Meeting Standard 3.3

As you know, the new standard for survivorship went into effect January 1, 2015. Here we are 18 months later and I hear a lot of discussion and concern about how cancer programs will be evaluated on Standard 3.3 that mandates survivorship care plan delivery. Some of the comments I’ve received and read from cancer centers who have been surveyed suggest that surveyors are primarily interested in the process you’ve developed rather than your actual numbers and percentages of care plan delivery. One responder explained their process for meeting this standard with patients who did not keep their survivorship appointment and had no plan to attend a future appointment. Documents were mailed to the patient, the patient was called, and the documents were reviewed by the nurse over the phone. From my viewpoint, this process felt like an extraordinary effort to meet the standard in a meaningful way for the significant population of patients that have no desire to come to a survivorship appointment. However, the surveyor said this was not adequate to meet the standard. Another commenter said the surveyor thought the Journey Forward care plan was too long and not specific enough with regard to chemotherapy doses. I believe there’s still a lot of confusion about the standard and how to implement it. As more programs are surveyed, the ACoS will be better informed about the real world issues involved in meeting this standard. Hopefully, this will translate into a revised 3.3 that clarifies these issues without compromising the care and information we provide to our patients. Look for revisions in 2017.

Survivorship Care Planning

The American Cancer Society is hosting a webinar on Survivorship Care Planning next Tuesday, November 11, 2014, from 1:00-2:30 p.m. With the deadline looming for ACoS CoC-accredited cancer centers to be compliant with Standard 3.3, many cancer centers are unsure of how to implement this standard, or even where to begin. Pearlman Cancer Center is honored to be a presenter on the webinar panel. We've been offering survivorship treatment summaries and care plans to our patients since early 2012. We'll talk about our experience in creating and delivering these documents and how they fit into a broader, more comprehensive survivorship program. We've tried several models for meeting this standard, so we have a sense of what works and what doesn't. Other presenters include representatives from the ACS, ACoS CoC, and another CoC-accredited cancer center. There will be an opportunity for questions after the presentations and the entire session will be available for viewing on YouTube for those who missed it. I'll post a link to the recorded session when it's available. Here's a link to register for the webinar, although it may already be closed out. https://acsevents.webex.com/acsevents/onstage/g.php?d=660933279&t=a. At last update, there were over 1300 registered. This topic has generated such interest, there may be an encore live webinar in a couple of months. Tune in if you can, or catch the recorded session.

It's been a busy year

So much has happened in the past year. In September, we presented a poster at the Georgia VHA Leadership Awards in Atlanta entitled Development of a Survivorship Program Blueprint for Community Cancer Centers. Just a few short weeks later we presented a poster at ACCC's 30th National Oncology Conference in Boston, on October 3. The presentation generated a lot of interest as cancer centers are working to determine the best way to implement survivorship services before the 2015 ACoS deadline. Our survivorship program was profiled in the Nov/Dec 2013 Oncology Issues, ACCC's publication. In March of this year, we were featured in ONS' Survivorship, Quality of Life, & Rehabilitation SIG Newsletter. And finally, next month, we'll have another poster at the 7th Biennial Survivorship Conference, Advancing Survivorship through Multilevel Collaborations, to be held in Atlanta June 18-20, 2014. If you can possibly make it to Atlanta, it will be worth the trip. It's an opportunity to see how other cancer centers are integrating survivorship services into their program and a chance to network with key people in this rapidly growing field. Good luck to you all as you develop your programs. If you need assistance or have questions, please reach out to us and visit www.pearlmansurvivorshipkit.com.

New Education Series for Primary Care Providers

George Washington Cancer Institute (GWCI) has been a leader in providing resources for Survivorship Education in this country for the greater part of the past decade. In association with the American Cancer Society and through grant support from the Centers for Disease Control and Prevention, GWCI has launched an initiative aimed at filling an important gap in survivorship care - the recruitment and education of primary care providers (PCP) to share in the care of our patients with a history of cancer. In a series of three e-learning modules, experts discuss the role of PCPs, physical effects, and psychosocial effects of cancer and its treatment. Three hours of free continuing education credits are offered. The series can be accessed here. Future modules will tackle health promotion and clinical guidelines in survivorship. Please share this important program with your contacts in the primary care practices in your community.

NCCN Publishes New Survivorship Guidelines

Last month the NCCN released new guidelines that address the evaluation and management of common survivorship issues following completion of therapy. They include anxiety and depression, cognitive dysfunction, exercise recommendations, fatigue, immunizations and infections, pain, sexual dysfunction, and sleep disorders. A sample baseline assessment tool is offered, with more in-depth survey questions included within each guideline. Most of the recommendations are category 2A, that is, based on lower level evidence, but supported by uniform consensus that the recommendation is sound. We've known for years that sexual issues are ubiquitous in our patients, and yet, they're probably the most consistently underaddressed  problem we see on a regular basis. Perhaps these guidelines will give us the knowledge and the push we need to begin routinely talking with patients about how cancer and our treatments have impacted their sexuality and intimate relationships. Please check out these new guidelines on the NCCN website http://www.nccn.org/professionals/physician_gls/f_guidelines.asp under Guidelines for Supportive Care. As well-designed randomized clinical trials are conducted in the area of Survivorship, the quality of our evidence will continue to improve. Eventually, there will be no gap in services for our cancer patients completing treatment.

Georgia CORE Best and Promising Practices

On November 27, 2012, we had the opportunity to speak on Survivorship Care Planning at Georgia CORE's one day seminar, held in Atlanta at the Georgia Tech Global Learning Center. The purpose of the meeting was to bring together oncology providers from around the state to discuss how best to work collaboratively to meet the ACoS 2012 Program Standards and create quality cancer programs. The standard that addresses survivorship care planning is being phased in over a three year period. By 2015, we should be providing our patients completing their first course of therapy with a Treatment Summary and Care Plan. These documents summarize the patient's cancer experience in a concise format, and offer guidelines for healthy living, optimal follow-up, and screening recommendations.
At South Georgia Medical Center, we have been doing this for about a year, and the response from our patients has been very positive. We use a template we developed locally for the Treatment Summary and pair it with a LIVESTRONG Patient Care Plan. For patients with a well-tolerated and uncomplicated diagnosis and therapies, it takes about 30-40 minutes to complete the Treatment Summary, plus an additional 10 minutes for the Care Plan. While this can be time consuming, the resulting documents are useful to the patient, the oncology team, and the primary care provider. We use a consultation model in our survivorship clinic. The Nurse Practitioner meets with the patient for an hour to review the Treatment Summary and Care Plan and discuss survivorship issues identified by the patient as concerning or causing significant distress. The patient then meets with the Dietitian and Social Worker to complete the survivorship evaluation and plan. Patients are offered a follow-up visit in 1-3 months, depending on the need. This model provides the survivor with knowledge about the next phase of care, resources to manage challenges, and three points of contact for additional follow-up as needed. Our experience is just one way to meet this standard, but we find it works well without adding a lot of additional resources. If you have experience with another approach, I hope you'll share it with us on this blog!

ACCC Conference in San Antonio

Tara Szymanski of Rhode Island Hospital wins the drawing for a Pearlman Survivorship Kit (L-R: Bridgett Young, RN, OCN, Director of Oncology Services, Pearlman Cancer Center, Valdosta, GA; Tara Szymanski; Mary Ann Heddon, RN, OCN, Co-Developer Pearlman Survivorship Kit and Clinical Trials Coordinator, Pearlman Cancer Center, Valdosta, GA)

The ACCC conference was great! The attendees we spoke with represented a somewhat different population of cancer care providers than the nurses we met at the AONN conference last month. It seemed like a modestly larger percentage of the administrative personnel we met have begun developing or already have a functional survivorship program. And yet clearly, the majority of community cancer centers still do not have a meaningful program in place. We held a drawing to give away a Pearlman Survivorship Kit, and Tara Szymanski of Rhode Island Hospital was the lucky winner. We'll be checking in with Tara to see what we can do to help her implement the components of the survivorship kit over the coming months.