Survivorship Care Plans Focus on Post-Treatment Health

Cancer survivorship care planning has come a long way in recent years, in part due to the increasing number of cancer survivors, and also because researchers and providers alike are continually learning more about the late- and long-term effects of cancer and its treatment, according to Deborah A. Boyle, MSN, RN, AOCNS, FAAN.

Boyle, who is the editor in chief of Oncology Nursing News, discussed survivorship care planning during the CURE Patient-Focused Sessions at the 36th Annual Miami Breast Cancer Conference.

Boyle opened the talk by discussing how vastly different breast cancer survivorship was when she first started in the 1970s.

“We really didn’t have a big focus on survivorship at that time because unfortunately there was a large cadre of women who did not survive,” she said. “We didn’t have a lot of tricks in our bag as far as managing breast cancer and look at potential cure rates for our patients. Now it’s definitely very changed.”

And while outcomes continue to improve, there are common late- and long-term effects that affect cancer survivors for years after they finish active treatment, such as stigma, feelings of isolation or abandonment, recurrence anxiety and persisting symptoms.

Survivorship care plans, though not mandatory in all cancer centers across the United States, are becoming more popular to help patients manage life after cancer treatment and ensure that they don’t, “slip through the cracks,” explained Boyle.

Boyle touched upon two different types of survivorship care plans. The first comes from the American Society of Clinical Oncology (ASCO) and is a brief listing of a patient’s cancer history, along with the treatment and procedures they received, as well as any ongoing or persistent symptoms and genetic cancer information, if applicable.

“It’s a listing. It’s not meant to be a medical record or give you the Bible of what happened to you. It’s a brief summary that you can keep that you can give to whoever is providing your survivorship care or if you have to go to another specialist for whatever reason,” Boyle said.

The second type of survivorship care plan discussed was from the Oncology Nursing Society (ONS), which is a bit more detailed, and includes what health care providers recommend for follow-up care and treatment. The ONS plan also provides wellness and diet and exercise recommendations for many patients.

“I can’t remember one person at the end of their treatment who has not said to me, ‘Well what can I do to ensure I stay well and ensure good outcomes long-term?’” Boyle said, noting that she predicts more “prescriptions for wellness” as researchers and providers better understand the effects of obesity and diet on cancer outcomes.

According to Boyle, the perfect survivorship care plan would include aspects from both the ASCO and ONS care plans. However, there are still barriers and unanswered questions when it comes to survivorship care plans, from questioning who is responsible for creating and paying for them, to their actual effectiveness.

“There’s a lot of debate about these care plans, because people are asking, ‘Do they make a difference?’” Boyle said. “We don’t have that data yet to say that there are definitive benefits with these survivorship care plans.”

However, the plans are a good start.

“There needs to be a communication tool for all stakeholders involved with cancer survivorship. That includes us as health care providers, that looks at you the patients, and that looks at primary care physicians who are usually caring for cancer survivors,” Boyle said.