Cancer Survivorship Visit

Putting It Together In One Visit

June 10, 2016

Who am I ?

Stephanie Downton, MSN, NP-C, OCN Eskenazi Health Center of Excellence: Breast Care Clinic Breast Surgical Oncology, High Risk Breast Cancer,

Benign Breast Disease Breast Cancer Survivorship Care Program Member: Midwest Consortium for Cancer Survivorship Breast Cancer Survivor Mom

What Does A Typical Breast Cancer Survivorship Visit Look Like?

But Wait…

Whenisacancerpa,entacancer“survivor?”

•  Atdiagnosis?•  A7erac,vetreatment?

Photocredit:Hope,Love,Thriveh?p://hopelovethrive.com/hopelovethrive/?p=615

Show of Hands: When is a cancer pa7ent a cancer “survivor?” A. At the 7me of a cancer diagnosis B. Upon comple7on of all short and long-term treatments C. Upon the comple7on of ac7ve treatment with cura7ve intent (not including long-term hormonal therapies) D. It just depends

Whenisacancerpa,entacancer“survivor?”A.Atthe,meofacancerdiagnosisB.Uponcomple,onofallshortandlong-termtreatmentsC.Uponthecomple,onofac,vetreatmentwithcura,veintent(notincludinglong-termhormonaltherapies)D.Itjustdepends

But don’t worry…there are some general rules,

and those are what I follow when providing the SV and SCP.

Most agree one is a cancer survivor at the time of diagnosis.

“Thephrase‘cancersurvivorship’wascreatedtodescribe[a]broadexperienceonthecancercon,nuum—livingwith,through,andbeyondacancerdiagnosis.”

National Coalition for Cancer Survivorship (NCCS, 2014). Defining Cancer Survivorship. Retrieved from http://www.canceradvocacy.org/news/defining-cancer-survivorship/

We have established who is considered a cancer survivor, but when do survivors receive their

SCP and SV?

Who Gets SVs? And When?: IOM Recommendations

TheCoC&TheSurvivorshipCenter:Twoamongmany…Uponcomple,onofac,vetreatment;mostexpertsagreeSCPsshouldbeprovideda7ertheconclusionofac,vetreatment.•  CommissiononCancer[CoC]2012,Standard3.3SurvivorshipCarePlan:“…focusedonthesubsetofsurvivorswhoaretreatedwithcura,veintent,andhavecompletedac,vetherapy(otherthanlong-termhormonaltherapy).”

•  TheNa,onalCancerSurvivorshipResourceCenter’s(TheSurvivorshipCenter)ClinicalSurvivorshipCareOverview:“Theworkgroup…recommendsthattheprovisionofsurvivorshipcareplansforeachsurvivortransi,oningtothepost-treatmentperiodbecomearou,neaspectofclinicaloncologyprac,ce.“

American College of Surgeons (2014). Accreditation committee clarifications for Standard 3.3 survivorship care plan. Retrieved from https://www.facs.org/publications/newsletters/coc-source/special-source/standard33

National Cancer Survivorship Resource Center (n.d.). Systems Policy and practice: Clinical survivorship care: Expert panel summit workgroup overview. Retrieved from http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-031408.pdf

At Eskenazi Health:

•  The individual who has completed active treatment with curative intent and is without clinical evidence of disease •  3 months post-treatment – Initial SV •  Routine follow-up intervals •  All follow-up after a predetermined duration

of time •  Alternating visits with MD/NP •  Risk stratification

Survivorship Visit (SV) Structure • Guidelines for SV Content: ASCO, ACS, NCCN, Others • 90 minutes – Initial SV •  History & Physical •  Breast Cancer Survivor Symptom Assessment •  Review Personalized Survivorship Care Plan (SCP) •  Time for Questions

• 30 minutes – Follow-Up SV •  History & Physical •  Symptom Assessment/Follow-up on goals •  Time for Questions

History & Physical Same H&P done at routine follow-up visits.

Special attention directed to: 1.  Late and long-term effects of cancer and its

treatment and 2.  Surveillance for disease recurrence (physical

exam, imaging, lab work).

Symptom Assessment •  Breast Cancer Survivor Symptom Assessment Tool •  Evidence-based •  15 most commonly reported symptoms/concerns •  Completed by patient after H&P •  Same tool used at follow-up SVs to evaluate progress

toward goals/improved quality of life

Reviewing the SCP; Health Promotion •  Cancer Screenings, lifestyle modification, living

healthy, preventive care, symptoms of recurrence •  Techniques from Motivational Interviewing (MI) •  Evidence-based approach •  Involve the survivor, identify survivor’s

priorities, trust-building •  Identify possible areas of change (based on

H&P, symptom assessment, and/or patient values, desire to make changes.)

•  Create a plan; keeping the survivor engaged •  Small, practical steps to implement changes

• AmericanCancerSociety(ACS)/AmericanSocietyofClinicalOncology(ASCO)2015guidelines

Source: Levensky, et al (2007). Motivational interviewing: An evidence-based approach to counseling helps patients follow treatment recommendations. Am J Nurs Oct;107(10);50-58.

Thank you for your attention! Questions?

Resources AmericanCancerSociety/AmericanSocietyofClinicalOncology(2015).AmericanCancerSociety/American

SocietyofClinicalOncologyBreastCancerSurvivorshipCareGuideline.Retrievedfromh?p://onlinelibrary.wiley.com/doi/10.3322/caac.21319/epdf

American College of Surgeons (2014). Accreditation committee clarifications for Standard 3.3 survivorship care plan. Retrieved from https://www.facs.org/publications/newsletters/coc-source/special-source/standard33

Levensky, E.R., Forcehimes, A., O’Donohue, W.T., Beitz, K. (2007). Motivational interviewing: An evidence-based approach to counseling helps patients follow treatment recommendations. Am J Nurs Oct;107(10);50-58.

National Cancer Survivorship Resource Center (n.d.). Systems Policy and practice: Clinical survivorship care: Expert panel summit workgroup overview. Retrieved from http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-031408.pdf

National Coalition for Cancer Survivorship (2014). Defining Cancer Survivorship. Retrieved from http://www.canceradvocacy.org/news/defining-cancer-survivorship/