Download survivorship care: implementing the essentials

Video Participant Guide
ADVANCING CANCER CARE TODAY (ACCT)
SURVIVORSHIP CARE:
IMPLEMENTING THE ESSENTIALS
This program meets Oncology Nursing Society (ONS) guidelines for quality educational content.
The ONS Seal of Approval does not constitute medical advice, and does not imply product endorsement by ONS.
Healthcare providers should exercise their own independent medical judgment.
The program is sponsored by and the speaker is presenting on behalf of Lilly USA, LLC. It is being presented consistent
with FDA guidelines and is not approved for continuing education credit.
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Program Objectives
Program Objectives
•

Discuss the importance of survivorship care
•

Describe the needs of survivors
•

Define the essential elements of survivorship care
•

Understand available resources for implementing
survivorship care in practice
Write your objectives for the program below
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Need
for Survivorship
TheThe
Need
for Survivorship
Care Care
•
The number of cancer
survivors continues to
increase due to1,2
5-Year Relative Survival
Rates, All Sites3
80
– Aging and growth of
the population
– Earlier detection
– Improvements in treatment
Survival Rates (%)
•
*
68%
70
US cancer survivors2
– ~14.5 million in 2014
– Expected ~19 million by 2024
60
50
49%
40
30
20
10
0
1975-1977
*P<0.05.
1. NCCN. Clinical Practice Guidelines in Oncology™ (NCCN Guidelines) Survivorship - Version 2.2014.
2. DeSantis CE, et al. CA Cancer J Clin. 2014;64(4):252-271.
3. American Cancer Society. Cancer Facts & Figures 2015. Atlanta: American Cancer Society; 2015.
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2004-2010
Years
3
Quality Organizations Focus
Quality
Organizations Focus on Survivorship
on Survivorship
Institute of Medicine (IOM)
•
2005: Landmark consensus report From Patient to Cancer Survivor: Lost in
Transition provided 10 recommendations for survivorship care1
Commission on Cancer (COC)
•
2012: Updated standards for accreditation including development and
dissemination of survivorship care plans to be phased in for 20152
ASCO’s Quality Oncology Practice Initiative (QOPI)
•
Includes chemotherapy treatment summary completion and dissemination
to patients and practitioners as core measures for certification3
ASCO=American Society of Clinical Oncology.
1. Hewitt M, et al. From Cancer Patient to Cancer Survivor: Lost in Transition; 2006.
2. American College of Surgeons. Commission on Cancer. Cancer Program Standards: Ensuring Patient-Centered Care; 2012.
3. ASCO. Quality Oncology Practice Initiative (QOPI®) Summary of Measures. http://qopi.asco.org/Documents/QOPI-Fall-13-MeasuresSummary.pdf. Accessed February 23, 2015.
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1,2
Needs
of Survivors
Needs
of Survivors
1,2
• Caregivers are a primary source of support to survivors and also have needs3
Physical issues
Information
Follow-up care
Psychosocial issues
Survivorship
1. Hoekstra RA, et al. BMC Family Pract. 2014;15(94):1-6.
2. Khan NF, et al. Br J Cancer. 2011;8(105):S46-S51.
3. Given BA, et al. J Support Oncol. 2012;10(2):57-64.
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Management of
long-term/late effects
4
Lifestyle
Factors
Impact
Survivorship
Lifestyle
Factors
Impact
Survivorship
•
According to research, various healthy behaviors
have been shown to help prevent new cancers or
recurrence, increase survival, and strengthen
quality of life (QoL)
•
A recent Behavioral Risk Factor Surveillance
System report found
– Approximately 15% of cancer survivors age
≥18 years were current cigarette smokers
– 27.5% of survivors were obese (BMI ≥30 kg/m2)
– 31.5% of survivors had not participated in any
leisure-time physical activity during the past 30 days
•
Survivor-specific resources and support should be
provided to promote healthy behavior adoption,
positive health outcomes, and improved QoL
Underwood JM, et al. MMWR Surveill Summ. 2012;61(1):1-23.
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1,2
Survivor’s
Journey
TheThe
Survivor’s
Journey
•
1,2
Cancer survivorship: the journey from the moment of diagnosis onward
– Trajectory varies for each survivor
– Survivor’s needs change throughout their journey
“Seasons of Survivorship”
Acute
Survivorship
Transitional
Survivorship
Extended
Survivorship
Permanent
Survivorship
• Maintained remission
• Cancer-free
• Living with cancer
• Cancer-free and
free of cancer
• Long-term/late problems
• Second cancers
• Secondary cancers
1. Mullan F. N Engl J Med. 1985;313(4):270-273.
2. Miller K, et al. Cancer J. 2008;14:369-374.
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5
Models
of Survivorship
Models
of Survivorship
Care Care
Transition to
primary care model
Consultative
clinic model
Integrated care model
• Patients return directly to their primary care physician (PCP)
immediately after treatment ends
• Risk-based approach may be most beneficial
• Offers a one-time comprehensive survivor visit with referral to
specialty services if needed
• Ongoing survivorship care provided at original
oncology practices
• Often provided by nurse practitioners (NPs)
Disease-specific model
• Can be costly
• Requires a large enough survivor population with a particular
cancer to warrant resources required
Multidisciplinary
clinic model
• Complex and resource intensive
• Challenging to have multiple providers available at the same
time for survivorship visits
McCabe MS, Jacobs LA. Semin Oncol Nurs. 2012;28(3):e1-e8.
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of Primary
TheThe
RoleRole
of Primary
Care Care
•
Increasingly a shared-care model (specialists working with
PCPs) is being adopted and driven by the Affordable Care Act1
– Includes sharing responsibilities for survivor care among PCPs,
specialized nurses, NPs, physicians assistants, and/or other
nonspecialist providers1,2
•
Primary care-based support comes with the expectation
that communication between the oncology team and PCP
will continue1
•
Surveys found PCPs prefer a shared-care model, whereas
cancer specialists prefer an oncologist-based model; this
may lead to poor coordination of care2
– Importantly, survivors who see both oncologists and PCPs are
more likely to receive recommended follow-up care3
1. McCabe MS, et al. Cancer. 2013;119(suppl11):2179-2186.
2. Cheung WY, et al. J Cancer Surviv. 2013;7(3):343-354.
3. Hudson SV, et al. Ann Fam Med. 2012;10(5):418-427.
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6
Components
of Survivorship
IOMIOM
Components
of Survivorship
Care Care
Coordination
between patients and all providers
to ensure survivors’ needs are met
Prevention
Surveillance
Intervention
of recurrent and new
cancers and other
late effects
for cancer spread, recurrence,
second cancers; assessment of
medical and psychosocial
long-term and late effects
for consequences of
cancer and its treatment
(physical, psychological,
social, spiritual)
Hewitt M, et al. From Cancer Patient to Cancer Survivor: Lost in Transition; 2006.
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Survivorship
Survivorship
CareCare
PlansPlans
•
Every survivor should have a
comprehensive survivorship care plan
(SCP) to improve health and QoL1
– Part A: Reflects treatment received
– Part B: Addresses post-treatment needs
•
Many organizations, including the
ASCO and the LIVESTRONG Foundation,
have developed publicly available
SCP templates2,3
1. Hewitt M, et al. From Cancer Patient to Cancer Survivor: Lost in Transition; 2006.
2. ASCO. Cancer treatment summaries. http://www.cancer.net/survivorship/asco-cancer-treatment-summaries. Accessed February 23, 2015.
3. LiveStrong. LiveStrong care plan. http://www.livestrongcareplan.org/. Accessed February 23, 2015.
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A: Treatment
Summary
PartPart
A: Treatment
Summary
Upon discharge from treatment every patient should be given a treatment
summary of all care received and important disease characteristics
Diagnostic tests performed and results
Tumor characteristics
Dates of treatment initiation and completion
Therapies provided, including treatment response, and toxicities experienced during treatment
Psychosocial, nutritional, and other supportive services provided
Full contact information for treating institutions and key individual providers
Identification of a key point of contact and coordinator of continuing care
Hewitt M, et al. From Cancer Patient to Cancer Survivor: Lost in Transition; 2006.
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B: Follow-up
PartPart
B: Follow-up
Care Care
Plan Plan
Every patient and primary HCP should receive a written follow-up care plan
incorporating available evidence-based standards of care, including
Likely course of recovery and possible late/long-term effects
Need for any ongoing maintenance/adjuvant therapy
Recommended cancer screening and other periodic testing/examinations
Information on possible signs of recurrence and second malignancy
Specific recommendations for healthy behaviors
Referrals to specific follow-up care providers and/or support groups
A listing of cancer-related resources and information
Hewitt M, et al. From Cancer Patient to Cancer Survivor: Lost in Transition; 2006.
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8
Essential
Elements
of Survivorship
Essential
Elements
of Survivorship
Care Care
In 2011, the LIVESTRONG Foundation partnered with cancer
stakeholders to identify essential elements of survivorship care
Tier 1
Consensus Elements
Tier 2
High-Need Elements
Tier 3
Strive Elements
Rechis R, et al. The essential elements of survivorship care: a LiveStrong brief. http://images.livestrong.org/downloads/flatfiles/what-wedo/our-approach/reports/ee/EssentialElementsBrief.pdf?_ga=1.50304998.1738371360.1424804295. Accessed February 23, 2015.
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Essential
Elements:
Essential
Elements:
Tier 1Tier 1
Tier 1: Consensus Elements
•
All medical settings MUST provide direct access or referral to the
following elements of care:
Symptom management
and palliative care
Screening for new
cancers and surveillance
for recurrence
Health promotion
education
Strategy that addresses care
coordination with PCPs and
primary oncologists
Survivorship care plan, psychosocial
care plan, and treatment summary
Rechis R, et al. The essential elements of survivorship care: a LiveStrong brief. http://images.livestrong.org/downloads/flatfiles/what-wedo/our-approach/reports/ee/EssentialElementsBrief.pdf?_ga=1.50304998.1738371360.1424804295. Accessed February 23, 2015.
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9
Essential
Elements:
Essential
Elements:
Tier 2Tier 2
Tier 2: High-Need Elements
•
All medical settings SHOULD provide direct access or referral to these
elements of care for high-need patients and to all patients when possible
Late effects
education
Transition visit and
cancer-specific
transition visit
Rehabilitation
for late effects
Family and
caregiver support
Psychosocial
assessment and care
Educational information about
survivorship and program offerings
Patient
navigation
Comprehensive
medical assessment
Nutrition services, physical activity
services, and weight management
Rechis R, et al. The essential elements of survivorship care: a LiveStrong brief. http://images.livestrong.org/downloads/flatfiles/what-wedo/our-approach/reports/ee/EssentialElementsBrief.pdf?_ga=1.50304998.1738371360.1424804295. Accessed February 23, 2015.
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Essential
Elements:
Essential
Elements:
Tier 3Tier 3
Tier 3: Strive Elements
•
All medical settings should STRIVE to provide direct access or referral to
these elements of care
Self-advocacy
skills training
Counseling for
practical issues
Ongoing qualityimprovement activities
Referral to
specialty care
Continuing
medical education
Rechis R, et al. The essential elements of survivorship care: a LiveStrong brief. http://images.livestrong.org/downloads/flatfiles/what-wedo/our-approach/reports/ee/EssentialElementsBrief.pdf?_ga=1.50304998.1738371360.1424804295. Accessed February 23, 2015.
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10
Sample
Survivorship
Care Plan
Sample
Survivorship
Care Plan
Journey Forward. Cancer survivorship care plans. http://journeyforward.org/professionals/sample-survivorship-care-plans. Accessed February 23, 2015.
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Developing
a Survivorship
Program
Developing
a Survivorship
Program
•
Determine who your survivor population will be
– Conduct focus group(s) with patients and
spouses/caregivers to determine most
needed services
•
Develop a referral network of trusted experts
(large institutions may be able to do this in-house)
•
Provide staffing, including a “front door”—a
skilled navigator able to address patient inquiries
and needs
•
Address sustainability from the start
– Survivorship programs are not moneymakers, but
they provide value through patient satisfaction,
loyalty, and relationships
Shaw G. Clin Oncol News. 2011;6(6):1-6.
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11
Barriers
to Success
Barriers
to Success
•
A fragmented and poorly coordinated cancer care system1
•
Conflicting perspectives among PCPs and oncologists2
•
Insufficient organizational resources for developing SCPs3-5
– Time, staff, money, and training
•
1.
2.
3.
4.
5.
Lack of systems, templates, training, and reimbursement
for SCP use3
Hewitt M, et al. From Cancer Patient to Cancer Survivor: Lost in Transition; 2006.
Potosky AL, et al. J Gen Intern Med. 2011;26(12):1403-1410.
Birken SA, et al. J Cancer Educ. 2013;28(2):290-296.
Chubak J, et al. J Oncol Pract. 2012;8(3):184-189.
Dulko D, et al. Oncol Nurs Forum. 2013;40(6):575-580.
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Overcoming
Barriers
Overcoming
Barriers
•
Develop a strategy for communicating with
internal and external providers
•
Include clear responsibilities for follow-up
care in every SCP1,2
•
Provide succinct, explicit, patient-specific,
and actionable information to address
possible training/education gaps in
partner providers2
•
Be aware that best practices in
survivorship care are still emerging1
•
Focus on what is most important and
achievable in your setting3
1. Hewitt M, et al. From Cancer Patient to Cancer Survivor: Lost in Transition; 2006.
2. Potosky AL, et al. J Gen Intern Med. 2011;26(12):1403-1410.
3. Earle CC, Ganz PA. J Clin Oncol. 2012;30(30):3764-3768.
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The Importance of a Survivorship Care Plan
What are your takeaways from the Patient Video?
Takeaways
KeyKey
Takeaways
•
Quality survivorship care is essential to help improve patient outcomes and
quality of life
•
Survivors have diverse needs throughout care
•
Quality survivorship care involves 4 key components
– Coordination between specialists and PCPs
– Prevention of recurrent and new cancers and late effects
– Surveillance for cancer spread, recurrence, or second cancers;
assessment of long-term and/or late effects
– Intervention for effects of cancer and its treatment
•
Resources are available to help
– Start a survivorship program
– Elevate an existing program
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13
Resources
Practice
ForFor
YourYour
Practice
•
ASCO Treatment Plan and Summary Resources
– http://www.asco.org/institute-quality/chemotherapy-treatmentplan-and-summaries
•
Journey Forward Survivorship Care Plan Builder and Other Tools
– http://journeyforward.org/professionals/survivorship-care-plan-builder
•
LIVESTRONG Professional Tools and Training
– http://www.livestrong.org/What-We-Do/Our-Actions/
Professional-Tools-Training/For-Health-Care-Professionals
• Living After Cancer Treatment free brochure series
•
National Coalition for Cancer Survivorship—Tools for Providers
– http://www.canceradvocacy.org/resources/resources/
tools-for-care-providers
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14
Patients
ForFor
YourYour
Patients
•
American Cancer Society—Survivorship: During and After Treatment
– http://www.cancer.org/treatment/survivorshipduringandaftertreatment/
index
•
ASCO Cancer.Net—Survivorship
– http://www.cancer.net/survivorship
•
National Cancer Institute—Survivorship—Living With and
Beyond Cancer
– http://www.cancer.gov/cancertopics/coping/survivorship
•
National Coalition for Cancer Survivorship—Cancer Survival Toolbox
– http://www.canceradvocacy.org/toolbox/
•
National Comprehensive Cancer Network—Life After Cancer
– http://www.nccn.org/patients/resources/life_after_cancer/default.aspx
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Caregivers
ForFor
Caregivers
•
National Cancer Institute (www.cancer.gov)
–
–
–
–
•
Caring for the caregiver
Communicating
Finding information
Making decisions
–
–
–
–
Going to medical visits
Problem solving
Negotiating
Advocating
American Cancer Society (www.cancer.org)
– Coping as a caregiver
– How to provide care
– Connecting with other caregivers
•
Cancer Care (www.cancercare.org)
– Counseling
– Finding support groups
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