Implementing a Survivorship Program/Clinic

Cynthia Waddington, RN, MSN, AOCN
Helen F. Graham Cancer Center, Christiana Care Health System, Newark, Delaware

Ms Waddington discussed survivorship trends, various recommendations and model survivorship programs, and options for survivorship care plans. She noted that the phases of survival include an acute phase during diagnosis and treatment planning, an extended period during the course of treatment, and a permanent phase equated with “cure.” Patients may experience changes in relationships, work experience, physical limitations, late effects of the disease, and fear of recurrence. During survivorship, patients may be cancer free or in a maintained remission, both of which can be considered extended survivorship, or be in a chronic survivorship during which they are living with cancer. Patients have unmet needs outside of their disease treatment, including feeling lost when active treatment ends.

An Institute of Medicine report states that the essential components of survivorship care should include prevention, surveillance, intervention, and coordination of care. Goals of survivorship treatment should be a central strategy for transition into survivorship to be used by the patient and the primary care provider, including diagnosis, treatment, follow- up care plan, and guidelines to meet the needs of the survivor. This should optimize opportunities for health promotion and management of persistent and delayed effects of the cancer and its treatment. The plan should specify providers responsible for this care and include resources and referrals.

Each institution may provide different levels of survivorship care, which may depend on available staff and funding. These include:

1. Level One: treatment summary and survivor care plan
2. Level Two: add education and support services
3. Level Three: add counseling, late/long-term care
4. Level Four: add survivorship subspecialty care (cardiology, fertility, sexual health, etc)

Staff is the largest single cost of survivorship care. Some costs may be offset for healthcare providers if they can bill under “history of cancer.” Coverage for other ser - vices may or may not exist, eg, nutrition or smoking cessation. Group education may be a way to control some of these costs, and the program may be justified if it refers to other services, eg, occupational or physical therapy. There are many survivorship plans available online for those who don’t want to create their own.

Ms Waddington described the specifics of the program at her institution, noting that not all physicians want to turn over survivorship care to someone else. Patients prefer faceto- face delivery of the transition plan at the end of treatment from their oncologist. Elements of a program should include quality of life; dealing with aftereffects of treatment, such as fatigue; and managing the fear of recurrence. As the population ages, the population of cancer survivors will continue to grow, as will the need for survi vorship care pl ans.