New Template Aims to Break Down Barriers to Survivorship Care Planning

October 14, 2014
Lauren M. Green

A new tool to help oncology practitioners working across all settings to develop their own survivorship care plans (SCPs) was unveiled today, and the experts who have worked hard to develop it hope that it will make the process less time-consuming and more straightforward for the nation's 14.5 million survivors and the healthcare providers who treat them.

Deborah K. Mayer, PhD, RN, AOCN, FAAN

A new tool to help oncology practitioners working across all settings to develop their own survivorship care plans (SCPs) was unveiled today, and the experts who have worked hard to develop it hope that it will make the process less time-consuming and more straightforward for the nation’s 14.5 million survivors and the healthcare providers who treat them.

The availability of the template was announced in conjunction with a presscast held in advance of ASCO’s 2014 Quality Care Symposium by Deborah K. Mayer, PhD, RN, AOCN, FAAN, chair of the ASCO Survivorship Care Plan Working Group. It follows on nearly a decade of growing awareness of the need to provide concrete, user-friendly SCPs to the nation’s ever-expanding number of cancer survivors.

In its 2005 seminal report, From Cancer Patient to Cancer Survivor: Lost in Transition, the Institute of Medicine recommended that patients receiving curative cancer treatment have access to an SCP that includes four essential components: prevention, surveillance for recurrence or new cancers, interventions for long-term and late effects, and coordination of care with the patient’s primary care provider.

However, implementation of this recommendation has been curtailed by the time needed to complete SCPs (sometimes as long as 90 minutes), insufficient reimbursement for the process, and a lack of systems to make SCPs a part of routine practice for every patient, noted Mayer, who is a professor in the School of Nursing at the University of North Carolina Chapel Hill and director of Cancer Survivorship at the UNC Lineberger Comprehensive Cancer Center.

“There have been a number of national studies that indicate survivorship care plans are being used for some of the patients, some of the time, in some of the practices,” Mayer noted, adding that the overall adoption rate so far is less than 30%.

The SCP template being released today builds on ASCO’s previous 2006 planning tool and has been revised and streamlined to make it easier for providers and patients to use and requires less time to complete, Mayer explained. It is focused more on essential information about the patient’s treatment, possible late effects, and the need for future checkups and screening tests.

Notably, the plan stresses providing ideas for survivors to improve their health, which, Mayer noted, is something about which survivors have expressed special interest: “Now that their treatment is over, what can they do to lead healthier lives?”

Mayer added that the Commission on Cancer (CoC) has established a 5-year phase-in period for implementation of its survivorship care standard, and the accrediting organization is suggesting that institutions use the ASCO template released today as a guide to those elements that should be included in their own SCPs.

“We’re hoping that in partnership with [the CoC], this new template will increase adoption, and then we will be able to measure that over time.”

A pilot study of the new template was conducted in 11 practices. The median time to completion was 30 minutes (range, 10 minutes to 1 hour). Mayer explained that the longer times could be attributed to the learning curve associated with something brand new, the time needed for patients receiving more complicated therapies, and also those practices relying on a paper and pencil system. Electronic health records, which many practices now use, should decrease the amount of time required, she said.

Along with time, payment has been a barrier to SCP adoption. “The actual visit where the survivorship plan is delivered is reimbursable,” said Mayer, “just not the planning leading up to it. We’re hoping that [reimbursement] will become less of an issue, as this becomes integrated into the care and into the electronic health record; it should take a lot less time.”

The template is being published today on the Journal of Oncology Practice website at http://jop.ascopubs.org. It is also part of ASCO’s Cancer Survivorship Compendium at www.asco.org/survivorship and available on ASCO’s patient information website at www.Cancer.Net.

“Patients should know that they should be receiving one of these at the end of treatment and if they don’t get one, they should be asking their oncology team for one,” concluded Mayer.