Only a minority of adult cancer survivors may have access to specialized survivorship services such as those addressing fertility and sexual health issues, and having survivorship standards in place may help cancer centers better provide services that meet the distinct needs of these patients, according to a recent study published by Stal et al in JAMA Network Open. The findings demonstrated the value of American College of Surgeons’ survivorship accreditation standards.
Background
The number of adult patients surviving cancer is expected to reach 23 million by 2032. The needs of this patient population are continuing to grow and are poorly understood and addressed. Adult cancer survivors often require distinct survivorship services focused on long-term well-being.
Since 2015, the American College of Surgeons Commission on Cancer accreditation standards have incorporated survivorship care. Beginning in 2021, cancer centers have been required to provide a survivorship program to adult patients who are being treated for cancer with a high likelihood of being cured. Commission on Cancer–accredited cancer care facilities currently treat over 74% of all patients with cancer across the United States.
“Treatment throughout the continuum of cancer care, including through survivorship, is paramount to help patients achieve optimal clinical outcomes,” explained co–study author Timothy Mullett, MD, MBA, FACS, Medical Director of the Markey Cancer Center Networks at the University of Kentucky and Chair of the Commission on Cancer. “We know that adult cancer survivors may develop a variety of late physical and psychosocial effects from cancer treatment that should be addressed with evidence-based care. Treatment should not end once cancer has been cured,” he stressed.
Study Methods and Results
In the recent study, the investigators analyzed the prevalence, types, and outcomes of cancer survivorship services available at Commission on Cancer–accredited cancer care facilities—with the goal of determining how cancer programs implement their survivorship services, the key challenges the facilities have faced, and what additional resources may aid in improving survivorship services. They sought to establish a national benchmark for survivorship care delivery at Commission on Cancer–accredited cancer care facilities.
Among approximately 1,400 eligible programs, 27.4% (n = 384) of the Commission on Cancer–accredited cancer care facilities responded to a survey, representing all geographic regions and Commission on Cancer program categories—including academic and community programs. The investigators asked the programs to identify whether they offered their patients cancer care delivery, clinical care, and psychosocial services. They discovered that 87.2% (n = 335) of the programs agreed that the 2021 survivorship standard implemented by the Commission on Cancer helped advance their institution’s survivorship programs.
The services most available to cancer survivors included screening for new cancers (87.5%), nutritional counseling (85.3%), and referrals to specialists (84.7%). These survivorship services were usually delivered by cancer treatment teams (63.3%) rather than specialized survivorship clinics (31.3%), whereas access to specialized survivorship clinics was more common in the pediatric cancer community. Such clinics were found to be particularly resource intensive, and having survivorship care delivered directly by cancer treatment teams may have been more feasible for the large number of adult cancer survivors requiring care.
Nonetheless, survivorship services that addressed sexual health (57.3%) and fertility (56.9%) were least offered to patients—indicating a need to prioritize these services and discuss barriers to care like limited insurance coverage, suboptimal access to specialists, and more training to better aid oncology providers in discussing these issues with their patients. The programs reported that the most critical barriers to patients accessing survivorship services were a lack of referrals to survivorship programs by treating oncologists and low patient awareness of survivorship services available.
Conclusions
“We found that most institutions actually have a reasonable number of survivorship services available to their patients—that’s encouraging because it means we have a foundation to work with when trying to advance survivorship care,” highlighted senior study author David R. Freyer, DO, MS, Director of the Cancer Survivorship Programs at the Children’s Hospital Los Angeles and the University of Southern California (USC) Norris Comprehensive Cancer Center. “Where we started to see differences is in which specific services were available and how institutions provide them,” he added.
The investigators emphasized that understanding the landscape of these services may contribute to identifying gaps, strengths, and interventional opportunities for improving survivorship care among the growing population of cancer survivors.
“Our goal is to help institutions advance survivorship programs on the ground. This research demonstrates good participation already in survivorship care at [Commission on Cancer]-accredited facilities, so we’re definitely not starting from zero. That’s the good news. The important question is: how do we build on that and help institutions expand the services they offer, enhance their quality, and increase uptake by the survivors themselves?” Dr. Freyer underscored. “The take-home message is that the [Commission on Cancer] standards work and are a very important quality metric. We believe that current and future … survivorship standards can provide an effective framework for advancing facility-level survivorship care,” he suggested.
“We look forward to using the results of this study, and others [that] follow, to improve the effectiveness of our critical survivorship standards. The [Commission on Cancer] strives for all of our programs to realize the value of survivorship care for our patients,” concluded Dr. Mullett.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
