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Implementing Cancer Survivorship Care Planning: Workshop Summary
Cancer type, treatments received, and their potential consequences;
Specific information about the timing and content of recommended follow-up;
Recommendations regarding preventive practices and how to maintain health and well-being;
Information on legal protections regarding employment and access to health insurance; and
The availability of psychosocial services in the community.
These content areas, adapted from those recommended by the President’s Cancer Panel (President’s Cancer Panel, 2004), are elaborated upon in Box 3-16.
The content of the survivorship care plan could be reviewed with a patient during a formal discharge consultation. Clinicians would likely have discussed some aspects of the survivorship care plan before or during treatment, for example, short- and long-term treatment effects and their implications for work and quality of life.1 However, during acute treatment, much time is spent dealing with the acute toxicities of treatment that little emphasis is given to the post-treatment care plan. A substantial amount of information needs to be communicated during this consultation and then documented in an end-of-treatment consultation note. Appropriate reimbursement should be provided for such a visit, given the complexity and importance of the consultation.
The member of the oncology treating team who would be responsible for this visit could vary depending on the exact course of treatment. The responsibility could be assigned either to the oncology specialist coordinating care or to the provider responsible for the last component of treatment. Oncology nurses could play a key role. The survivorship care plan may need revision as new knowledge concerning late effects and interventions to ameliorate them, genetic disorders, and surveillance methods is identified. Cancer survivors can help to ensure that the plan is followed. The consultation at the conclusion of primary treatment could serve as a teaching event for survivors and their family members and provide opportunities to discuss with clinicians their prognosis, concerns, lifestyle issues, and follow-up schedules. The plan could be used by survivors subsequently to raise questions with doctors and prompt appropriate care during follow-up visits.
Providing a survivorship care plan may prove difficult for those individuals who cease treatment prematurely and do not return for the remainder of their care. Primary care physicians involved in subsequent care of such patients may need to contact oncology providers to obtain a survivorship care plan.