An Updated Survivorship Care Planning Template and Identifying Barriers to Implementation

Recently, the American Society of Clinical Oncology (ASCO) released an updated cancer survivorship care planning (SCP) template—news that was captured by several medical online news outlets including Healio, Medscape, and Cancer.net.

Survivorship care planning is a process of cancer care delivery that NCCS has advocated for over the last 20 years. In follow-up to a 2005 Institute of Medicine (IOM) report released in 2005, collaboration among UCLA, NCCS, the Oncology Nursing Society, WellPoint, and Genentech was formed to create a program called Journey Forward with a goal of creating and distributing templates for post-treatment survivorship care planning. This service is in accordance with the IOM recommendations as a best practice for cancer survivors.  Journey Forward used the ASCO templates as a basis for developing the a suite of tools to help providers implement SCPs in practice.

ASCO originally started developing SCP templates nearly a decade ago and in that time, other advocacy organizations and cancer centers developed their own. This most recent update was developed by a joint workgroup of the ASCO Cancer Survivorship Committee and the ASCO Quality of Care Committee. The current template evolved from a multi-stakeholder consensus conference convened in September 2013.

The updated template is streamlined and more user-friendly. At just two pages, it aims to assist survivors in tracking the major aspects of their cancer treatment and recommendations for follow-up care. However, while the update is certainly an improvement, we still remain cautious of any assumption that this will result in a higher rate of usage, as many barriers still exist to using this or other tools.

In the ASCO Clinical Expert Statement on Cancer Survivorship Care Planning released this month, four barriers to implementation were highlighted, including the substantial time required to complete a SCP, inadequate reimbursement for the time and resources required to completed the SCP, challenges in coordinating care among providers and between providers and survivors, and incomplete penetration of electronic health record systems in the marketplace that can facilitate SCP completion.

These barriers were taken into consideration during the consensus meeting and informed the design of the new SCP tool. Prior to releasing the updated template, a pilot study among ASCO Quality Oncology Practice Initiative (QOPI) practices was completed and found that the SCP took an average of 30 minutes to complete. QOPI practices also found that it was easy to complete, clear in its questions, included important elements for survivorship care planning, and useful. However, what this survey did not examine was the likelihood of use by practices if not reimbursed. ASCO did attempt to encourage use of the SCP template by simplifying it, though we maintain that without proper reimbursement, adoption of survivorship care planning as a standard practice will be insufficient. Reimbursement reform must remain a priority to bring survivorship care planning to fruition.

The bottom line remains that if survivors do not ask for a care plan, it will likely not become the standard practice that we feel is essential to best care in post-treatment planning for cancer survivors. Oncology practices, internal medicine providers, and patient advocacy groups have a responsibility to inform survivors of this tool. NCCS will continue to bring awareness to the importance of the survivorship care planning process and all similar efforts to bring quality improvement to cancer care.