So, what is the proposal? Essentially, the goal is that oncologists should prepare a written treatment plan at the initiation of a course of cancer therapy. Typically, that includes chemotherapy, but it might include radiation, alternative treatment; other modalities are possible. Furthermore, oncologists should prepare a treatment summary at the end of a treatment course. The transition to survivorship care plans, which you heard so much about from Dr. Ganz and others this morning, we conceive of as a more detailed and extensive type of this particular summary. To get there, oncology professionals need to achieve consensus about the key elements for a treatment plan and summary. Professionals also need to specify standard formats that can accommodate free text, synoptic as well as fully digitized versions, that are made available to a variety of practice settings and types. And that these should adopt open source models.

What would be the key elements of a Treatment Plan/Summary? Well, the idea is not to produce 15-page informed consent documents. The goal is for something relatively succinct. Think about operative notes, pathology reports, radiation oncology summaries, which are absolutely standard. Think about the people in Hurricane Katrina, who all of a sudden had to change their sites of care quickly. The idea is not full disclosure of everything, but to provide a succinct summary. We have vetted this around quite widely, trying to achieve consensus about what those elements ought to be, and the ones that appear again and again are shown in Box 3-1.

So, what is the development strategy? How are we going forward with this? Well, I would say that having spoken about this in a number of settings, I think it is fair to say that we have achieved consensus among oncology practitioners, and I include physicians and nurses, that this is a good idea. And that if we could accomplish this and streamline the burden of documentation, it would be a good thing both for us as providers, and for our patients, and for our ability to communicate with our colleagues in other medical disciplines, dentists, teachers, all kinds of people, who may want these documents and need them.

What we are grappling with are the specifics in what those ought to look like. We are in the process of trying to develop some standard formats and templates, and are incorporating feedback we have received as part of this process. Then there will be some pilot testing, which we hope to conduct in a variety of settings, specifically through some of the NCCN institutions, and through QOPI, which is ASCO’s Quality Oncology Practice Initiative. It is a group of private practitioners who are very motivated to participate in quality improvement initiatives. And then ultimately, when we think about dissemination and implementation of this, we have to get involved with software developers and, healthcare payers to, as Dr. Ganz said earlier, make sure this activity is appropriately reimbursed. And, of course, advocacy organizations have spearheaded this effort from the very

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