Survivorship care plans have been recommended by the President’s Cancer Panel and by the IOM committee, however, the implementation of such plans has not yet been formally evaluated. Despite the lack of evidence to support the use of survivorship care plans, the committee concluded that some elements of care simply make sense—that is, they have strong face validity and can reasonably be assumed to improve care unless and until evidence accumulates to the contrary. Having an agreed-upon care plan that outlines goals of care falls into this “common sense” area. Health services research should be undertaken to assess the impact and costs associated with survivorship care plans, and to evaluate their acceptance by both cancer survivors and health care providers.

DEVELOPING CLINICAL PRACTICE GUIDELINES FOR SURVIVORSHIP CARE

The Survivorship Care Plan would inform clinicians involved in the subsequent care of cancer survivors about treatment exposures and signs and symptoms of late effects, and, in some cases, would provide concrete steps to be taken. To carry out this plan, an organized set of clinical practice guidelines based on the best available evidence is needed to help ensure appropriate follow-up care. Some guidelines are available for certain aspects of survivorship care, but most are incomplete. Such guidelines would provide specific information on how to manage the complex issues facing survivors of adult cancers. Assessment tools and screening instruments for common late effects are also needed to help identify cancer survivors who have, or who are at high risk for, late effects and who may need extra surveillance or interventions.

Recommendation 3: Health care providers should use systematically developed evidence-based clinical practice guidelines, assessment tools, and screening instruments to help identify and manage late effects of cancer and its treatment. Existing guidelines should be refined and new evidence-based guidelines should be developed through public- and private-sector efforts.

Cancer survivors represent a very large at-risk population and without evidence-based clinical practice guidelines, health care providers will vary widely in their practices, leading to inefficiencies in care delivery (see Chapters 3 and 4). More than 60 percent of cancer survivors are aged 65 and older, so the Centers for Medicare and Medicaid Services (CMS) the administrators of the Medicare program, have a stake in developing clinical practice guidelines. The Agency for Healthcare Research and Quality (AHRQ) maintains a National Guideline Clearinghouse and supports Evidence-Based Practice Centers that review relevant literature on clinical, behavioral, or-



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