Survivorship guidelines have begun to address the premise that every patient deserves high-quality, individualized, and risk-based follow-up care. However, future efforts in the development of these guidelines should focus more on reducing ambiguity, improving consistency, and leveraging technology to provide decision support for patients and providers, according to Tara Sanft, MD, Assistant Professor at Yale School of Medicine and Director of the Cancer Survivorship Program at Smilow Cancer Hospital in New Haven, CT.
“The landscape of survivorship is one of multiple paths, but we want to be able to show a clear pathway for patients,” she said at the ASCO Cancer Survivorship Symposium. “Remember, our job is to not only think about risk of recurrence, surveillance, and screening guidelines to detect second cancers; we’re also tasked with addressing late- and long-term effects, health promotion, and age-appropriate guidelines as patients enter into older phases.”
Although numerous “correct” paths can be chosen in survivorship care, Dr Sanft encourages giving patients a choice of plans when it comes to their care. Each patient should have a clear plan mapped out and appropriately tailored to his or her own individual needs, necessary intensity, and length of follow-up, she said.
The Importance of Awareness
The Institute of Medicine defines clinical guidelines as recommendations that direct clinical behavior. They should be valid, easily applicable, clearly understood, and multidisciplinary in nature, and should lead to consistent, higher-quality care.
Multiple cultural, societal, institutional, and individual factors influence whether clinical guidelines are adopted, but one factor that aids in their uptake is awareness. According to Dr Sanft, a growing number of organizations have contributed to increasing that awareness since the inception of the National Coalition of Cancer Survivorship.
But although a plethora of guidelines now exist (ie, American Society of Clinical Oncology/American Cancer Society, National Comprehensive Cancer Network, Children’s Oncology Group, Oncology Nursing Society, etc), minimal elements are universally endorsed. Guidelines can be general, age-based, disease-based, or symptom-based, and guidelines for the same cancer type can differ in their recommendations.
Broad-based, inclusive guidelines are often underutilized by oncologists who find them difficult to tailor to their patients, and specific disease-based guidelines often leave out the primary care providers who see patients with cancer in long-term follow-up. This lack of consistency and “preponderance of vagueness” can lead to confusion and frustration for healthcare providers.
By 2040 there will be over 26 million cancer survivors in the United States alone. The number of oncologists available will not be able to keep up with the demand, but according to Dr Sanft, increasing awareness and uptake of survivorship guidelines among primary care providers will help to ensure that this shortage of oncology providers will not be detrimental to survivors.
“The intentions are good,” she said. “But some of the awareness is still left to be disseminated. We need to continue to expand our evidence base, because that will give us the meat that will allow people to implement and uptake these guidelines,” she said. “We want every survivor to have a clear path forward, and one that’s unique to them.”
