Background: Survivorship care plans (SCPs) have played an important role in cancer care for over a decade and are included in the quality metrics or accreditation standards of several institutions, including the American College of Surgeons Commission on Cancer (ACS CoC). However, in May 2019, following a reduction in CoC SCP standards for 2018, the ACS CoC announced that SCPs would no longer be included as an accreditation requirement. This announcement sheds light on the insurmountable challenges cancer programs face when implementing SCPs and the continued need to better understand these challenges to identify solutions, particularly considering the increasing complexity of cancer treatment and rapid advancement in immunotherapies.
Objectives: To investigate the SCP implementation practices and challenges as part of quality metrics or accreditation standards among community cancer programs to inform future accreditation standards, education, and technical assistance.
Methods: We performed a secondary analysis on the results of a survey distributed to approximately 700 cancer programs across the nation. This survey was completed by 93 community cancer centers, including academic medical centers, freestanding cancer centers, community hospitals, and private practices. For the purposes of the secondary analysis, the data were cleaned to reflect only complete responses to questions regarding institutional requirements of SCPs as part of the CoC or another accreditation process (n = 75). Descriptive analysis was then performed to identify key themes among this subset of survey responses.
Results: Of the 75 respondents who indicated their institution requires SCPs as part of the CoC or another accreditation process, only 20% (n = 15) indicated that they “always” provide cancer patients with SCPs. Fifty-seven percent (n = 43) indicated that they provided SCPs “very often,” 20% indicated that “sometimes” SCPs were provided (n = 15), and 1 respondent indicated that SCPs were “never” provided. Nonteaching community hospitals comprised 37% and academic medical centers 47% of respondents who selected “very often” and “sometimes,” respectively. Among the respondents who indicated that SCPs were required as part of accreditation and who indicated the staff responsible for creating SCPs (n = 68), the most common disciplines named were advance practice providers (43%, n = 29), navigators (32%, n = 22), and nurses (15%, n = 10). Additionally, of the respondents who indicated that SCPs were required as part of accreditation and who explained why immunotherapy patients did not receive a care plan (n = 38), 24% indicated the primary reason was patients not adhering to follow-up visits, and 21% indicated lack of staffing infrastructure needed to create SCPs. Less common challenges among this group of respondents included poor reimbursement, technology issues, and lack of measurable outcomes.
Conclusions: These findings align with previous research showing that accreditation standards do not always translate to full compliance with providing SCPs to cancer patients due to various barriers. Our results highlight specific barriers (eg, patient adherence, staffing infrastructure) and target audiences (eg, academic medical centers, advance practice providers) who may be wellsuited for educational programming or technical assistance, and who should be considered in the development of future quality metrics or accreditation standards.
Disclosure: Support for the original survey was provided by Bristol-Myers Squibb, AbbVie, Celgene, Novartis, Pharmacyclics, and Takeda Oncology.
- Association of Community Cancer Centers. Elevating Survivorship: Results from Two National Surveys. www.accc-cancer.org/docs/documents/oncology-issues/articles/mj19/mj19-elevating-survivorship.pdf?sfvrsn=e2b4783_7.