The optimal living and survivorshipprogram: Piloting a novel cancer survivorship care model
Authors: S. Corcoran, J. Russell, J. Clayton, A. Smith, K. Keenan, M. Robson, N. Iyengar
Journal: Cancer Research (2021)

Background: Multiple national agencies define cancer survivorship as beginning at the time of cancer diagnosis However, traditional care models typically deliver “survivorship care” months or years after diagnosis, which canlead to disruption in care and “transition anxiety”  We hypothesized that an approach centered around wellbeingcould be applied across the cancer continuum (starting at diagnosis) and serve as a novel survivorship care model  Methods : We developed the Optimal Living and Survivorship Program, a novel telehealth platform that is designedto better engage cancer survivors by providing multidisciplinary and individualized lifestyle management during andafter cancer therapy  Our multilevel approach relies on three key components: 1) a digitized centralized model thatprovides automated and coordinated multidisciplinary care;2) an individualized Wellness Plan (WP);and 3)enrollment at the time of cancer diagnosis in order to mitigate the experience of post-treatment transition Participants complete a digital wellness questionnaire (WQ) consisting of validated instruments that provide riskassessment for a broad range of lifestyle and psychosocial factors prior to the first medical oncology consult, receivea validated algorithm-based WP reviewed by a Wellness Coordinator, and meet with a specially trained WellnessAdvanced Practice Provider (WAPP) via tele-medicine  The WP consists of individualized topic-specific educationalmaterials (e g , webinars, videos) and referrals to indicated supportive services (e g , nutrition, exercise physiology,financial counseling, integrative medicine)  The WAPP will ultimately assume care of the patient in the post-treatment (“survivorship”) phase  We piloted this approach in patients diagnosed with breast cancer beginning in November 2019  The primary outcome is feasibility defined by completion of the WQ  Secondary outcomes includeparticipation in the WAPP visits, attendance at referral appointments, and quality of life (QOL)  Results: As a result of COVID-19, the pilot was paused in February 2020  Data collected from November 2019through February 2020 reveal a total of 67 eligible patients with newly diagnosed breast cancer were approached,with 65 (97%) enrolled in the program  All participants completed the WQ and all received a WP with indicatedsupportive referrals and educational resources  All participants engaged partially or fully with WP recommendations Participants were screened at high risk for an average of 3 8 unmet needs, and 98% were at high risk for 2 or moreneeds at the time of diagnosis  Exercise was identified as the highest unmet need (83%)  There was 76%adherence with referral to the program's Exercise Physiologist  Other commonly identified areas of needs werenutrition (59%) and sleep quality (51%)  WAPP tele-medicine visits began in June 2020 and are ongoing;visitcompletion rates and interventions will be presented  Qualitative data regarding patient experience and QOL will beobtained via focused interviews and feedback will be categorized in thematic domains  Conclusions: In this pilot, the majority of patients with newly diagnosed breast cancer enrolled in the program,completed a WQ in advance of their initial medical oncology visit, and engaged with the WP  Our findings suggestthat this early introduction to survivorship care is feasible  Earlier patient engagement and incorporation of wellnessand supportive services from time of diagnosis may significantly improve our ability to address multifactorial needsduring and after cancer therapy