Health Provider Teams:

How you can support cancer survivors after treatment

Washington CARES about Cancer Partnership: Survivorship Taskforce

June 2012

Presentation Outline• Survivors in the U.S.• Lost in transition• Descriptions• Certification/accreditation• Reimbursement• When to transition care• Models of survivorship care• Examples

Survivors in the U.S.

• More than 12 million cancer survivors in the U.S.

• This is a 400% increase in the past 40 years

• There are an estimated 250,000 cancer survivors in Washington State

• More than 2 out of 3 people diagnosed with cancer are alive more than 5 years later

Lost in Transition• 2005 report released by The Institute of Medicine

• Titled “From Cancer Patient to Cancer Survivor: Lost in Transition”

• Recommends every cancer survivor receives a survivorship care plan

• Found: www.iom.edu.reports/2005/title

Survivorship Care PlanSet of documents the oncology team puts together for each patient to describe his/her cancer, all of the treatments received, and future needs to stay healthy. Includes:

• Ongoing care the patient will need (i.e. tests for recurrence, identifying and managing late and long-term effects of the cancer and treatments, etc).

• A personalized set of recommendations on how to stay healthy and take care of themselves after having cancer (i.e. healthy eating, active living, and emotional support).

• Full contact information for all of their doctors, nurses, and anyone else that took care of them.

Treatment SummaryIncludes the patient’s diagnostic evaluation and the treatment(s) received. These should include:

• Disease characteristics (site, stage, grade, marker information)

• Dates of treatment initiation and completion

• Types of treatments (surgery, radiation, chemotherapy, etc.) including drugs used, dosages, treatment response and major toxicities experienced

• Psychosocial, nutritional, and other supportive services provided

When to transition care

• After treatment

• Should include:• Management of treatment side effects , including

potential late effects of therapy• Cancer surveillance• Preventive care recommendations to maintain and

improve patient’s health

Challenges in transition• Survivors may not have services in their community

• Survivors may have barriers (i.e. insurance, disabilities, cultural and health disparities, etc)

• Survivors may not know what they need, or even know what to ask for. They may be afraid, feeling like they’re on their own.

• Providers may be making assumptions about coordination with one another• Who orders follow-up tests?• Are they talking to one another regularly?

Certification• Providers do not need special certification to complete

these• In 2015, programs who have COC accreditation will need

to provide survivors with a treatment summary/care plan in order to maintain their certification status.

• Now is a good time to setup processes in preparation.• More details:

American College of Surgeon’s Commission on Cancer (COC)http://www.facs.org/cancer/

Reimbursement

• Charge a (CPT) Level 5 Established Patient Office Visit under the Primary Cancer Diagnosis Code (ICD 9), including “more than 50% of time spent on counseling and coordination of care”

Models of Survivorship Care

Models of Survivorship Care

Communication

• Whoever is completing the survivorship care plan and treatment summary should communicate back to:

• Primary oncologist• Primary care provider

Templates: Survivorship CPswww.journeyforward.org

• Journey Forward www.journeyforward.org • Lance Armstrong Survivorship

www.livestrongcareplan.org • American Society of Clinical Oncology

www.cancer.net/patient/survivorship • National Cancer Institute

www.cancer.gov/cancertopics/coping/survivorship

Templates

Support Services & Resources• Prevention & risk factors

• Healthy eating• Active living• Preventive visits

• Psychosocial supportive care after treatment for survivors and family: healing emotionally, physically, and spiritually after treatment• Support groups • Individual Counseling• Educational materials

Upcoming materials• New website: www.wacancer.org

• DONE: Patient factsheet on cancer survivorship and treatment summaries

• Palliative Care: Provider fact sheet – Coming soon

• Palliative Care: Patient fact sheet – Coming soon

More information

References• Calculated by applying national estimates to Washington’s 2011 population. See MMWR:

www.cdc.gov/mmwr/preview/mmwrhtml/mm6009a1.htm

• Cancer survivor = Defined as a person who has been diagnosed and overcome any type of cancer. Time begins at diagnosis and lasts to the end of life.

• CDC and the Lance Armstrong Foundation (LAF) are leading a public health effort to address the issues faced by the growing number of cancer survivors living with, through, and beyond cancer. Through their collaboration, A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies was developed. The National Action Plan represents the combined effort of almost 100 experts in cancer survivorship and public health. Many cancer associations/societies, institutions, hospitals, cancer centers and individual physicians are moving forward with the development of Survivorship Programs across the nation.

• American College of Surgeons: Cancer Programs: www.facs.org/cancer/coc/programstandards2012.html. Website accessed on 2/1/12.

• www.asco.org/ascov2/Practice+&+Guidelines/Quality+Care/Quality+Measurement+&+Improvement/Chemotherapy+Treatment+Plan+and+Summary/Cancer+Treatment+Plan+and+Summary+Resources

• www.cancer.net/patient/Publications+and+Resources/Support+and+Resource+Links/General+Cancer+Organizations+and+Resources/Support+Groups

Thank you!

Special thanks to Dr. Scott Baker for contributing materials and slides