From the Editor: Care Plans: Déjà Vu All Over Again

August 3, 2009

Formal recommendations for the support and management of cancer patients who are transitioning from active treatment to long-term follow-up are fairly recent, documented notably in the 2006 Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition.

Formal recommendations for the support and management of cancer patients who are transitioning from active treatment to long-term follow-up are fairly recent, documented notably in the 2006 Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition.

As the Institute of Medicine report emphasizes, optimal care of cancer survivors includes a treatment summary along with a care plan outlining the components needed for comprehensive follow-up care: the identification and management of medical and psychosocial long-term and late effects, recommendations for appropriate cancer screening, education about healthy living practices that are focused on diet and exercise, and guideline-driven monitoring for cancer recurrence.

In her article in this issue, Nancy Houlihan offers an excellent discussion of the essential components of a survivor care plan, with recommendations on how to tailor plans for a specific patient population.

So does this begin to sound a bit familiar? A care plan is a plan for care. Haven’t nurses always been developing and implementing plans of care for our patients? So as the momentum builds nationally for incorporating these patient care summaries into standard practice, we nurses should see this as an essential part of our coordination and implementation of high-quality care for cancer survivors. We are very familiar with plans of care that begin at diagnosis and continue on through treatment. It is now time to formalize plans for the post-treatment period and provide our patients with the necessary transition to living beyond their cancer.

Still, we need not limit our thinking to the cancer survivor who has completed treatment and who is disease-free, but rather we should extend this care planning to include another important group-patients who are living with chronic disease.

As a result of the recent advances in treatment of cancer, many patients live many years with disease. They, too, need comprehensive plans of care. In another important piece in this issue, Pamela Haylock highlights the importance of supporting the best life possible for individuals who have advanced disease. For this group, the plan of care has a different emphasis, one that is focused on the palliation of symptoms, optimization of physical functioning, and psychosocial well being.

As momentum builds toward incorporating patient care summaries into standard practice, nurses are a critical part of this widening patient safety net, ensuring high-quality and coordinated care for cancer survivors.

A key example of such a patient group living with disease is provided by Krista Rubin and Donald Lawrence in their cover feature article discussing the management of melanoma. As they note, melanoma incidence is increasing rapidly, and it causes more years of lost life than any other cancer except leukemia because response to chemotherapy is modest. Certainly this group would benefit from a plan of care that is focused on both the patient and family, optimizing function, and reducing medical and surgical morbidity.

I think we can all agree that it is critically important to promote the development and use of tailored survivorship care plans. Equally important, however, is our responsibility to expand our thinking about “care plans” to include their use across the entire care continuum. After all, our patients deserve nothing less.