Background: “Care of the cancer survivor should include prevention, surveillance, assessment of late effects and intervention for consequences of cancer and treatment.”1 Survivor PLACE (People Living After the Cancer Experience) (SP) was created as a multidisciplinary clinic using the Yale model2 to evaluate and provide recommendations to those who have completed cancer treatment. The Institute of Medicine’s recommendations were utilized.3 SP focuses on wellness, quality of life, and health promotion. Patients receive a comprehensive evaluation by a CRNP, dietitian, social worker/counselor, nurse navigator, and rehabilitation specialist. Genetic counselors provide recommendations. Each patient receives a treatment summary and survivor care plan, which includes individualized recommendations. Prior to the visit, patients fill out a homegrown quality of life (QOL) assessment so that individual needs are addressed along with standard survivorship recommendations. Survivors fill out the same assessment 3 months later for comparison. Although SP was designed as a one-time visit, many patients requested annual visits.
Objectives: To utilize information from QOL surveys for optimal interaction and to provide individualized interventions. SP visit effectiveness is evaluated through the 3-month follow-up survey. Results will be used to identify the appropriate multidisciplinary team and resources to positively impact survivors’ physical and mental health and promote wellness after cancer treatment.
Methods: Our assessment contains 21 physical, social, and mental health QOL questions. Survivors complete the questions using a 5-point Likert scale. Severe problems are rated 5, no problem is rated 0. Questionnaires are reviewed by the team prior to the visit. Our team members are certified or educated in oncology. Patients meet with the full team at the initial visit. Patient preference and QOL assessment determine interventions at annual visits. Each team member meets individually with the patient to evaluate, educate, and make appropriate referrals/recommendations for ongoing support. Thirty-one patients (18 new, 13 annual) completed both baseline and 3-month QOL assessments. A total of all the patients’ scores on each item was used to determine the total score at baseline and at 3-month assessments.
Results: Both QOL scores were analyzed and compared. Of the 21 criteria analyzed, greatest improvement/decrease in scores for new patients were Fear of Future (61%), Satisfaction with Life (53%), Ability to Concentrate (50%), Sleep (50%), Pain (45%), and Weight Satisfaction (43%). For annual patients, greatest improvements were Weight Satisfaction (71%), Neuropathy (36%), and Body Image (35%).
Conclusion: QOL assessments from cancer patients posttreatment demonstrate a decreased QOL in several areas. Patients who are assessed by a multidisciplinary team addressing physical, psychological, and social issues show improvement in some areas. Our results indicate that overall, QOL scores improved at 3 months for patients who have had a multidisciplinary survivorship visit. Lehigh Valley Health Network has resources for physical therapy, nutrition, weight control, fitness, and emotional support. Based on the results of this study, the SP team will incorporate resources such as the sex therapist, pelvic floor therapist, and cognitive rehabilitation into the survivorship plan of care as appropriate.
- NCCN Guidelines & Clinical Resources. www.nccn.org/professionals/physician_gls/default.aspx.
- Sevedge K, Morrone D, Gardner S, et al. (September-October 2013). Survivor Place: Evolution of a multidisciplinary approach to survivorship care. www.accc.cancer.org.
- Hewitt M, Greenfield S, Stovall E. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: National Academies Press; 2006.