The care of cancer survivors is gaining new, much needed attention as the number of survivors in this country tops 11 million and there is recognition of the unique unmet needs of this group as a whole. In their article, Marcia Grant and Denise Economou trace the emergence of the cancer survivorship movement through private and federal agency reports and advocacy and service-based programs.
They highlight the recommendations of the 2006 Institute of Medicine report, which offers a blueprint for the health care industry, researchers, legislators, and providers to address the looming crisis in the face of the growing numbers of survivors and the lack of a comprehensive plan for provision of quality care. Grant and Economou identify specific measures to improve quality care. Provision of a Treatment Summary and Survivorship Care Plan, one of the IOM recommendations, is highlighted as a solution to overcoming problems related to poor communication between providers and patients, particularly during transition from oncology to primary care.
A Treatment Summary contains the details of treatment and is useful to patients as they seek care from other providers who can incorporate this information and the impact of cancer treatment into their overall health care. A Survivorship Care Plan contains recommendations for surveillance for cancer recurrence, screening for and management of late treatment effects, and education about preventable health problems.
The authors cite a significant barrier to implementation of Treatment Summary and Care Plans as the lack of published guidelines for survivorship care. Another well-cited barrier is the time commitment and lack of reimbursement to providers for preparation of this often complex document. Organizations such as ASCO and the Lance Armstrong Foundation Centers of Excellence network are developing standardized electronic templates that would allow providers to more accurately and efficiently prepare these documents.
The authors describe three models of survivorship care under evaluation, including a one-time consultation with a survivorship expert and referral for identified problems; a nurse practitioner (NP) model in which ongoing, comprehensive care is focused on cancer- and treatment-related needs and eventual transition to primary care is accomplished; and a multidisciplinary clinic for those with more complex problems, modeled on the pediatric long-term followup programs, which offers assessment by multiple specialists during one visit.
Evaluation of the effectiveness of these models includes assessment of their appropriateness for specific populations and usefulness in academic vs community settings. Nurses play a key role in the care of cancer survivors. Oncology nurses have long spearheaded the education of patients and caregivers in preparation for cancer treatment and management of symptoms through active therapy. As the trajectory of cancer care expands to include the post treatment experience as the IOM report recommends, nurses can be instrumental in applying that same degree of attention to the needs of patients following cancer treatment.
Teaching patients about chronic and late treatment effects, counseling about healthy behaviors such as smoking cessation and regular exercise, identifying resources, and participating in development of the treatment summary and care plan are distinct nursing responsibilities. Nurse practitioners are well suited for assuming care of patients post treatment and, as mentioned above, multiple models incorporating NPs are being tested. As plans for survivor care evolve, nurses need to be counted as important contributors to solutions for quality of care and health care resource utilization.
This paper is the fi rst in a series of articles about survivorship care in ONCOLOGY Nurse Edition. In their overview of survivorship care issues, the authors have set the stage for a presentation of various efforts in place to identify needs and improve the care of people treated for cancer, and their caregivers.