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Meta-Analysis
. 2020 Feb;25(2):e351-e372.
doi: 10.1634/theoncologist.2019-0184. Epub 2019 Oct 25.

Survivorship Care Plans in Cancer: A Meta-Analysis and Systematic Review of Care Plan Outcomes

Rebecca E Hill  1   2 , Claire E Wakefield  1   2 , Richard J Cohn  1   2 , Joanna E Fardell  1   2 , Mary-Ellen E Brierley  1   2 , Emily Kothe  3 , Paul B Jacobsen  4 , Kate Hetherington  1   2 , Rebecca Mercieca-Bebber  1   2   5
Affiliations
Meta-Analysis

Survivorship Care Plans in Cancer: A Meta-Analysis and Systematic Review of Care Plan Outcomes

Rebecca E Hill et al. Oncologist. 2020 Feb.

Abstract

Background: The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta-analysis compares patient-reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision.

Methods: We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient-reported outcomes for SCP recipients versus controls were eligible for the meta-analysis. We performed random-effects meta-analyses using pooled standardized mean differences for each patient-reported outcome.

Results: Eight articles were eligible for the meta-analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self-reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self-efficacy or at 12 months on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects.

Conclusion: SCPs appear feasible but do not improve survivors' patient-reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies.

Implications for practice: Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient-reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.

Keywords: Cancer; Dissemination; Implementation; Meta-analysis; Outcomes; Survivorship.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1
Figure 1
Selection of included studies using PRISMA guidelines. Source: Moher et al. 87.
Figure 2
Figure 2
Forest plot of effect sizes for studies reporting patient‐reported outcomes. Abbreviation: RE Model, random effects model.
See this image and copyright information in PMC

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