Download Survivorship Essentials for Practice Administrators

Survivorship Essentials for
Practice Administrators
Christina Bach, MBE, MSW, LCSW, OSW-C
Carolyn Vachani, MSN, RN, AOCN
Before we get started...
● How many of you represent a Commission on Cancer (CoC)
accredited practice?
● How many of you represent a practice that is not CoC
accredited?
● How many of you have a survivorship clinic affiliated with your
practice?
● How many of you have a plan for providing survivorship care or
transitioning your oncology patients back to primary care after
completion of their cancer treatment?
What is A Cancer Survivor?
● A person with cancer is considered a “survivor” from the time of
diagnosis.
● Many groups include caregivers, family and friends in the
definition as well.
● However, in clinical practice, survivorship care typically begins
at the end of active treatment.
● This difference in definitions may leave some behind when it
comes to survivorship needs.
What Does a Survivor
Experience?
• Society, family and friend’s
expectations.
• Their own expectations.
In Reality
• Feel that their safety net has
been taken away.
• Fear of what is to come and
what to expect.
• When will I feel “normal”
again?
What Does a Survivor Need?
● Support during the transition to survivor and beyond.
● Education about life after cancer:
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Physical effects.
Practical concerns: financial, work, insurance.
Fear and anxiety of recurrence.
Importance of healthy lifestyle.
Preventive medicine.
● Plan for follow up care, concerning symptoms to report .
What Is Survivorship Care?
Common Physical Concerns
● Fatigue
● Neuropathy
● “Chemo Brain”
● Fertility concerns
● Sexuality & intimacy
● Pain
concerns
● Weight gain or loss
● Lymphedema
● Risk of osteoporosis
● Menopause symptoms
Common Psychosocial Concerns
● Worry, anxiety and
depression
● Fear of recurrence
● PTSD
● Relationships / dating
● Changes in physical abilities
● Body image/appearance
changes
● Changes in what you
thought your future would
look like
● Insomnia
● Job or school issues
● Insurance – health & life
● Financial
What is a Treatment Summary?
● A document that summarizes
the cancer diagnosis &
treatments.
● Relevant pathology results
● Surgery
● Medical therapies (chemo,
hormone, biotherapy)
● Radiation therapy
● No “right way” to do this!
What is a Survivorship Care Plan?
● A survivorship care plan (SCP) is a
document that outlines possible
health risks, psychosocial effects,
financial effects and genetic risk
related to cancer and cancer
therapy.
● How to reduce health risks, when
possible, through healthy lifestyle
and preventive therapies.
● How to monitor for late effects with
your healthcare team.
● Follow up care & other screening.
● Referrals for follow up care and
resources.
Why All the Fuss?
● People have been surviving cancer for many years, but in
recent years the focus on survivorship has increased.
● Over 15 million survivors in the US today = a VOICE!
● Institute of Medicine Report (2006).
● Commission on Cancer accreditation mandates (2015).
Institute of Medicine Report
● Published in 2006 by an expert panel.
● Raises awareness of the medical,
functional and psychosocial
consequences of cancer & cancer
treatment.
● Defines quality health care for survivors
& identifies strategies to achieve this.
● Recommends policies to improve
survivor’s rights.
● Also discusses most PCP’s discomfort
with caring for survivors and the lack of
guidance by oncology teams.
Institute of Medicine Report
●Report recommends:
●More research initiatives.
●Increase awareness of
survivorship issues.
●Increase communication
between providers (oncology,
other specialists & PCP).
●All survivors (& their PCP) should
receive a treatment summary
and survivorship care plan.
●Survivors be active participants
in their care.
Commission On Cancer
● A consortium of 51 oncology professional organizations .
● The CoC accredits over 1500 cancer programs in the US.
● In order to achieve accreditation, programs must meet a set of
standards.
CoC Definition of
Cancer Survivor
● Focuses on a subset of cancer survivors, “eligible patients”
who:
● Are being treated with curative intent.
● Have completed active therapy (other than long term
hormonal treatment).
● All disease sites that fit these criteria are included as
potential “eligible patients.”
● Recommends “eligible patients” receive:
● “A comprehensive care summary and follow up plan that is
also clearly and effectively explained to the patient AND
caregivers.”
CoC Survivorship Mandate
Implementation Goals
● 1/1/16- The program will provide survivorship care plans to
25% of eligible patients.
● 1/1/17- The program will provide survivorship care plans to
50% of eligible patients.
● 1/1/18- The program will provide survivorship care plans to
75% of eligible patients.
● 1/1/19-The program will provide survivorship care plans to
eligible patients.
Other Regulatory Requirements
● NAPBC (National Accreditation Program for Breast Centers)
● TS/SCP in place in < 1yr from tx completion.
● “Process” in place for pts. Stage 0-III.
● QOPI (ASCO Quality Oncology Practice Initiative)
●Focuses on treatment summary after chemotherapy.
● Patient Centered / Oncology Medical Home
●Very few accredited sites.
●Includes survivorship care that mirrors CoC standard.
Oncology Care Model
●Demonstration project through CMS.
●Value based payment model for physician practices
administering chemotherapy.
●Goal: Provide cancer patients with higher quality, better
coordinated care at a lower costs.
●Requires practices to documents a CANCER care plan.
●A survivorship plan is a required component of the cancer
care plan.
●Must include recommendations for follow-up and surveillance,
risk reduction and health promotion.
One Size Does Not Fit All:
Models of Survivorship Care
• Oncology specialist care
• Multi-disciplinary survivorship care
• Disease specific survivorship care
• General survivorship clinic
• Consultative survivorship clinic
• Community generalist model (PCP)
• Shared-care model (oncology/PCP; with/without transition)
http://www.asco.org/practice-research/models-long-term-follow-care
Challenges to Providing
Survivorship Care
● Resources – Tools to provide SCP, EMR integration.
● Personnel – Whose job is it?
● Reimbursement & billing challenges.
● Finding the model for your practice and community.
● What is the PCP’s role in survivorship?
● Is there benefit to SCPs?
Resources for Survivorship Information
● National Coalition for Cancer Survivorship:
www.canceradvocacy.org
● Office of Cancer Survivorship: dccps.nci.nih.gov/ocs
● ACS / GWU National Cancer Survivorship Resource Center:
www.cancer.org/survivorshipcenter
● Center for the Advancement of Cancer Survivorship, Navigation,
and Policy (caSNP): smhs.gwu.edu/gwci/survivorship/casnp
● OncoLink, ACS, CancerCare, LIVESTRONG, cancer.net
Discussion and Questions?
Thank you!
Contact Information:
Carolyn Vachani: [email protected]
Christina Bach: [email protected]