In the last decade, and especially after
2005 with the Institute of Medicine report From Cancer Patient
to Cancer Survivor: Lost in Transition, a greater consensus
has formed around the need for cancer survivorship care plans. (See
the related IOM Fact Sheet.) This year the American College of
Surgeons Commission on Cancer (CoC) decided to integrate
survivorship care plans into their accreditation program standards. The CoC
accreditation process will phase in requirements for survivorship
care plans starting in 2015. These requirements are as follows:
survivorship care plan is prepared by the principal provider(s) who
coordinated the oncology treatment for the patient with input from
the patient's other providers.
survivorship care plan is given to the patient on completion of
(c) The written
or electronic survivorship care plan contains a record of care
received, important disease characteristics, and a follow-up care
plan incorporating available and recognized evidence-based
standards of care, when available. The minimum care plan standards
are included in the Fact Sheet: Cancer Survivorship Care Planning,
from the IOM.
Compliance with the new CoC survivorship
care plan standards requires programs to fulfill two criteria:
1. The cancer
committee has developed a process to disseminate a comprehensive
care summary and follow-up plan to patients with cancer who are
2. Each year,
the process is implemented, monitored, evaluated, and presented to
the cancer committee.
From now to 2015 (and beyond) we have an
opportunity to measure uptake as accredited cancer centers move
from a current best practice to a future mandate. How exactly will
this occur? Who are the agents of change? What are the barriers and
facilitators? Perhaps by studying dissemination of survivorship
care planning, we can learn something useful about transforming the
standard of cancer care for the future.
The CoC standards point to care planning
templates available from several sources such as the American
Society of Clinical Oncology, National Coalition for Cancer
Survivorship, and the Lance Armstrong Foundation (Livestrong). How
will these templates differ? Will we see differences as drastic as
those seen in the standards for mammography screening from the U.S.
Preventive Services Task Force and the American Cancer Society?
Livestrong has already taken initiative in defining what their
survivorship care planning template(s) will consist of. In
September 2011, a hundred leaders, stakeholders, and experts met
with Livestrong to determine what elements are essential in
survivorship care. (See both Livestrong Blog and Dr. Len's Cancer Blog for further details.)
Other organizations such as UT MD Anderson Cancer Center have
constructed long-term clinical practice algorithms around
survivorship. Will these algorithms, or others like them, diffuse
through organizations across the country as the 2015 CoC
requirements for survivorship care planning draw closer? Will
organizations create their own algorithms and templates?
There is currently quite a lot of
flexibility for implementation of survivorship care plans both
across and within healthcare organizations. This flexibility
presents many opportunities for study. What will survivorship care
plans look like? Will there be one standard template in an
organization, or will there be multiple templates? Will the
specifics of implementation be left up to each individual
oncologist? Will survivorship care plans be updated? How often?
Will they be utilized? Will the care plans be effective?
As we learn more about the needs of cancer
survivors, we will continue to adapt our clinical standards and
practices to better serve this emerging population. Our healthcare
system can greatly benefit by learning how to best go about such a
complex and dynamic process of change.
2011 CCRC Doctoral Fellow
Texas A&M Health Science Center (TAMHSC) School of Rural Public