2 Volume 28, Issue 1, wInter 2018 • CanadIan onCology nursIng Journal reVue CanadIenne de soIns InfIrmIers en onCologIe
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ately I have been hearing a lot of conversations and pre- sentations at conferences about transitions in cancer care, especially the transition at the end of primary cancer treat- ment. What happens during the transition from primary cancer treatment to post treatment follow-up care, or survi- vorship, is seen as critical to the long-term health of survivors.The growing number of cancer survivors has stimulated an emphasis on finding new models of care for some cancer pop- ulations whereby the responsibility for survivorship follow-up is transitioned to primary care providers, either completely or as a shared approach. A variety of models and tools have been designed to assist in this transition and cancer nurses are at the forefront in testing some of these approaches.
One of the key tools to successful transition has been her- alded as the survivorship care plan. It is seen as a key com- ponent of survivorship care and a vehicle for supporting transition. It is meant to help both the individual who is enter- ing follow-up care and the health care provider(s). A survi- vorship care plan generally contains information about the person’s diagnosis and treatment received, surveillance fol- low-up regimens, late and long-term side effects to watch for, self-management strategies, lifestyle and coping advice, and community resources that could be of use.
Early work evaluating the effectiveness of survivorship care plans was not entirely promising. However, there were sig- nificant challenges with these evaluations: lack of agreement on appropriate outcomes, wide variation in actual models and modes of delivery, and lack of attention to implementa- tion processes. More recent work has taken these shortcom- ings into consideration and the resulting evaluations are much more promising. One consistent finding from survivors who have received a survivorship care plan has been satisfaction with having relevant information about their own situation ‘at their fingertips’.
Despite this situation, uptake of survivorship care plans and implementation of evidence-based models of survivorship care has been slow, hindered by a range of barriers (e.g., confu- sion about roles and responsibilities, financial concerns, time constraints, not seeing survivorship are part of the cancer jour- ney). Yet survivors continue to report unmet needs post pri- mary cancer treatment. They have identified the urgent need for improvements in access, availability and coordination of services; currently they experience a fragmented and some- what chaotic system of care once they complete their primary cancer treatment. They find there is confusion about where to go and whom to see if they have concerns. In particular,
survivors have indicated the need to feel better prepared at the end of treatment for what is ahead of them. The transition to follow-up care can be an anxiety-filled proposition for them.
I believe that oncology nurses are in an ideal position to pro- vide leadership surrounding the transition of cancer patients.
As nurses anticipate the end of primary cancer treatment for an individual, conversations about transitioning could be tak- ing place and patient concerns identified. Oncology nurses could be the health care professional who organizes and shares a survivorship care plan with the individual patient (and fam- ily) and reviews it with them. Or oncology nurses could orga- nize group sessions where transitioning is the main focus of the interactions. It could be conceived as an orientation ses- sion for survivorship, similar to the orientation sessions we currently hold prior to beginning cancer treatment.
Here are a few recent articles that might be helpful in undertaking this important aspect of survivorship cancer care:
Birken, S.A., Mayer, D.K., Weiner, B.J. (2013). Survivorship care plans:
Prevalence and barriers to use. Journal of Cancer Education, 28, 290–296.
Brant, J.M., Blaseg, K., Aders, K., et al. (2016). Navigating the transition from cancer care to primary care: Assistance of a survivorship care plan. Oncology Nursing Forum, 43(6), 710–719.
doi:10.1188/16.ONF.710-719
Dulko, D., Pace, C.M., Dittus, K., et al. (2013). Barriers and facilitators to implementing cancer survivorship care plans. Oncology Nursing Forum, 40(6), 575–580. doi:10.1188/13.ONF.575-580 Kvale, E.A., Huang, C.S., Meneses, K.M., et al. (2016). Patient-centered
support in the survivorship care transition: Outcomes from the patient owned survivorship care plan intervention. Cancer, 122, 3232–3242.
Mayer, D.K., Deal, A.M., Crane, J.M., et al. (2016). Using survivorship care plans to enhance communication and cancer care coordination: Results of a pilot study. Oncology Nursing Forum, 43(5), 636–645. doi:10.1188/16.ONF.636-645
Reb, A., Ruel, N., Fakih, M., et al. (2017). Empowering survivors after colorectal and lung cancer treatment: Pilot study of a self- management survivorship care planning intervention. European Journal of Oncology Nursing, 29, 125–134.
Thompson, J., Coleman, R., Colwell, B., et al. (2014). Preparing breast cancer patients for survivorship (PREP)—Pilot study of a patient- centered supportive group intervention. European Journal of Oncology Nursing, 1, 10–6. doi:10.1016/j.ejon.2013.10.004
Margaret Fitch, RN, PhD Editor in Chief, CONJ
