Diagnosing and Treating Adult Cancers and Associated Impairments (2021) / Chapter Skim
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10 Survivorship Outcomes and Care Delivery
10 Survivorship Outcomes and Care Delivery
Pages 317-344
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From page 317... ...
The chapter also identifies key members of the cancer care team, describes the settings where care occurs, and explores the challenges inherent in delivering high-quality, comprehensive care throughout the care trajectory, particularly interventions to promote return to work and other activities valued by cancer survivors. Finally, the chapter outlines emerging approaches to cancer care delivery that may improve future outcomes.
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From page 318... ...
Thus, while guidelines advise clinicians on how to treat the population of cancer patients and several recommend the use of shared decision making with the patient and a multidisciplinary care team (see Chapter 4) , the concept of personalized, patient-centered care means that treatments will need to be adapted to meet the characteristics (e.g., age and comorbidities)
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From page 319... ...
At any point in the cancer care trajectory, beginning with diagnosis and often in conjunction with active cancer treatment, patients may receive supportive or palliative care (distinct from end-of-life care) for relief from the symptoms and stress of serious illness, with the goal of improving the quality of life for the patient and caregivers (NCP, 2018)
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From page 320... ...
FIGURE 10-2 Domains of cancer survivorship care. None of the five domains are mutually exclusive, and all should be considered as critical aspects of survivorship care.
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From page 321... ...
. Survivorship care entails an assessment of such risk factors followed by surveillance for recurrences and the development of new cancers.
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From page 322... ...
Clini cians caring for cancer survivors should work together to assess a survivor's readiness for behavior change. Survivorship care is complex, and each of the five domains is critical to the provision of patient-centered care although the focus may vary based on the patient's characteristics, cancer type, and treatment.
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From page 323... ...
Patients require knowledge, education, and support to access these interventions in a manner that will allow them to return to their optimal function and quality of life after cancer; hence, there has recently been an emphasis on "supported Physicians Providing Oncology Care Mental Health Nurses Professionals and Spiritual Workers Palliative Patients and Care Pharmacists Caregivers Practitioners Patient–Provider Interactions Advanced Practice Rehabilitation Providers Specialists (NPs and PAs) Clinicians Providing Non-oncologic Care FIGURE 10-3 The cancer care team.
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From page 324... ...
, are used, it is important that patients and caregivers be informed about the availability of evidence-based treatments (including the availability of clinical trials) and rehabilitation services, including palliative care, to restore or maintain function and quality of life during and after active cancer treatment.
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From page 325... ...
The IOM report Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis focused on the ways that the patient, clinicians, and the health care system interact to influence patient-centered care and improve communication and health outcomes. The report stated that patient-centered care includes fostering good communication between pa tients and their cancer care team; developing and disseminating evidence based information to inform patients, caregivers, and the cancer care team about treatment options; and practicing shared decision making.
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From page 326... ...
Support, resources, and guidance for appropriate survivorship self-management, described above, are thus critical components of the cancer survivorship trajectory which sometimes may be lacking. Survivors may need to be connected to appropriate resources such as patient support groups or care navigators who can work with them to attain the best-possible physical function and quality of life.
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From page 327... ...
Information Technology A critical aspect of communication and coordination among the cancer care team is access to the patient's health information, from laboratory tests to caregiver information, and the ability to share that information among providers and to convey information to and from the patient. Electronic health records (EHRs)
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From page 328... ...
. EHRs combined with the ability to exchange health information electronically provide safer and higher-quality care by providing current and complete patient information at the point of care, allowing for better coordination of care and safer prescribing (ONC, 2019)
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From page 329... ...
Thus, although telemedicine can be an integral part of patient-centered care, it needs to be integrated into other parts of the health care information system along with EHRs to facilitate communication among and between cancer survivors and their health care teams. Historically, a major barrier to uptake of telemedicine has been payment policies.
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From page 330... ...
This shift places the onus of supportive care on patients and their caregivers rather than on the health care system. At the same time as care delivery has become more outpatient-focused, there have been notable shifts in the types of practices providing oncology care.
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From page 331... ...
Many hospitals or practices that provide oncology care seek additional cancer-focused recognition which may identify their interest in providing high-quality and patient-centered oncology care. Such recognition may also identify a specific interest in cancer clinical trials.
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From page 332... ...
, which must meet commission standards for high-quality, multidisciplinary cancer care and that typically in clude services for psychology and mental health, pain management, and rehabilitation services (American College of Surgeons, 2020) and, more recently, cancer survivorship care.
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From page 333... ...
necessary for the timely diagnosis and high-quality treatment of cancer in order to yield the best long-term patient outcomes. EMERGING DIRECTIONS IN CANCER CARE DELIVERY In the prior sections the committee outlined the complexities of cancer survivorship care across the cancer care trajectory.
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From page 334... ...
is attributed to the organization. The use of accountable care organizations provides incentives for lowering costs but no direct incentives for improving oncology care delivery.
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From page 335... ...
In addition, there has been a call for a personalized or risk-stratified approach to cancer survivorship care (Kline et al., 2018; Mayer and Alfano, 2019)
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From page 336... ...
However, survivors who require specialized care need to be identified and referred to appropriate health care specialists who have the knowledge, skills, and experience to care for them. Methods are needed to assess cancer survivors for potential risk factors for long-term outcomes and to improve referral to health care professionals with training in cancer survivorship in order to maximize function and the ability to return to work after cancer treatment.
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From page 337... ...
10. Methods are needed to assess cancer survivors for potential risk factors for long-term outcomes and to improve referral to health care professionals with training in cancer survivorship in order to maximize patients' function and the ability to return to work after cancer treatment.
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2012. Cancer survivorship and cancer rehabilitation: Revitalizing the link.
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2020. Survivorship care plans and the commission on cancer standards: The increasing need for better strategies to improve the outcome for survivors of cancer.
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2018. Knowledge, attitudes, and practice of oncologists and oncology health care providers in promoting physical activity to cancer survivors: An international survey.
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2018. Long-term survivorship care after cancer treatment -- Summary of a 2017 National Cancer Policy Forum workshop.
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2019. Developing a quality of cancer survivorship care framework: Implica tions for clinical care, research, and policy.
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2017. The underutilization of rehabilitation to treat physical impairments in breast cancer survivors.
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From page 344... ...
2016. Increasing the frequency of physical activity very brief advice for cancer patients.
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