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11/11/2014
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George Washington University
(GW) Cancer Institute
An Overview of Survivorship
Activities
Learning Objectives
• Summarize cancer survivorship clinical practice
guidelines developed through the National Cancer
Survivorship Resource Center
• Describe the components of the Cancer Survivorship E-
Learning Series
• Identify characteristics of survivorship models of care
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GW Cancer Institute
• Founded in 2003
• Vision: To set the standard for patient-centered care
and eliminate cancer health disparities.
• Mission: To ensure access to quality, patient-centered
care across the cancer continuum through community
engagement, patient and family empowerment, health
care professional education, policy advocacy, and
collaborative multi-disciplinary research.
Survivorship at GW Cancer
Institute
• Center for the Advancement of Cancer Survivorship, Navigation and Policy
– Survivorship & Navigation Resources
– Health Policy Initiatives
– Education & Training
• National Survivorship Surveys
• National Cancer Survivorship Resource Center
• Evaluating Cancer Survivorship Care Models
• Comprehensive Cancer Control Technical Assistance
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National Cancer Survivorship
Resource Center
• A collaboration between the American
Cancer Society and the GW Cancer Institute
• Funded by a 5-year cooperative agreement
from the Centers for Disease Control and
Prevention (#1U55DP003054)
• Goal: Shape the future of cancer survivorship
care and improve the quality of life of cancer
survivors as they transition from treatment to
recovery.
National Cancer Survivorship
Resource Center
Cancer.org/SurvivorshipCenter
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National Cancer Survivorship
Resource Center
Developing and distributing a broad range of cancer survivorship tools and
resources for providers, cancer survivors and
caregivers.
Developing cancer survivorship clinical practice guidelines for primary care
providers.
Educating primary care providers about how to best
care for survivors.
Promoting healthy behaviors to reduce late and long-term effects of cancer and its treatment through
self-management.
American Cancer Society
Prostate Cancer Survivorship
Care Guidelines
bit.ly/ACSPrCa
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Overview of Guideline
Development ProcessThe guidelines are based on the American Cancer Society Prostate Cancer Survivorship Guidelines published in July 2014.
The guidelines panel represented a diverse group of providers, including oncologists, surgeons, primary care providers, psychosocial providers, etc. to avoid the appearance of professional conflicts.
ACS staff conducted preliminary systematic evidence reviews to develop a foundation for expert panelists. Expert panelists were divided into topic focused subgroups and conducted additional literature review and analysis to serve as the basis for all guidelines.
468 articles met the inclusion criteria for the literature review, and 222 were included as citations to support the guidelines.
Before publication, all draft survivorship guidelines were vetted by internal experts, the Priority Mission Outcomes Committee, National Board of Directors, and relevant external experts, organizations, and societies.
American Cancer Society
Prostate Cancer Survivorship
Care Guidelines
Health Promotion
(Meeting information needs,
Obesity and weight management to improve health
outcomes, Physical activity, Nutrition and alcohol
consumption, Smoking cessation)
Surveillance for Prostate Cancer Recurrence
Screening and Early Detection of Second Primary Cancers
Assessment and Management of Physical and Psychosocial Long-Term and Late Effects
(Using validated surveys and comprehensive measures of
cancer health-related quality of life)
Care Coordination
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Guidelines for Care Coordination
• PCPs maintain role as care coordinator throughout the spectrum of
prostate cancer detection, treatment, and aftercare
• When care is transferred to the PCP, the cancer specialist should:
– Provide a treatment summary and SCP to the PCP
– Clarify the need for and frequency of PSA monitoring
– Establish thresholds for referral back
• Annually assess for the presence of long-term or late effects of
prostate cancer and its treatment
• Refer survivors to appropriate community-based and peer support
resources
Sources: Hewitt M, et al. Washington, DC: National Academies Press. 2006; American College of Surgeons. Commission on Cancer. Cancer Program Standards 2012. http://www.facs.org.
Cancer Survivorship E-Learning
Series for Primary Care Providers
CancerSurvivorshipCenterEducation.org
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E-Learning Series: Theoretical Base
• Needs-based: The program is based on recommendations from national reports and experts.
• Multi-modal strategies: The components of each module include multiple modalities to enhance learning.
• A series of modules: The program will be comprised of discreet modules that cover a variety of topics and that can be taken in any order.
E-Learning Series: Theoretical Base
• Contextual learning using case studies: Case studies are used throughout the presentations.
• Interactivity: Quizzes are included in each module to provide immediate feedback.
• Evidence-based content: All content is based on evidence.
• Patient-education materials: Supplemental materials, including patient education materials, are included in each module.
• Ease of technology: The program has been designed to be easy to use.
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E-Learning Series: Module
Components
Components
Brief pre-assessment
(required for CE)
Voice of a Cancer
Survivor
Archived webinar
presentations (2)
Brief post-assessment
(required for CE)
Resource list
E-Learning Series: Module Components
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E-Learning Series: Module Topics
Module 1• The Current State of Survivorship
Care and the Role of Primary Care Providers
Module 2
• Late Effects of Cancer and its Treatments: Managing Comorbidities and Coordinating with Specialty Providers
Module 3
• Late Effects of Cancer and its Treatment: Meeting the Psychosocial Health Care Needs of Survivors
E-Learning Series: Module Topics
Module 4
• The Importance of Prevention in Cancer Survivorship: Empowering Survivors to Live Well
Module 5
• A Team Approach: Survivorship Care Coordination
Module 6
• Cancer Recovery and Rehabilitation
Modules 7-10
• Spotlight on Prostate/Breast/Colorectal/ Head and Neck Cancer Survivorship: Clinical Follow-Up Care Guidelines for Primary Care Providers
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E-Learning Series: Evaluation
11,686 total visits
7,369 unique visitors
90 countries
50 states and DC
1116 modules completed
E-Learning Series: Evaluation93% female
69% > 40 years old
49% hospital based, 25% office based
57% nurses, 16% nurse practitioners, 5% physicians
66% oncology, 23% other, 14% primary care
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E-Learning Series: Evaluation
Preliminary FindingsEvaluation Question Module 1 Module 2 Module 3 Module 4 Module 5 Module 6
My current knowledge base was enhanced as a result of the
module content.95% 99% 97% 94% 95% 83%
The module content promoted improvements in the quality
of health care.95% 97% 98% 96% 93% 87%
The module content was useful and relevant to my practice. 94% 94% 95% 95% 91% 91%
I gained new strategies/skills/information that I can apply to
my area of practice.90% 94% 95% 91% 82% 87%
I plan to implement new strategies/skills/information into
my practice.82% 88% 92% 89% 83% 78%
I need more information before I can implement new
strategies/skills/information into my practice behavior.50% 45% 53% 51% 41% 35%
The module content was communicated clearly and
effectively.96% 98% 95% 97% 93% 87%
The module content utilized good, practical examples to
teach/illustrate its major points.94% 97% 97% 95% 95% 83%
The module content was free from commercial bias. 97% 98% 98% 97% 96% 83%
Guide for Delivering Quality
Survivorship Care
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Implications for Comprehensive
Cancer Control (CCC)
• The E-Learning Series can be used to help your program address the public health needs of cancer survivors.
• The E-Learning Series is free and open to anyone. You can promote the program through newsletters or by downloading the flyer at CancerSurvivorshipCenterEducation.org
• In addition to primary care providers, oncology providers find the program useful.
National Survivorship Surveys
• Best Practices in Navigation and
Survivorship Survey
– Patient navigation case load, measures tracked,
tracking tools, clinical tools, funding, challenges and
recommendations for financial sustainability
• Best Practices for Cancer Survivor
Education Programming Survey
– Successes and challenges for education cancer
survivors through classes
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Evaluating Cancer Survivorship
Care Models
Compare
care models according to
survivor needs
Identify survivor
needs and gaps
Identify current
survivorship practices
Goal: To compare the effectiveness of cancer survivorship care delivery models on patient-centered outcomes
American Cancer Society
Cancer Support
Community
Commission on Cancer
LIVESTRONG
Evaluating Cancer Survivorship
Care Models
Analysis of data that has already been collected on survivors’ concerns, needs and gaps in care (completed)
Focus groups with breast, prostate and colorectal cancer survivors to identify survivors’ concerns, needs and gaps in care (completed)
Completion of an environmental assessment to identify current survivorship practices at Commission on Cancer-accredited institutions across the country (completed)
A national survey of breast, prostate, and colorectal cancer survivors to identify the most important health care services needed and identify outcomes that survivors themselves prioritize as most important (completed)
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Evaluating Cancer Survivorship
Care Models
Development of a patient-prioritized framework for quality care that defines, from the survivor perspective, quality post-treatment care (completed)
Creation of a tool to measure how well survivorship practices are achieving patient-centered survivorship outcomes (completed)
Description of models of care that provide more specific information about what services are provided, how, by whom and for whom (drafted)
Comparison of the effectiveness of 3 models of care and their impacts on outcomes that cancer survivors identify as most important (fall 2014-summer 2016)
LIVESTRONG Essential ElementsTier 1
• Survivorship care plan, psychosocial care plan, and treatment summary
• Screening for new cancers and surveillance for recurrence
• Care coordination strategy which addresses care coordination with primary care physicians and primary oncologists
• Health promotion education
• Symptom management and palliative care
Tier 2
• Late effects education
• Psychosocial assessment
• Comprehensive medical assessment
• Nutrition services, physical activity services, and weight management
• Transition visit and cancer-specific transition visit
• Psychosocial care
• Rehabilitation for late effects
• Family and caregiver support
• Patient navigation
• Educational information about survivorship and program offerings
Tier 3
• Self-advocacy skills training
• Counseling for practical issues
• Ongoing quality-improvement activities
• Referral to specialty care
• Continuing medical education
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CCC Technical Assistance
Leveraging the GWCI’s existing Online Academy to develop and implement multiple online trainings to expand public health skills and address CCC priority areas;
Creating resource guides to help public health practitioners more easily translate existing evidence into practice;
Connecting CCC practitioners with experts, including researchers and CCC peers, and facilitating the sharing of evidence-based interventions and promising practices;
Convening stakeholders to identify opportunities for integrating cancer prevention with other chronic disease prevention efforts;
Providing large-group, small-group, and one-on-one technical assistance for CCC grantees and coalitions;
Creating easier ways to align local initiatives with national health priority indicators.
CCC Survivorship-Specific
Technical Assistance
• Cancer Control TAP – website and online
resource repository
• National Survivorship Report
• Ask the Expert sessions
• State Cancer Plan Goal Bank
• Online Training
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CancerControlTAP.org
Executive Training on Navigation
and Survivorship
• Nuts and bolts for program development
• Helps meet CoC standards
• Transitioning from in-person to online format
• Launch by the end of the month
Needs assessment
Goal settingProgram elements
Demonstrating value
Process & outcomes evaluation
