Background: Nationally, many cancer survivors do not receive a survivorship care plan following completion of therapy. The American College of Surgeons’ Commission of Cancer’s Standard 3.3 requirement for accreditation placed this issue front and center for many of the participating cancer programs. The Commission on Cancer (CoC) survey found only one fifth of the cancer programs would be successful by 2015 and thus updated the standard in 2017. We describe a successful process created to deliver on this standard in an NCI designated cancer center to meet the needs of our patients. Methods: In early 2017, a multidisciplinary task force was created to initiate and implement survivorship care plans for newly diagnosed patients. Eligibility for care plans is determined by the CoC and the Moffitt cancer committee. The initiative included a cost-effective solution, “Journey Forward.” Moffitt Cancer Center was able to incorporate additional specific patient education and surveillance recommendations. A dedicated nursing team creating the care plans individually discussed with patients with the oversight of the Cancer Committee. Results: With collaboration from the cancer registry, nursing leadership and survivorship clinic, the diseases targeted initially were breast, gastrointestinal, genitourinary, head and neck, gynecology, non-small cell lung, thyroid, and lymphoma. Within 5 months of inception of the task force, 25% of survivorship care plans (SCP) were completed and by the end of the 2017 calendar year, we delivered 50% of analytic cases treated, amounting to approximately 2,500. The care plans were housed in the electronic medical record and available for patients via the patient portal. Conclusions: This initiative is made up of a multidisciplinary team from senior leadership, cancer committee members, the cancer registry, the survivorship clinic staff, nursing, social work, health information management, case management, and our information technology colleagues. A shared passion and vision lead the task force’s momentum. We all believed this was not just a mandate to comply with but a communication tool that is essential for our patients’ wellness long-term. Although there is minimal evidence to show the benefit of SCP with regard to outcomes, our team felt this document can indeed assist cancer patients’ transition into the next phase of their journey. Our project has improved the patient experience with positive feedback.
Bianshly Rivera Rivero, Brenda Connolly, Melissa Kapsick and Smitha R. Pabbathi
Bianshly Rivera Rivero, Sonya Pflanzer, Diane Riccardi and Smitha R. Pabbathi
Background: There are 4 components of survivorship care: prevention, surveillance, interventions, and coordination between oncology and primary care/specialists. As part of the initial visit in Moffitt’s survivorship program, we provide a comprehensive and personalized care plan to our patients with a focus on wellness. We understand the transition from active treatment into the extended phase of survivorship can be fraught with many unexpected physical, emotional, psychological, and social challenges, yet this could also be a critical period where survivors are uniquely positioned to adopt healthy and resilient behaviors. We want to help patients be empowered through knowledge from interactive and multidisciplinary classes and we aim at improving their quality of life. Methods: We created an 8-week curriculum customized and designed for breast cancer survivors by experts in nutrition, social work, physical therapy, yoga, arts in medicine, and survivorship medicine with utilization technique–driven live food demonstrations. The core message of the series is further echoed and instilled by use of weekly journaling and guidance on how to practice the techniques following each class. Results: We completed one 8-week course. 15 patients were enrolled in the program; of these 9–12 participants consistently presented to the sessions. Sessions consisted in education regarding nutrition, emotional health, exercise, mindfulness, and medical management after completing cancer treatment. To further determine the impact of sessions, we are measuring change in health-related quality of life through the RAND-36 questionnaire with a precourse survey and a postcourse survey. As we continue our sessions and our patient population increases, we expect to have substantial data to report on the impact of this curriculum. Conclusions: It is estimated that there are more than 3.1 million women in the United States with history of breast cancer. Development of a multidisciplinary program focused in comprehensive care for breast cancer survivors may improve quality of life. These techniques can positively impact the transition from active treatment and position survivors to be better managers of their wellness.
Katherine Robinson, Amber Todd, Abu-Sayeef Mirza, Madeline Macdonald, Noura Ayoubi, Rahul Mhaskar, Richard Roetzheim, Laurie Woodard and Smitha Pabbathi
Background: There are limited studies documenting the prevalence of malignancies and the cancer screening practices of the uninsured population. Cancer survivors require continued cancer surveillance and screening for recurrence and second primaries. However, screening may be suboptimal among the uninsured. Our objective was to identify and document the screening rates and adherence to ACS guidelines in our local uninsured community. Methods: Demographic data, cancer history and associated cancer screening measures were extracted from electronic medical records of patients managed in 8 free clinics between January 2016 and December 2017 in the Tampa Bay Area. Frequencies, proportions, and Pearson correlation coefficients were used to describe the population and statistically significant relationships. Using the ACS cancer screening recommendations, the charts were reviewed for appropriate cancer screening. Results: From manual chart review, 6,958 charts were reviewed and 201 (2.89%) patients had a diagnosis of cancer. The average age was 55.58 years and 134 (66.67%) were women. Most common malignancies included breast cancer (49, 24.38%), prostate (18, 8.96%), colorectal (13, 6.47%), leukemia/lymphoma (11, 5.47%), cervical (10, 4.98%), melanoma (10, 4.98%), ovarian (9, 4.48%), thyroid (9, 4.48%), renal (6, 2.99%), bladder (5, 2.49%), and uterine (5, 2.49%). Of the 201 patients diagnosed with cancer, 104 (51.74%) met the guidelines for a screening mammogram; however, only 49 (47.12%) had this completed. 115 (57.21%) met the guidelines for a screening Papanicolaou smear; 28 (24.35%) had it completed. 145 (72.14%) met the guidelines for a screening colonoscopy; 23 (15.86%) had it completed. 39 (19.4%) met the guidelines for prostate screening; 3 (7.69%) had it completed. Of the 201 patients, 14 (6.97%) reported a greater than 30 pack smoking history but no patients were screened with a low-dose CT of the thorax. Of the 10 patients with melanoma, 3 (30%) mentioned having routine skin exams. Conclusions: The uninsured population have many barriers to obtaining health care and appropriate screening for malignancies. This retrospective chart review highlights the need for easier access to screening. Increasing screening rates in the uninsured population will decrease cancer mortality as well as being cost effective to the community. It is important for free clinic providers to emphasize guideline-directed cancer screening at every visit.