Cancer survivorship care plans empower
Follow comprehensive guidelines
At the Dana-Farber Cancer Institute Lance Armstrong Foundation (LAF) Adult Survivorship Clinic in Boston, a nurse practitioner works with patients to develop a survivorship care plan.
According to Karen Sommer, NP, a nurse practitioner at LAF Adult Survivorship Clinic and Perini Pediatric Survivorship Clinic, these follow-up care plans take many shapes and forms, but most have certain key components.
All have recommendations for surveillance for the kind of cancer for which the patient was treated. That is particularly appropriate for patients within five years of having ended treatment and less of a concern farther out, she says.
As part of surveillance, plans include signs and symptoms patients should report to their physician. For example, something that might be ignored as heartburn could be a sign of esophageal cancer, says Sommer.
Plans also contain recommendations on management and screening for late effects a patient has experienced resulting from the past cancer and treatment.
A fourth piece would be identification of potential late effects for which a patient is still at risk and recommendation on mitigation or prevention of those late effects, states Sommer.
A plan would contain information on general health and disease prevention based on the recommendations of the U.S. Preventative Services Task Force in Rockville, MD, and cancer screening recommended by the American Cancer Society, headquartered in Atlanta.
General health and promotion measures would be identified with an eye to a patient's past cancer treatment, says Sommer. For example, everyone should get regular checkups that include cancer screening such as skin exams. However, for patients who have had radiation therapy to a large area of their body, skin exams are particularly important, for those patients are at increased risk for skin cancer.
Survivorship care plans benefit patients in many ways, says Sommer. They empower patients, giving them some control with regard to their disease prevention and certainly with regard to their general health. Patients can be educated about future late effects and take appropriate steps, she says. For example, the patient could be at risk for developing cardiac problems, and he or she could make lifestyle changes, such as following a heart-healthy, low-fat diet and exercising three to five times a week. A person who was not told he or she was at greater risk for heart disease might not be compelled to make healthy lifestyle changes and develop heart disease much earlier than would otherwise occur, says Sommer.
"Knowledge is power, and hopefully through knowledge you can effect change that positively impacts a patient's health going forward," explains Sommer.
Care plans not for patients only
The information in survivorship care plans should be shared with family members and a person's primary care provider. The demand for oncologists and oncology follow-up is becoming far greater than the number of oncologists that currently exist. Therefore, a growing number of cancer survivors will return to their primary care physicians for ongoing follow-up, and these providers will need to learn about late effects.
"One of the first steps is empowering patients, so they can be advocates for themselves. Second to that is empowering the primary care providers, so they feel comfortable taking care of this increasing number of cancer survivors," says Sommer.
Survivor care plans integrate a health and wellness program around a patient's prior cancer into primary care practice, along with a recommendation for the surveillance for potential late effects.
In addition to medical care, psychosocial health must be considered. At Dana-Farber Cancer Institute, every patient who is new to survivorship is seen by a psychosocial clinician with the option to follow-up with that clinician as needed or agreed as appropriate by the patient and clinician.
To make recommendations about surveillance and follow-up, nurse practitioners at the LAF Adult Survivorship Clinic follow comprehensive guidelines published by the National Comprehensive Cancer Network based in Fort Washington, PA. This organization publishes surveillance guidelines for most cancers up to about five years from the end of therapy, says Sommer. The American Society of Clinical Oncology in Alexandria, VA, also publishes similar guidelines, she says.
When a survivor two years past his or her treatment is seen, the guidelines are referred to in order to make recommendations on clinical exams, blood work, and other follow-up measures. The recommendations are made in consultation with a patient's oncologist.
Because adult survivors of childhood cancer are often seen, guidelines from the Children's Oncology Group based in Arcadia, CA, are also used as a reference.
Sources
Karen Sommer, NP, LAF Adult Survivorship Clinic, DFCI, Perini Pediatric Survivorship clinic, DFCI, Boston, MA. Telephone: (617) 632-5100. E-mail: [email protected].
American Society of Clinical Oncology, 2318 Mill Road, Suite 800, Alexandria, VA 22314. Telephone: (571) 483-1300. Website: www.asco.org.
Children's Oncology Group, Research Operations Center, 440 E. Huntington Dr., Suite 400, Arcadia, CA 91006-3776. Telephone: (800) 458-6223. Website: www.childrensoncologygroup.org.
National Comprehensive Cancer Network, 275 Commerce Dr., Suite 30, Fort Washington, PA 19034. Telephone: (215) 690-0300. Website: www.nccn.org.
At the Dana-Farber Cancer Institute Lance Armstrong Foundation (LAF) Adult Survivorship Clinic in Boston, a nurse practitioner works with patients to develop a survivorship care plan.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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