APRNs Bridge the Gap in Survivorship Care

April 05, 2018 by Kristen Baileys, RN, MSN, CRNP, OCN® , and Michele Galioto DNP, RN, CNS, Assistant Executive Director for the ONS Center for Innovation

As improved screening, diagnosis, and treatments lead to cancer’s classification as a chronic disease, people with cancer are surviving longer than ever before. However, with lengthened survival comes long-term physical and emotional symptoms (https://doi.org/10.1188/16.ONF.710-719) and other sequelae that require ongoing surveillance and management. Advanced practice registered nurses (APRNs) are essential to delivering quality survivorship care.

APRN Models of Survivorship Care

The classic publication (https://doi.org/10.17226/11468) From Cancer Patient to Cancer Survivor: Lost in Transition stated, “An ideal system of survivorship care would provide all cancer survivors with preventive services, surveillance, necessary interventions, and coordination with primary care to ensure that all of the survivor’s care needs are met.” Other issues it brought to attention included the thought that primary care providers (PCPs) sometimes provide limited post-treatment care to patients with cancer because of lack of expectations; survivors may not be aware of when to seek care for late effects; and although willing to comply, PCPs don’t often receive explicit instructions from oncology specialists on what is required post-treatment. One of the recommendations was for nurses with advanced training in oncology to assume important roles in providing survivorship care.

Oeffinger and McCabe proposed (https://doi.org/10.1200/jco.2006.07.0474) risk-stratified survivorship health care, identifying patients at low, intermediate, and high risk for long-term cancer and cancer treatment-related sequelae. A risk-stratified approach and other models of survivorship care bring the oncology care team together with PCPs for optimal care coordination; appropriate resource use; and effective surveillance-, prevention-, and health-focused care. Newhouse et al. conducted (https://www.nursingeconomics.net/ce/2013/article3001021.pdf) a systematic review of patient outcomes as a result of care provided by nurse practitioners over an 18-year period. The results indicated that APRNs provide effective, high-quality patient care with equivocal outcomes to physicians. 

Oncology and Primary Care Coordination

Survivorship care plans (SCPs) have long been considered a tool to enhance communication between oncology and primary care providers. The National Cancer Institute has recommended (https://deainfo.nci.nih.gov/advisory/pcp/annualReports/pcp03-04rpt/Survivorship.pdf) them since 2004, and SCPs were identified as a priority in the American College of Surgeons Commission on Cancer’s (https://www.facs.org/~/media/files/quality%20programs/cancer/coc/2016%20coc%20standards%20manual_interactive%20pdf.ashx) Cancer Program Standards: Ensuring Patient-Centered Care. SCPs are intended to serve as a tool to address unmet needs and identify likely long-term sequelae. SCP development should involve the full care team, and those responsible for discussing the plan with patients and caregivers should be included in the practice procedures. 

More needs to be done to ensure comprehensive and coordinated survivorship care between PCPs and oncology specialty care. Dossett et al. identified (https://doi.org/10.3322/caac.21385) several communication-related issues between oncology and primary care, all highlighting a need for improved communication, coordination of responsibilities, and role clarification. APRNs have much to contribute to enhance communication and bridge knowledge gaps regarding guideline implementation, especially with respect to symptom management and health surveillance. To ensure quality patient care across the cancer care continuum, APRNs must remain in the pivotal role of bridging the gap of survivorship care between active cancer therapy and long-term follow-up.

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