Goals for this Talk Understand what Survivorship Care in Oncology is - - PDF document

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Goals for this Talk

Understand what Survivorship Care in Oncology is and be able to answer the following questions when asked by friends, family members, or random strangers:

Who is a survivor? What does “survivorship” mean? What is a Survivorship Care Plan? Why is Survivorship Care important for patients?

Diversity and Survivorship

We have no cookie-cutter cancer patients. And, so, we have no cookie-cutter cancer survivors! We are all a unique (and diverse!) combination of what we’re born with, who we’ve grown up with, where we’ve been, what we’ve learned, what we’ve done AND our physical bodies.

In short, we are all a culmination of all our individual experiences.

Survivorship is about acknowledging what you’ve been through, who you are now, and making a plan for moving forward.

“I’m not a survivor yet, it’s only been 4 months.” “Am I really a survivor, it’s only been 10 years?” “I can’t be a survivor until my doctor says I’m cured.”

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Definition of a “Survivor”

Any person with a history of cancer, from the time

• f diagnosis to the end of their life.

Cancer Treatment & Survivorship Facts and Figures, ACS, 2017

Definition of “Survivorship”

The time in the life of any person with a history of cancer, from the time of diagnosis to the end of their life.

Cancer Treatment & Survivorship Facts and Figures, ACS, 2017

The Good and The Bad

Screening tests are better, early screening numbers are increasing, and treatment is more effective so:

More people are surviving their cancer! Cancer survivors are living longer!

But living longer post cancer treatment also means:

Living longer with the side effects of treatment. Longer monitoring for late and long term side effects.

Finishing treatment for cancer is not like getting your braces off.

Sometimes people who have never been through cancer treatment don’t understand that…

Poss ssib ible La Late and and Lon Long T Term Side Ef Side Effect ects

Anemia Bleeding or clotting issues Bone density loss Nausea Changes in taste Constipation Diarrhea Urinary problems Hair changes Lymphedema Weight loss Weight gain Change in body image Premature menopause Infertility Sexual dysfunction Relationship and intimacy issues Anxiety Depression Distress Decreased concentration Memory loss Spiritual distress Fear of recurrence Post-traumatic stress disorder Pain Muscles and joint stiffness Peripheral neuropathy Sleep problems Fatigue Heart Disease Lung dysfunction Changes in vision Skin changes Changes in hearing Secondary cancers Financial toxicity Insurance problems Medication management Role changes School and/or work issues

In 1985 Dr. Fitzhugh Mullan said:

“The challenge of overcoming cancer is not only to find therapies that will prevent or arrest the disease quickly, but also to map the middle ground of survivorship and minimize its medical and social hazards.” “It is as if we have invented sophisticated techniques to save people from drowning, but once they have been pulled from the water, we leave them on the dock to cough and splutter on their own in the belief we have done all that we can.”

• Dr. Mullan is the Founding President of the National Coalition for Cancer Survivorship.

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IOM’s From Cancer Patient to Cancer Survivor: Lost in Transition (2006)

This Report Stated that Every Survivor Should:

Receive a treatment summary and care plan at the end of treatment Understand prevention, surveillance, and detection

• f:

New and recurrent cancers Potential late and long term side effects of cancer and its treatment

Have coordination of care between specialists and primary care providers to ensure that their health needs are met

Commission on Cancer (CoC): Standard 3.3

Patients treated with curative intent should receive a survivorship care plan which includes:

A summary of what happened during active cancer treatment Recommendations for follow-up care and surveillance testing Referrals for support services the patient may need going forward Any other information pertinent to the survivor’s short- and long-term survivorship care

CoC: Standard 3.3 (cont’d)

Care plans should be

“…given and discussed with the patient upon completion of active, curative treatment.” “…clearly and effectively explained.”

Goals Set For Oncology Providers:

The CoC and the National Accreditation Program for Breast Centers want 50% or more of all eligible patients (per their criteria) to receive a Survivorship Care Plan. To be compliant with the CoC and NAPBC, most care plans should be given within 6 months after treatment has ended and within 1 year from diagnosis.

Goal Set By the Survivorship Clinic at TCCC:

ALL patient should be given the chance to achieve the best quality of life possible after cancer treatment. So, ALL eligible patients and every patient who wants a visit regardless of when they finished treatment or the stage of their cancer, should have access to a Survivorship Clinic Visit because…

That’s Just Good Patient Care

(and that’s what really matters)

How SCPs are given varies

I feel certain that for every 50 oncology clinics that care for patients, there are at least 50 ways of giving survivorship care plans! SCPs can be given by a nurse, or a provider (including physicians, nurse practitioners and physician assistants) The Tri-Cities is unique because we have the Cancer Center which is owned by all three local hospital systems

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Survivorship Clinic at TCCC

Addresses the unique needs of survivors Created and run by a nurse practitioner (that’s me!) Coordinates care between oncology and primary care At TCCC, it is targeted towards survivors who have completed their acute, curative cancer treatment but all patients are welcome to request a visit. Ideal time to be seen is ~3-4 months after acute treatment is completed, however patients are welcome to request a visit no matter how long ago they completed treatment.

5 FAQs Regarding Survivorship Clinic Visits

• 1. How d

How does a es a pati tient g t get s t sched heduled?

TCCC patients, outside referrals, self referrals

2.

• 2. Doe

Does i insu surance co cover S Survivorship vi visits?

Yes! (but everyone is encouraged to check with their individual plan)

• 3. Wh
• 3. What ha

happens be before a a vi visit?

All information pertaining to the cancer diagnosis, treatment, and potential late and long term effects are compiled. Medical records are thoroughly reviewed to gain an understanding of each patient and their unique circumstances.

• 4. What h

happens d ns during ng a a visit?

Patient receives a treatment summary, focused assessment of current symptoms, referrals to services as needed as well as follow-up care and testing recommendations.

5.

• 5. Wha

What ha happen ppens after after a a visit visit?

A copy of the treatment summary, Long-Term Health Recommendations, Resources and Education (The Survivorship Care Plan) and my chart note are shared with the patient’s primary care, medical oncologist and radiation oncologist, as well as any other providers the patient requests.

5 FAQs Regarding Survivorship Clinic Visits

Meet Natalie Knockers

Home Surgeon’s Home Medical Oncologist’s

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Home Radiation Oncologist’s

All Done!

(go back to normal life, right?)

Survivorship Clinic Home

3-4 Months Later…

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Survivorship Clinic Home

Just to recap…

The purpose of receiving a Survivorship Care Plan is:

To understand what you’ve been through. To discuss your current side effects. To review potential late side effects of your specific treatments. To learn how best to take care of yourself going forward, including surveillance and screening recommendations, Healthy lifestyle information and resources are also given. To make sure all of your providers know how best to take care of you in the future given your specific history of cancer and your specific cancer treatment.

The Biggest Challenge for Survivorship Care in South-Eastern Washington Survivorship care is so new that often times people in the community, including patients, don’t understand its importance.

What you can do to help…

Talk to people you know about survivorship and why it’s an important part of cancer care!

And feel free to call or email me with any questions you may have. (509) 737-3372, lisarootvik@tccancer.org

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Thank you for coming today!

If you, or anyone you know, is interested in a Survivorship Clinic visit, please call my nurse, Rebecca, at (509) 737-3483.

Question Questions? s?

Lisa Lisa C C.S. Root

• otvik, A

ARNP (509 (509) 737-3 737-3372 lisar arootvik@

• otvik@tccanc

ccancer.or

• rg