1. health and fitness
2. disease
3. cancer

CANCER
SURVIVORSHIP:
WHAT, WHEN, HOW?
JIMMIE WELLS, MSN, RN, OCN
ONCOLOGY SURVIVORSHIP NAVIGATOR
ST. DOMINIC HOSPITAL
OBJECTIVES
Discuss cancer survivorship and it’s intended goals
Review identified focus and national accreditation goals for
survivorship care planning (SCP)
Discuss when SCP should be initiated, disseminated and/or
completed
WHAT?
CANCER SURVIVOR
“an individual is considered a
cancer survivor from the time of
cancer diagnosis through the
balance of his or her life.”
(National Coalition for Cancer Survivorship and the
NCI office of Cancer Survivorship)
ACS CANCER SURVIVOR
FACTS & FIGURES
SURVIVORSHIP CARE
Starts at diagnosis
Optimize patient outcomes
Reduce cost of care
Support the overall physical and psychosocial well-being of
survivor
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•
•
•
•
Psychological
Physical
Social
Spiritual
Economic
LIFE AFTER CANCER
TREATMENT
Transition Theory
Ending
Neutral Zone
New Beginning
Bridges, W. (2004). “Transitions: Making sense of Life Changes”
ENDING
Leaving the familiar
• “Swimming out to sea”
Physical recovery
Unrealistic expectations
Fatigue/depression
Difficult to shed role of “patient”
Rancour, P. (2008). Clinical Journal of Oncology Nursing
NEUTRAL ZONE
Characterized by sense of confusion, chaos and anxiety
• “Treading water in the middle of the sea with no land in site”
Lack of structure
No longer have cancer but not “normal” either
Rancour, P. (2008). Clinical Journal of Oncology Nursing
NEW BEGINNING
Ready to make a new beginning
• Spotted land and began to swim with purpose
Recognize opportunities
May not be the same as before cancer diagnosis
Time of exploration
Review “meaning of life”
Rancour, P. (2008). Clinical Journal of Oncology Nursing
2015 COC
Standard 3.3 – Survivorship Care Plan
• “The cancer committee develops and implements a process
to disseminate a comprehensive care summary and follow-up
plan to patients with cancer who are completing cancer
treatment. The process is monitored, evaluated, and
presented at least annually to the cancer committee and
documented in minutes.”
• American College of Surgeons – Commission on Cancer (CoC),
2015
STANDARD 3.3
(CLARIFICATION)
Focused on the subset of survivors who are treated with
curative intent, and have completed active therapy (other
than long-term hormonal therapy).
• Patients with metastatic disease are not targeted for SCP
•
•
•
•
•
2015 – 10% of eligible patients
2016 – 25% of eligible patients
2017 – 50% of eligible patients
2018 – 75% of eligible patients
2019 – 100% of eligible patients
SURVIVORSHIP
Not just treatment summaries (Care Plans)
Broad scope of services
•
•
•
•
•
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Symptom management
Support groups
Nutritional counseling
Rehabilitation
Education on late, long-term effects
Surveillance
WHEN?
SCP DEVELOPMENT
Delivery when “completed active therapy”
• When to start??
• Where patients identified?
Develop a SCP Process/work flow for your facility
• Unique to your facility
• Follow national guidelines
• Start small
CHOOSE A TEMPLATE
Amount and type of information
• Health literacy
• Oncologist/PCP desired information
• Prioritize ease of use
Document format
• Paper/electronic
• Follow-up plan availability
Creation
• Who
• Data retrieval/entry method
TEMPLATES OPTIONS
Homegrown
• Requires up-front staff time investment
• Manual and/or electronic
ASCO
• Free
• Manual
LiveStrong
• Free
• Manual
Journey Froward
• Free
• Manual
Commercial providers
• Software acquisition cost
• IT compatibility
HOW?
IDENTIFY DATA
SOURCES
Patient population/location targeted
Required information
Access
Internal record keeping
Medical record sources
Cancer Registrar availability
• Timeliness of registry reporting
ASSIGNED STAFF
RESPONSIBILITY
Oncologist
• Overview program
• Review SCP
RN
Navigators
Cancer registry
Data entry personnel
DELIVERY TIME
FRAME
Completion of “active therapy”
• Timing important
• Separate appointment vs along with existing appointment
When
• Patient preference
• Patient readiness to engage
• Schedule of follow-up appointments
DELIVERY METHOD
Face-to-face meeting
• Preferred
• Staff availability
• Who delivers
• RN
• NP
• MD
Telephone
Electronic media
EVALUATION GOALS
Gather feedback
Monitor adherence to recommended screenings
Develop measurable to evaluate effectiveness
• Surveys
• Survivors
• PCP
• Oncologist
RESOURCES
National Coalition for Cancer Survivorship
www.canceradvocacy.org
1-877-622-7937
Survivorship A to Z
www.survivorshipatoz.org/cancer
Cancer Support Community
www.cancersupportcommunity.org
American Cancer Society
www.cancer.org
LiveStrong
www.livestrong.org
Journey Forward
www.journeyforward.org
REFERENCES
Oncology Roundtable, Delivering Sustainable Survivorship
Care,
www.advisory.com
“The Survivorship Challenge”, The Advisory Board Company,
2014
www.Advisory.com/or/survivorship.com
American College of Surgeons: Commission on Cancer
www.coc@facs.org