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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:

(a) A 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.

(b) The survivorship care plan is given to the patient on completion of treatment.

(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 completing treatment.

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.

Richard Wood
2011 CCRC Doctoral Fellow
Texas A&M Health Science Center (TAMHSC) School of Rural Public Health

Written by CCRC at 12:58

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