A new study published in the Journal of Cancer Survivorship by Mandi L. Pratt-Chapman, PhD, MA, associate center director for patient-centered initiatives and health equity at the George Washington University (GW) Cancer Center, and collaborators from the National Cancer Institute (NCI), the Centers for Disease Control and Prevention and Brigham and Women's Hospital reviewed and analyzed cancer survivorship-related goals and objectives from comprehensive cancer control (CCC) plans. 

The researchers, including first author Michelle A. Mollica, a program director of the Healthcare Delivery Research Program at NCI, reviewed 62 CCC plans from states, territories, tribal organizations and the District of Columbia to assess their alignment with recommendations from the landmark report, From Cancer Patient to Cancer Survivor: Lost in Transition, published by the former Institute of Medicine (IOM).

In its report, the IOM recommended that states develop, implement and evaluate plans that include consideration of survivorship care. In this study, the researchers were looking to identify the inclusion of cancer survivorship-focused goals and objectives and examine alignment of survivorship-focused objectives with the IOM recommendations, listed below:

  1. Raising Awareness: Health care providers, patient advocates, and other stakeholders should work to raise awareness of the needs of cancer survivors, establish cancer survivorship as a distinct phase of cancer care, and act to ensure the delivery of appropriate survivorship care
  2. Survivorship Care Plan: Patients completing primary treatment should be provided with a comprehensive care summary and follow-up plan that is clearly and effectively explained. This Survivorship Care Plan should be written by the principal provider(s) who coordinated oncology treatment. This service should be reimbursed by third-party payors of health care.
  3. Utilizing Evidence-Based Guidelines: Health care providers should use systematically developed evidence-based clinical practice guidelines, assessment tools, and screening instruments to help identify and manage late effects of cancer and its treatment. Existing guidelines should be refined and new evidence-based guidelines should be developed through public- and private-sector efforts.
  4. Developing and Implementing Quality Measures: Quality of survivorship care measures should be developed through public/private partnerships and quality assurance programs implemented by health systems to monitor and improve the care that all survivors receive.
  5. Models of Coordinated Care: The Centers for Medicare and Medicaid Services, National Cancer Institute, Agency for Healthcare Research and Quality, the Department of Veterans Affairs, and other qualified organizations should support demonstration programs to test models of coordinated, interdisciplinary survivorship care in diverse communities and across systems of care.
  6. Survivorship as a Public Health Concern: Congress should support Centers for Disease Control and Prevention, other collaborating institutions, and the states in developing comprehensive cancer control plans that include consideration of survivorship care, and promoting the implementation, evaluation, and refinement of existing state cancer control plans.
  7. Healthcare Profesional Capacity: The National Cancer Institute, professional associations, and voluntary organizations should expand and coordinate their efforts to provide educational opportunities to health care providers to equip them to address the health care and quality of life issues facing cancer survivors.
  8. Employment-Related Concerns: Employers, legal advocates, health care providers, sponsors of support services, and government agencies should act to eliminate discrimination and minimize adverse effects of cancer on employment, while supporting cancer survivors with short-term and long-term limitations in ability to work.
  9. Adequate and Affordable Health Insurance: Federal and state policy makers should act to ensure that all cancer survivors have access to adequate and affordable health insurance. Insurers and payors of health care should recognize survivorship care as an essential part of cancer care and design benefits, payment policies, and reimbursement mechanisms to facilitate coverage for evidence-based aspects of care.
  10. Investments in Research: The National Cancer Institute, Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services, Department of Veterans Affairs, private voluntary organizations such as the American Cancer Society, and private health insurers and plans should increase their support of survivorship research and expand mechanisms for its conduct. New research initiatives focused on cancer patient follow-up are urgently needed to guide effective survivorship care.

Topics that appeared most frequently in CCC plans included raising awareness, survivorship care plans and health care professional capacity. Although not specifically recommended by the report, palliative care appeared in more plans than did any other topic. Employment-related concerns, developing and implementing quality measures and investments in research were not frequently included in objectives.

The authors noted that assessing alignment of survivorship content in cancer plans with survivorship recommendations from the report allows for targeting efforts to improve outcomes and allows CCC coalitions to evaluate their plans based on their local context and priorities. Recommendations from the study included:

  1. Expand state, territory, and tribal organization comprehensive cancer control plans to include survivorship goals aligned with NAM recommendations as appropriate.
  2. Implement systematic assessment of patient-reported outcomes relevant to cancer survivors (e.g., quality of life, functional status, distress).
  3. Prioritize survivorship objective implementation based on assessment of jurisdiction-level patient and provider needs.
  4. Assess region-level healthcare provider supports needed to improve provision of evidence-based cancer survivorship care.
  5. Educate healthcare providers on available cancer survivorship-focused clinical practice guidelines using evidence-based learning strategies.
  6. Focus on sustainability of quality survivorship care through adequate reimbursement.
  7. Partner with researchers to track, assess, and evaluate plan goals, objectives, and impact on stakeholders.
  8. Publish action plans and jurisdiction-level outcomes at least annually through a public-facing report to enhance peer learning.
  9. Use evaluation data for continuous quality improvement of prioritized comprehensive cancer control survivorship strategies.
  10. Disseminate best practice approaches to other jurisdictions.

"The growing number of survivors requires broad-ranging policy strategies," the report noted. "Future efforts are needed to assess the implementation and impact of plan strategies to improve the overall wellness of cancer survivors."

The paper, "Survivorship Objectives in Comprehensive Cancer Control Plans: A Systematic Review," was published in the Journal of Cancer Survivorship in January 2020.

To access the paper, visit https://www.ncbi.nlm.nih.gov/pubmed/31953645.