Long-Term Survivorship Care After Cancer Treatment - Summary of a 2017 National Cancer Policy Forum Workshop

Abstract

The National Cancer Policy Forum of the National Academies of Sciences, Engineering and Medicine sponsored a workshop on July 24 and 25, 2017 on Long-Term Survivorship after Cancer Treatment. The workshop brought together diverse stakeholders (patients, advocates, academicians, clinicians, research funders, and policymakers) to review progress and ongoing challenges since the Institute of Medicine (IOM)'s seminal report on the subject of adult cancer survivors published in 2006. This commentary profiles the content of the meeting sessions and concludes with recommendations that stem from the workshop discussions. Although there has been progress over the past decade, many of the recommendations from the 2006 report have not been fully implemented. Obstacles related to the routine delivery of standardized physical and psychosocial care services to cancer survivors are substantial, with important gaps in care for patients and caregivers. Innovative care models for cancer survivors have emerged, and changes in accreditation requirements such as the Commission on Cancer's (CoC) requirement for survivorship care planning have put cancer survivorship on the radar. The Center for Medicare & Medicaid Innovation's Oncology Care Model (OCM), which requires psychosocial services and the creation of survivorship care plans for its beneficiary participants, has placed increased emphasis on this service. The OCM, in conjunction with the CoC requirement, is encouraging electronic health record vendors to incorporate survivorship care planning functionality into updated versions of their products. As new models of care emerge, coordination and communication among survivors and their clinicians will be required to implement patient- and community-centered strategies.

Figure 1.

Modified from Nekhlyudov et al. Lancet Oncology 2017 (98). Risk-based strategy for cancer survivorship care. For the purposes of cancer survivorship care, five years is based on the general recommendations of the cancer community, although the timing of the transition of care may vary. Examples of risk categories include low-risk cancers, which are defined as individuals with common cancers that are treated at an early stage, and/or standard treatment. The noncancer chronic condition burden may be low to high, with the latter potentially benefiting from primary care-based follow-up. Intermediate-risk individuals are those with less common cancers, those treated at an advanced stage, and/or the use of multimodal treatment. As with the low-risk individual, noncancer chronic condition burden may vary. High-risk individuals are those with rare cancers, advanced stages, and those requiring complex medical treatment with important late/long term effects. An oncogeneralist is a primary care provider with expertise in survivorship who can integrate the complex needs of adult cancer survivors. An oncology/survivorship provider is an oncology specialist or provider with cancer survivorship expertise. These providers may be physicians or advanced practice clinicians.