A variety of survivorship care models have been developed internationally, but data comparing the different plans are limited. A retrospective analysis assessed the concordance of care plans for adult cancer survivors in nurse practitioner (NP)-led clinics with Institute of Medicine (IOM) guidelines for comprehensive survivorship care. The researchers presented the study at the ASCO Annual Meeting.
The researchers reviewed three survivorship clinics to determine the frequency of surveillance for recurrence (SR), screening for second cancers, symptom management (e.g., physical, psychological), health promotion education (e.g., alcohol, tobacco, cholesterol, and bone density screenings; as well as diet and exercise discussions), and care coordination (e.g., provision of care plan). Visit length and payer mix were also assessed.
Between 2011 and 2013, 9,052 unique visits occurred within the three clinics, with the following visits randomly selected for review.
- Breast cancer (n = 210)
- Prostate cancer (n = 208)
- Colorectal cancer (n = 204)
All breast cancer survivors underwent SR, and 99% received screenings for new primary cancers. The frequency of health promotion activities discussed ranged from 83%–100%. At most visits, physical (91%) and psychological (93%) symptoms were discussed.
All prostate cancer survivors underwent SR, and 97% were screened for new primary cancers. The frequency of health promotion activities discussed ranged from 70%–97%. At most visits, physical and psychological symptoms (89%) were discussed.
All colorectal cancer survivors underwent a colonoscopy for SR, and 97% had a carcinoembryonic antigen test. Among female patients, 97% had a mammogram and 96% had a Pap test. Among male patients, 83% had a prostate-specific antigen test. At most visits, health promotion activities ranged from 69%–100% and symptoms discussions from 93%–97%.
The provision of care plans varied substantially among the clinics, partly because of staffing and clinical systems issues for 36% with prostate cancer, 70% with breast cancer, and 92% with colorectal cancer.
The researchers concluded, “These findings suggest the success of NP-led clinics in providing quality survivorship care in accordance with IOM standards. Although IOM guidelines are not considered a final authority, they provide normative standards. This assessment is an important step in evaluating survivorship outcomes.”