Do Training-Guided Survivorship Visits Benefit DLBCL Patients?

December 5, 2018
Leah Lawrence
Leah Lawrence

A study looked at whether survivorship care plans were able to enhance patients' knowledge and adherence to physician recommendations.

Patients with Hodgkin lymphoma or diffuse large B-cell lymphoma (DLBCL) had greater knowledge about their cancer and had greater adherence to follow-up health care recommendations when their physicians received communication skills training and applied that training to a survivorship care plan (SCP), according to a new study.

According to Patricia A. Parker, PhD, of Memorial Sloan Kettering Cancer Center, and colleagues, survivorship care plans are thought to enhance patient knowledge and disease management, but evidence to support these benefits is lacking.

“Our results suggest that patients may benefit from survivorship-dedicated consultations in terms of improved knowledge and some increased uptake of recommended screening and vaccination behaviors,” Parker and colleagues wrote in Cancer. However, they noted that the evaluation of whether the change in knowledge is clinically significant is challenging.

In the study, 42 physicians were randomly assigned to communication skills training and use of a survivorship care plan during a survivorship-focused office visit, or to training in a time-controlled, manualized wellness rehabilitation consultation that focused on healthy nutrition and adherence to physician recommendations for vaccination and cancer screenings. The study included 198 patients with lymphoma in complete remission. More patients were assigned at survivorship care plan sites than at wellness rehabilitation consultation sites (59% vs 41%).

After adjusting for baseline knowledge, patients assigned to survivorship care planning had a greater uptick in knowledge over time compared with the wellness rehabilitation consultation arm (P = .01).

Influenza vaccination is one clear recommendation for the first year of survivorship after lymphoma treatment, according to the study. Survivorship care plan patients were more than twice as likely to get a flu vaccine as patients assigned to the wellness rehabilitation consultation arm (odds ratio [OR] = 2.42; P = .02), and were significantly more likely to undergo colonoscopy (P = .02). Other behaviors such as mammography or Pap test did not improve among survivorship care patients compared with wellness rehabilitation consultation patients.

The researchers noted that the quality of the survivorship care office visit was likely enhanced by their multilevel intervention approach.

“The training included how to effectively use the survivorship care plan,” they noted. “Other studies without the communication skills training component have typically shown that although patients are satisfied with the survivorship care plans, their use has not resulted in other positive outcomes.”

There were several study limitations including the use of physicians who expressed an interest and willingness to participate.

“This novel SCP intervention has the potential to enhance the survivorship experience for patients who have recently received news of being cancer-free and may be unprepared for this transition,” the researchers wrote. “SCPs have many elements and warrant dedicated consultations to empower the patients and help them to discuss and understand the variety of survivorship issues that they may encounter.”