Basic Information for Health Care Professionals and Researchers

Nearly 15 million Americans who have been diagnosed with cancer are living in the United States. People are living longer after a cancer diagnosis because of advances in early detection and treatment. About two out of every three people who are diagnosed with cancer are expected to live at least five years after diagnosis. After completing treatment, survivors may encounter ongoing or future needs related to their cancer or its treatment.

Cancer survivors are at greater risk than people who have never had cancer for recurrence and for developing second cancers due to the effects of treatment, unhealthy behaviors, underlying genetics, or risk factors that contributed to the first cancer. Survivors also often face physical, emotional, psychosocial, spiritual, and financial challenges as a result of their cancer diagnosis and treatment.

To reduce the impact of this increasing burden of cancer, medical and public health professionals can address possible long-term and late effects of cancer and its treatment on survivors’ physical and psychosocial well-being, provide coordinated care, and promote healthy behaviors.

Survivorship Care Plans

Survivorship care plans are documents often delivered at the completion of cancer treatment that summarize a patient’s cancer and treatment history, potential long-term effects of cancer or its treatment, and recommended screening, surveillance, preventive care, and follow-up. The providers responsible for different aspects of care need to be specified in the care plan.

In response to the 2005 Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition, several expert organizations have recommended that patients and their primary care providers receive a treatment summary as part of a comprehensive survivorship care plan. However, implementation of these plans has been slow, largely because they can be very time-consuming to produce.

Templates and tools are being developed to help reduce barriers to delivering survivorship care plans to cancer survivors. For example, the Colorado Central Cancer Registry, with funding from CDC’s National Program of Cancer Registries, developed a secure, Web-based application that allows providers to use data from the central and hospital cancer registries to pre-populate and semi-automate survivorship care plans. Through this application, the provider can edit or add to the survivor’s diagnosis and treatment information and provide customized guidance, such as recommended follow-up and behavior changes.

What Is the Evidence for Survivorship Care Plans?

From Cancer Patient to Cancer Survivor: Lost in Transition concluded that many survivors are lost to follow-up after completing cancer treatment and during the transition to post-treatment care. Survivorship care plans were recommended to facilitate communication and coordinate care between survivors and their health care providers. Plans are now included in some cancer quality initiatives.

Whether survivorship care plans improve health outcomes is an active area of research. Although some studies suggest care plans may be associated with increased use of recommended care¹ or improved knowledge of cancer history and treatment,² two randomized controlled trials reported little difference in some patient-reported outcomes.^{3 4} A recent systematic review of the limited studies to date showed few benefits of care plans, although cancer survivors reported high levels of satisfaction with having the document. Additional evidence is needed to understand the impact of care plans on health outcomes.

References

¹Oeffinger KC, Hudson MM, Mertens AC, Smith SM, Mitby PA, Eshelman-Kent DA, Ford JS, Jones JK, Kamani S, Robison LL. Increasing rates of breast cancer and cardiac surveillance among high-risk survivors of childhood Hodgkin lymphoma following a mailed, one-page survivorship care plan. Pediatric Blood & Cancer 2011;56(5):818–824.

²Nissen MJ, Tsai ML, Blaes AH, Swenson KK, Koering S. Effectiveness of treatment summaries in increasing breast and colorectal cancer survivors’ knowledge about their diagnosis and treatment. Journal of Cancer Survivorship 2013;7(2):211–218.

³Grunfeld E, Julian JA, Pond G, Maunsell E, Coyle D, Folkes A, Joy AA, Provencher L, Rayson D, Rheaume DE, Porter GA, Paszat LF, Pritchard KI, Robidoux A, Smith S, Sussman J, Dent S, Sisler J, Wiernikowski J, Levine MN. Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. Journal of Clinical Oncology 2011;29(36):4755–4762.

⁴Hershman DL, Greenlee H, Awad D, Kalinsky K, Maurer M, Kranwinkel G, Brafman L, Jayasena R, Tsai WY, Neugut AI, Crew KD. Randomized controlled trial of a clinic-based survivorship intervention following adjuvant therapy in breast cancer survivors. Breast Cancer Research and Treatment 2013;138(3):795–806.