking about how to proceed.
A Gradual Effort for All
This is not to say that the barriers cited don’t exist or that they are insignificant, but rather that it’s time to refocus and seize an important opportunity to take a positive step forward and develop a progressive plan for the implementation and evaluation of this ASCO care plan template. To be sure, moving forward will not occur at warp speed, nor is the template an all-or-nothing proposition. The effort will be a gradual one for all of us. Success will be linked to the maturity and connectivity of our electronic health record systems, coupled with the American College of Surgeons Commission on Cancer standard for the Survivorship Care Plan, and informed by the evidence developed through evaluation of the ASCO template across provider groups and practice types.
Wisely, and with attention to its membership, the Commission on Cancer has recalibrated its initial guidance requiring completion and delivery of survivorship care plans. This change is based on a readiness survey of its member organizations, in which only 37% of respondents were “completely confident” that their program would be able to implement the standards in 2015.
The Commission on Cancer has now published a communication revising its initial standard for Commission on Cancer hospitals to a phased-in approach that sets out a plan in which hospitals can incrementally strive to provide all appropriate survivors with a survivorship care plan over a 5-year period.2 In the same communication, the Commission on Cancer highlights the use of the ASCO template as a minimal data set for compliance.
One Resource Among Many
As we move into 2015, let’s not make the survivorship care plan the tail wagging the dog. It is not all of survivorship care, but rather it is a tool for improving communication and care. Its utility will evolve as we learn more about documenting transitions in care and as our electronic medical records become more robust.
The ASCO care plan highlights this point by its brevity. It is not attempting to be all things to all constituents. For example, it doesn’t take the place of the medical record or a conversation between the survivor and oncology care provider (be it MD or NP/PA), nor is it intended to provide all the information needed by the primary care provider when a symptomatic cancer survivor is in his/her office. It is one resource among many for our cancer survivors, families, and health professionals.
Looking Forward
So, to continue looking forward, let’s focus on actions to be taken. First, in the spirit of open source software, it would be wonderful to share information about how the ASCO template is used and adapted by various practice configurations and across patient populations. This effort would be a nice addition to the growing ASCO Survivorship Compendium. Second, we need to conduct research to better understand the utility of the ASCO template and the health outcomes that are improved by its use. And, third, we should work toward a formal effort to join the oncology community with the primary care community to develop an educational curriculum that ensures a knowledge exchange about the ongoing care of cancer survivors.
Remember, timing is everything. ASCO, along with many other professional and patient organizations, is poised to improve survivorship care planning, and the new template is an important step forward. ■
Disclosure: Ms. McCabe reported no potential conflicts of interest.
References
1. Mayer DK, Nekhlyudov L, Snyder CF, et al: American Society of Clinical Oncology clinical expert statement on cancer survivorship care planning. J Oncol Pract 10:345-351, 2014.
2. American College of Surgeons: Accreditation Committee clarifications for standard 3.3 survivorship care plan. Available at https://www.facs.org/publications/newsletters/coc-source/special-source/standard33. Accessed November 25, 2014.
Ms. McCabe is Director of the Cancer Survivorship Initiative, Memorial Sloan Kettering Cancer Center, New York.
