Survivorship care plans (SCPs) have been in the realm of cancer care for years now, but the research around the benefit of SCPs is inconclusive, and providers still struggle with their implementation, according to Deborah Mayer, PhD, RN, Director of Cancer Survivorship at the University of North Carolina at Chapel Hill.
“Our focus has been on figuring out how to develop and implement these, but I think in many ways we’ve lost focus on these being tools to address the unmet needs of survivors,” she said at the ASCO Cancer Survivorship Symposium. “But part of this is really basic patient education: giving patients written materials about what it is we’re planning on doing.”
In 2012, the Commission on Cancer recommended full implementation of SCP delivery by 2015. Around the same time, there was an increased responsiveness in the literature to the topic of survivorship care, and a number of systematic reviews of SCPs reported a general consensus: “patients and primary care providers like them,” she said. But randomized controlled trials have yet to display a significant benefit.
Changing practice to get people to incorporate something new into their workflow has been the biggest challenge to making SCPs standard practice. “One of the reasons given for that is the lack of evidence that they make a difference,” she said. “But if you really take that stance, then show me the evidence for pain as the fifth vital sign, or a post-op note, or a discharge summary, because those don’t exist either.”
According to Dr Mayer, SCPs clearly need to address some basic principles of patient education, but the question is, what are they? What is the minimum necessary information that both patients and providers need to know what might come next, or what they should be concerned about? In other words, what active components of the care plan have the biggest bang for your buck?
Research has shown that patients prefer to receive their care plans earlier than at the end of treatment. “We found they don’t want it on their last day of treatment because there’s too much going on and it’s too confusing,” she noted.
How the care plan is delivered is another vital step. SCPs should not be mailed or handed to a patient as they walk out of the clinic. It should be used as a tool to discuss the transition of care and as a mechanism to move the patient into the survivorship phase; it should help to foster the discussion about what’s next.
SCPs were meant to be a process and should be reviewed on a periodic basis with the eventual hope of improving patient outcomes. But if the delivery and the communication components are not even being met, it’s hard to expect survival improvements 5 or 10 years down the road, Dr Mayer noted.
“We know survivors have a lot of unmet needs,” she added. “This is a way—just like distress screening—to identify them and match patients with the right referrals to the right resources in order to help them deal with this transition into no treatment, for those lucky enough to be in that category.”