A new template published by the American Society for Radiation Oncology (ASTRO) standardizes and streamlines the creation of patient-focused plans for long-term cancer survivor care following radiation therapy. As the number of cancer patients and survivors in the United States continues to grow—the American Cancer Society predicts a 37% increase in the number of cancer patients surviving 5 years or longer over the next decade—so does the need for greater attention to long-term survivorship care. The template and related research papers1,2 are published in Practical Radiation Oncology.
Template Creation
The template was developed to coordinate post-treatment care for cancer survivors among the various contributors to their care, including primary care providers and oncology specialists (radiation, medical, and surgical), as well as patients themselves.
The framework also enables practices to meet new accreditation requirements set by the American College of Surgeons Commission on Cancer (CoC). In response to a 2006 recommendation from the Institutes of Medicine that cancer patients be provided with a survivorship care plan following treatment, CoC issued a mandate that cancer programs provide survivorship care plans for all curative cancer patients by 2019 to maintain accreditation.
The new CoC requirement may necessitate changes for the majority of radiation oncology programs, according to data from a March 2014 survey of ASTRO members, which included nearly all practicing radiation oncologists in the United States. The survey found that only 40% and 19% of respondents used survivorship care plans for curative and palliative patients, respectively. Primary barriers to implementation included cost and the lack of a standardized, comprehensive survivorship care plan framework suited to patients who received radiation. Nearly 80% of the radiation therapy providers who reported using survivorship care plans relied on a framework developed internally within their practice, indicating that different patients may receive different types of information depending on where they receive treatment.
“This two-page template facilitates consistency in survivorship care plans across the discipline and also reduces the time and effort required by providers to complete each individual plan,” said Ronald Chen, MD, MPH, Associate Professor in Radiation Oncology at the University of North Carolina at Chapel Hill. “The field of radiation oncology has a long tradition of creating treatment summaries for each patient, even before the Institute of Medicine recommended survivorship care plans in 2006. This radiation oncology–specific template will serve a dual purpose as both a traditional radiation oncology treatment summary and a plan for survivorship care that meets CoC requirements, thus reducing the burden on radiation oncologists from having to create two documents for each patient.”
Dr. Chen was the Chair of ASTRO’s Clinical, Translational, and Basic Science Advisory Committee, the group that examined current adoption levels of survivorship care plans and developed the template to standardize them in the future.
Template Content
While many radiation oncologists provide their patients with follow-up material such as diagnosis and treatment summaries; contacts for ancillary services such as financial or nutritional counseling; and information on potential late treatment effects, the survivorship care plan template coordinates these components in a central document. The template includes both elements required by CoC in survivorship care plans, namely a summary of past treatment and directions for future care.
The treatment summary outlines the survivor’s diagnosis and stage information; treatment details such as the site, dosage, and schedule of radiation therapy; and contact information for providers who delivered the treatment. The plan for follow-up care covers anticipated toxicities from radiation therapy; expected course of recovery from treatment-related toxicities; possible functional and/or social limitations; recommendations for preventative measures and behaviors; cancer information resources; and referrals to supportive care providers. ■
References
1. Chen RC, Hoffman KE, Sher DJ, et al: Development of a standard survivorship care plan template for radiation oncologists. Pract Radiat Oncol 3:e24-e253, 2015.
2. Koontz BF, Benda R, De Los Santos J, et al: US radiation oncology practice patterns for posttreatment survivor care. Pract Radiat Oncol. October 6, 2015 (early release online).
