bluuebunny/crossref_metadata_2025_split huggingface dataset:
A model for delivering survivorship care: Integrating the oncology and the primary care setting: Follow-up of the first cohort of patients.
Authors: Lorenzi Elena , Morello Lucia , Mazza Rita , Garassino Isabella Maria Giovanna , Cavina Raffaele , Giordano Laura , Carlo-Stella Carmelo , Santoro Armando 
Published: March 2017

40 Background: In our Institution, we started a survivorship care program that integrates survivors’ health care provided by the oncologist and the primary care physician (PCP).We present the follow-up analysis of the first cohort of patients (pts) enrolled from April to July 2015. Methods: We included adult pts affected by hematologic or solid tumors without evidence of disease from at least 5 years (yrs). They are referred to the PCP with a survivorship care plan. An online platform for cancer survivors (CS) and their PCPs will be available. Progression free survival (PFS), overall survival (OS) and treatment related clinical events were calculated after 17 months from the start of the project. Results: We analyzed data from 269 CS. The median age was 67 yrs, they were mainly females (77%). The most frequent histological types were breast (157), colorectal (37), and hematologic (30) tumors. 189 pts had an early stage disease. 161 pts received chemotherapy with 95 pts receiving anthracycline-based-chemotherapy (ABC), 86% at a cumulative dose > 240 mg/mq. 154 pts underwent radiation therapy (RT), 94% at a dose > 30 Gy. 58 pts received both ABC and RT. The 10-yr cumulative risk of secondary cancer (SC) was 4% with a median latency period from the first cancer diagnosis of 11.3 yrs. 15-yr OS was 98% (one patient died of myocardial infarction), and 15-yr PFS was 96%. The 10-yr cumulative risk of late cardiologic toxicity (LCT) was 11% and 37 pts developed cardiologic complications with a median latency period from treatment of 10.5 yrs. The adhesion to the survivorship care plan was 84%. 13% of pts returned to our Center. The main non-clinical reason for returning was the lack of confidence in PCP. No association was observed between ABC and/or RT exposure and LCT or SC development. Conclusions: In this cohort of patients a high risk of LCT was observed. The risk and latency of SC was similar to the ones reported in literature. The number of cardiac events and SC is too low to give solid conclusions about the association with therapeutic exposure. So far, the compliance of patients and PCPs with the program was high. More data and longer follow-up period are necessary to confirm the accuracy of this model of care.
Implementation of a novel primary care-centered clinic for survivorship care.
Authors: Radhakrishnan Archana , Choi Youngjee , Berger Zackary , Pollack Craig Evan , Dy Sydney Morss , Peairs Kimberly S. 
Published: March 2017

41 Background: Patients often face challenges in transitioning to the survivorship stage of cancer care and coordinating with primary care. Prior research has highlighted the uncertainty in who provides survivorship care, leaving patients “lost in transition”. Integrating primary care providers (PCP) into cancer care offers one potential solution. Expanding traditional PCP roles to participating throughout the cancer continuum and familiarizing PCPs with cancer patients’ needs can address this gap. We describe an innovative model of incorporating PCPs to delivering primary care to cancer survivors at a large academic institution. Methods: As one part of a plan to address an identified need for improving survivorship care for cancer patients at Johns Hopkins, PCPs and cancer survivorship care experts developed the Primary Care for Cancer Survivors clinic (PCCS) in 11/2015. The clinic receives referrals from the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and patients are seen for either a one-time consultation or can transition their primary care to the clinic. We also are creating a database of internal and external referrals to meet the specific needs identified by patients. We descriptively analyzed the utilization of PCCS from 11/2015 through 9/2016. Results: A total of 35 patients have been seen at PCCS. The average age of patients was 56.8 (SD 12.4) and 32 were female and 3 were male. 24 patients identified as white, 8 black, 1 Asian, and 2 others. Most patients transitioned their PC to the clinic (n = 30). The majority of patients had breast (n = 19) and colorectal cancer (n = 5); 10 patients had metastatic disease (3 have deceased). Commonly, referrals were made to physical therapy, including pelvic rehabilitation and lymphedema management, and nutrition counseling. Conclusions: Patients with a wide variety of cancers and at all stages of disease were seen for survivorship care in the PCCS clinic. Integrating nutrition care, psychosocial support, exercise programs, and palliative care were key early factors in meeting patients’ needs. Continuing to assess and meet survivors’ individual needs and build referral networks are important next steps in the development of the clinic.
Survivorship care plan (SCP) program development within a large hospital network.
Authors: Garces Natalie , Eaton Tara , York Beth , Bailey-Dorton Chasse Margot , Brick Wendy G. 
Published: March 2017

42 Background: Barriers to SCP delivery are pervasive, with limited data available on strategies to address implementation barriers. Despite the variety of models for SCP-based survivorship care planning, there is a dearth of studies on SCP program development for larger hospital networks. Large networked hospital systems, including the Levine Cancer Institute (LCI), have unique challenges for implementing a SCP program. Methods: Beginning in 2014, LCI implemented a process for delivery of SCPs across its network of 8 Commission on Cancer accredited hospitals. Obstacles to implementation were evaluated and methods of establishing procedures for insuring SCP delivery were reviewed. Improvement in SCP delivery was measured over 3 years. SCP program development involved leveraging technology, developing processes for identifying eligible survivors, and engaging providers and practice managers in this key organizational initiative. Results: In 2014, the SCP program consisted of 3 advanced care providers (ACPs) in 3 LCI medical oncology clinics, delivering SCPs to 67 (2%) of the eligible 3,336 survivors. In the second year of implementation, 14 ACPs and 4 MDs delivered 348 (11%) SCPs to eligible survivors in 14 LCI clinics. By the end of the 2016 calendar year, it is estimated that > 1,029 SCPs ( > 25%) of eligible survivors will receive a SCP throughout the LCI hospital network. Conclusions: While challenging to deliver, SCPs are important both for cancer program accreditation and for communication between patients and physicians. At its large, multi-center cancer program, LCI has implemented a number of methods and protocols to insure that eligible patients receive informative and timely SCPs. LCI’s processes have resulted in an improvement in the number of SCPs delivered and have also served to eliminate obstacles to increasing the number of SCPs that will be delivered in the future. It is recommended that oncology practices consider the methods and interventions that LCI found helpful to improve SCP delivery in large hospital networks. It is also encouraged that oncology practices to continue to share their methods with other centers to promote eventual SCP delivery to eligible survivors.
Surveillance or symptom management? Insights from 5 years of caring for survivors.
Authors: Shaw Amy Elizabeth , Jennings-Shaw Peg Jo 
Published: March 2017

44 Background: One of the most widely held definitions of cancer Survivorship is that it begins "at the time of diagnosis and for the balance of life" (NCCS). An emphasis on providing Survivorship Care Plans (SCP), pushes many Survivorship Programs toward long-term surveillance and care planning for patients who have completed treatment. The needs of survivors who are in the period between diagnosis and completion of treatment are not addressed by SCP. In 2011, our multidisciplinary oncology group hired a board-certified Family Physician to develop a Survivorship Program that would serve the needs of cancer patients at the time of diagnosis and for the balance of life. We report here on what we have learned about our survivors after the first 5 years of caring for them. Methods: Cancer patients were referred to the program by oncology specialists, community physicians, or by patient self-referral. De-identified data for each case were entered into a database including cancer type, stage, treatment, age at diagnosis and at first visit, and primary reason for referral (surveillance, symptom management, or assistance with complex medical decision making). Results: During the 5-year period, 994 patients were seen, median age 61 years (min 26, max 94). Breast cancer was the most common (86%). Patients were referred for surveillance (46%), symptom management (49%), or decision-making (5%). Patients referred for surveillance decreased from 62 to 22%. Patients referred for symptom management increased from 36 to 57%. Patients referred for decision-making increased from 2 to 21%. Patients referred for symptom management were younger (median age 60 vs 63), more likely to have stage II, III, or IV disease (53 vs 34%), and more recently diagnosed (median 1 vs 4 years) than patients referred for surveillance. Conclusions: Over the past 5 years our patients' needs have forced our program to evolve away from surveillance and prevention for early-stage, lower risk patients at the end of their treatment. We are now focused primarily on managing the adverse treatment-related symptoms for patients with higher stage disease. We have observed that patients require and desire survivorship care throughout their cancer experience, not just at the end of treatment.
The use of electronic health record systems to create treatment summaries and survivorship care plans.
Authors: Gilmore Katherine Ramsey , Choi David K , Chapman Patricia , Lewis-Patterson Paula A. , Palos Guadalupe R. , Rodriguez Maria Alma 
Published: March 2017

56 Background: The Commission on Cancer’s recent mandate stated that accredited programs issue treatment summaries (TSs) with survivorship follow-up care plans (SCPs). ASCO’s model of survivorship care also supports the use of these documents. One of the primary purposes of the documents is to enhance coordination and communication between the oncology team and primary care providers. Here we describe the experience of a survivorship program in using electronic health records (EHR) to develop TSs and SCPs. Methods: An interdisciplinary team at an academic cancer center was appointed to develop clinical tools to facilitate the creation and dissemination of TSs and SCPs. Enhancements were made to an institutional off-the-shelf EHR system that automatically populated available treatment information to the TS. This system used SmartLinks to pull data from the primary source of entry (e.g. surgical history, chemotherapy administered, and cancer stage). Clinicians edited and added pertinent information not automatically generated using one of the 19 disease-specific templates that provided lists of common treatments for various cancers. Electronic routing functions existed to share TSs with external providers through the medical records department. Results: From March-Sept, 2016, 766 SCP were completed by 50 providers in 14 clinics. Reports were created in the EHR to track SCPs and TS metrics. Data was reported from the TS on both a patient level and aggregate level by provider and clinic. Patient level data allowed providers to track incomplete TSs and edit them directly from the report. Of the TSs completed, 528 (69%) have been shared with patients and 261 (34%) have been shared with their community-based providers. Conclusions: EHRs provide a mechanism to successfully create and share TSs and SCPs among team members and primary care providers. They promote patient-provider education and communication about follow-up care. Research is needed to determine how they enhance coordination and ultimately outcomes for long-term survivors.
What do social media savvy cancer survivors tell us about the state of survivorship programs?
Authors: Radford Diane Mary , Staley Alicia C. , Landercasper Jeffrey , Dietrich Leah L. , Vang Choua A , Borgert Andrew , Attai Deanna J. 
Published: March 2017

57 Background: Patients treated for cancer are surviving their disease in increasing numbers. The 2005 Institute of Medicine (IOM) report From Cancer Patient to Cancer Survivor - Lost in Transition resulted in a call to develop survivorship programs. The Commission on Cancer (CoC) standard 3.3 became effective in 1/2015 requiring the delivery of a survivorship care plan (SCP) at the completion of treatment. Many cancer patients use social media (SM) as a way to obtain support and information. We sought to determine if SM savvy patients have received a SCP. Methods: An IRB-approved survey was conducted via the online tool SurveyMonkey between 3/21/2016 and 4/2/2016. Patients were invited to participate via SM outlets reaching cancer-related communities including Twitter chats, Facebook groups, blogs, and targeted emails. Cochran-Armitage Trend test, exact version, was performed by year for % of survivors receiving a SCP. Results: A total of 312 patients responded. 63% had completed their treatment (excluding endocrine therapy). Of a total of 194 individuals only 11.8% (23) were given a SCP at the end of treatment. A breakdown by treatment completion year is given below. Of those who did not receive a care plan 65% (112/172) answered that it would still be helpful to receive one. Most SCPs (86%) were supplied in paper form. However, patient-reported preferences for SCP delivery were paper (50%), online patient portal (41%), and email (9%). Conclusions: Despite the IOM report and CoC standard 3.3, the majority of SM savvy cancer survivors (88.2%) do not receive SCPs. In the respondents to this survey, there was no significant increase from 2015 onwards, p = 0.11, confirming an Advisory Board survey that just over 1/3 of programs felt confident that they could implement 3.3 by 2015. The CoC has updated its standard such that 25% of eligible patients should receive a plan by 12/31/2016. According to these data, that goal of 25% may not be achieved. [Table: see text]
Development of phase-specific breast cancer survivorship care plans (SCPs).
Authors: Parsons Susan K. , Weisberg Tracey , Boehm Lauren , O'Rourke Arlene , Rodday Angie Mae , Linendoll Nadine , Erban John Kalil 
Published: March 2017

61 Background: There are nearly 3 million breast cancer (BC) survivors in the US. Among the recently diagnosed, accrediting organizations (e.g., Commission on Cancer) now require SCPs at the completion of curative therapy. Within the Oncology Care Model, the preparation and delivery of SCPs is recognized as one of the 13 quality metrics. SCPs, combining treatment summaries (TS) and follow-up care plans (FUCPs), assist patients and providers in the delivery of high quality long-term care. BC presents a unique challenge, as the risk of recurrence extends decades past initial treatment; adjuvant risk reduction may extend up to 15 years. Periodic FUCPs provide a mechanism to review updated information and may allow providers to catch up with longer term BC survivors whose care was delivered prior to SCPs. We explored the role of phase-specific SCPs within the heterogeneous BC survivor population. Methods: Oncologists and nurse practitioners (NPs) from the Breast Health and Survivorship Programs at Tufts MC, an academic medical center in Boston, and New England Cancer Specialists, a community-based private oncology practice in Maine--together caring for more than 2,000 BC survivors--convened to develop and test phase-specific survivorship tools. Using an adapted ASCO template for BC, TS were completed at the end of initial therapy by trained NPs. FUCPs for initial, 5-year, and 10-year visits were designed with clinical input, literature reviews, and existing guidelines. Results: FUCPs were pilot tested and refined before incorporation into the electronic health record. Further testing is planned to identify barriers to effective survivorship care, particularly involving documentation of changes in recommendations and the transition from oncologist to primary care physician. Conclusions: SCPs are critical for providing quality health care to BC survivors, but a single SCP, written at the conclusion of curative treatment, might not be sufficient to address changing needs of individuals as they progress through survivorship. Thus, phase-specific SCPs enable providers to focus on salient aspects of care that may change over time. Despite growing recognition of the value of SCPs, implementation remains a challenge across cancer programs.
Addressing survivorship challenges using a collective impact approach.
Authors: Migliore Santiago Patti , Guerrero Rose , Rajderkar Chinmaya , Vanevenhoven Carol 
Published: March 2017

64 Background: The American Cancer Society (ACS) estimates 352,830 cancer survivors in WA State today. We had a group of avid stakeholders in the WA CARES About Cancer Partnership wanting to address survivorship issues. The challenge was how to work together to focus on improving the quality of life beyond treatment, recognizing that no single organization has the ability to solve the issues alone. Individual organizations were going their own way creating a duplication of effort. What would it look like if we aligned resources? We had influential champions, grant funds, and a true sense of urgency for change. Methods: We turned to FSG and their research on collective impact. Phase 1 of a collective impact approach was completed. We formed a cross-sector group, mapped the cancer survivorship landscape utilizing state cancer registry data, ACS Survivorship Report and local facility input. In Phase 2 a common agenda was agreed upon. Shared measurements of success for Survivorship Care Plans (SCP) were set. Mutually reinforcing activities were developed in an action plan. Methods and frequency of communication were decided. WA Dept. of Health (DOH) was designated as the hub organization. Results: DOH provides adaptive leadership skills and the ability to mobilize people without imposing an agenda or taking credit for success. We hosted a GW Cancer Institute Executive Training on Survivorship, June 2015. We held a 2 day planning retreat to develop a common agenda and action plan, Dec. 2015. Developed and deployed survey for CoC accredited hospitals to create a baseline for SCP utilization and challenges, Feb. 2016. In May 2016 we hosted 1 day retreat for the leadership team to finalize its action plan and added a second priority to launch a pilot in Yakima County to partner with 2-1-1 to provide resources to survivors. We have moved from having uncoordinated plans to embracing a centralized system. Conclusions: We recognize the need to identify and catalog previously unnoticed resources and make them available statewide; perform ongoing evaluations to elicit feedback for decision making; and, the need for further study to determine if tailored SCP and 211 resources improve patient/provider survivorship experience and attain financial sustainability.
Piloting breast cancer survivorship care planning in a safety net hospital.
Authors: Garcia Sofia F. , Wortman Katy , Guevara Yanina , Hahn Elizabeth A. , Corona Maria E. , Shrestha Shakuntala , Khosla Paramjeet 
Published: March 2017

65 Background: Survivorship care plans (SCPs) include treatment summaries and follow-up care recommendations intended to improve patient care and well-being after cancer treatment. Limited research has yielded mixed results regarding SCPs' impact on patient and system outcomes, but emphasized provider burden as an implementation barrier. We created a patient-centered SCP template and implemented its delivery at a safety net hospital that serves primarily racial/ethnic minority patients. Methods: In a single-arm feasibility study, oncologists and advanced practice nurses used the template to deliver SCPs to post-treatment breast cancer survivors (BCS) in consultation visits. We assessed changes in patient-reported outcomes from baseline (pre-SCP) to a 3-month follow-up, as well as provider time burden. Results: Female BCS participants (n = 75; mean age = 58.5 years) were primarily African-American (73%) and had high school/GED education or less (61%). Average time since diagnosis was 3.7 years (SD = 3.8); all received surgery; most received radiation (84%), hormone (77%), and/or chemotherapy treatment (73%). At follow-up, a majority rated their SCPs as good to excellent (92%), easy or very easy to understand (84%), a good to excellent summary of their treatment (92%) and as motivation for healthy lifestyles (88%). BCS follow-up scores improved significantly from baseline on breast cancer knowledge (p = .02), self-efficacy (p = .03), the QLQ-INFO25 (p < .01), and the FACIT TS-PS satisfaction with health care staff communication subscale (p < .01). No significant differences between baseline and follow-up scores (p < .05) were found for overall treatment satisfaction, health behaviors, and health-related quality of life. Preparing and delivering SCPs took providers considerable time (M = 54 & 22 minutes, respectively). Conclusions: This pilot study is limited by a single-arm design, but results suggest that SCPs may be related to improved survivor knowledge, information, self-efficacy and communication with health care staff. The individualized, comprehensive SCPs were well received by BCS in a safety net hospital but delivery was time-intensive. These findings will inform future research trials and clinical care initiatives.
Survivorship care plan utilization and challenges.
Authors: Migliore Santiago Patti , Guerrero Rose , Rajderkar Chinmaya , Vanevenhoven Carol 
Published: March 2017

68 Background: Based on June and Dec. 2015 Survivorship Retreats hosted by WA Alliance for Cancer Survivorship (WACS), it was clear that staffing models, use of EMRs, cancer registry software programs or commercial products were program dependent with limited flexibility for facilities to adopt a single, state-wide, Survivorship Care Plan (SCP) model. Attendees at the retreats were concerned with financial sustainability of SCPs as the Commission on Cancer (CoC) requirement increased from 10-25-75% of all eligible patients by Dec. 31, 2018. The largest concern was the time spent on the preparation of the SCP. WACS wanted to validate resource needs across settings to identify needs/gaps being experienced. We asked the American Cancer Society (ACS) to conduct a survey of CoC accredited hospitals. Results would be limited to aggregate data and individual confidentiality would be maintained. Methods: ACS field staff made in-person appeals to each accredited program leveraging their existing relationship with CoC Liaisons. A 60% survey completion goal was set. A secure electronic survey was deployed in February. ACS staff promoted the project, followed up on non-responders, aggregated the data and prepared the results report. Results: We achieved a 70% participation rate for accredited programs. 75% of rural facilities, 71% urban but only 50% suburban facilities participated. Results showed they were spending 45 minutes to 2 hours to gather data to prepare the SCP and an equal amount of time being devoted to the patient SCP visit. There is a clear need and desire to have an efficient data gathering process for surveillance recommendations, latent side effect management and ready access for cancer site specific supportive care resources to reduce the time spent in preparation/delivery of the SCP and create a sustainable financial model. Conclusions: The transition from active treatment to survivorship care is a complex process, complicated by residual symptoms, educational needs and health risks. Our baseline information will inform our efforts to streamline the development of SCP as programs work to meet CoC goals. We plan to develop a survey to examine survivors recall and adoption of SCP recommendations to measure how SCPs are improving patient and facility outcomes.