Background: The impetus to create a survivorship program at our community hospital–based cancer center was our desire to attain NAPBC accreditation. NAPBC Standard 2.20: a comprehensive breast cancer survivorship care process, including a survivorship care plan (SCP) with accompanying treatment summary, is in place within 6 months of completing active treatment and no longer than 1 year from date of diagnosis. The IOM in 2005 recommended a treatment summary and follow-up care plan be given to every cancer patient, and it should be clearly explained. Survivors typically do not remember important details of their diagnosis, treatment, and long-term effects. They are searching for meaning in their lives and struggle with a sense of control following the life-altering experience of cancer.
Objectives: To develop a survivorship program that meets the NAPBC accreditation standard; delivers evidence-based, patient-centered care; and is financially sustainable.
Methods: 1) Work group was established in late 2014. We evaluated many software programs for developing a survivorship care plan. We needed one that would interface with our cancer registry, Metriq. Journey Forward was chosen as it communicates with Metriq. 2) All eligible breast cancer patients stage 0 to III were deemed eligible. 3) Our rationale for a nurse practitioner (NP)-driven program has been supported by return on investment (ROI); program billable at a level 5 based on face-to-face time spent with patient. NP scope of practice includes ordering further workup (labs, imaging) and initiating referrals to address patients’ current needs and issues. 4) NCCN distress tool is given on first follow-up visit (after active treatment ended) to reassess needs/issues. NP and navigator developed a survivorship pathway map to standardize the process. 5) Implementation was to start in 2015 and review process quarterly. 6) Social worker identified financial, social, communication, and logistical barriers and added resources/referral sites for our SCP. 7) Tracked NP, navigator, and oncology nurse time spent completing SCP. Validated that this is billable for a level 5 by NP, which will assist in making program sustainable.
Results: 1) NP tracked all eligible breast patients for 2015. A total of 54 patients were considered eligible: 17 (31.5%) SCPs were completed, 8 (14.8%) were HER2+ and are still under treatment, 9 (17%) were late, and 20 (37%) were still to be completed within the 1-year time frame. 2) The number of distress tools completed of all eligible patients with SCPs in place was 13 of 17 (76%). 3) Overall cost of SCP development was $148. Mean for insurance reimbursement ~$431. ROI: ~$283 for SCP and treatment summary.
Conclusions: An NP-driven survivorship program was developed and has proved to be financially sustainable. The original pathway process for scheduling patients for an SCP visit after active treatment was modified due to documented issues with process. With input from staff, a new standard work order process was implemented. Review of program and data provided us with the realization there needed to be NP time blocked out for a 1-hour prep for each SCP and 1 hour for a survivorship visit. Currently we do not have a method to monitor effectiveness of a survivorship visit. We have been assessing tools to measure effectiveness, ie, patient education/knowledge and patient satisfaction. This will add to the body of data needed to promote future programs of this nature.
