We’re grateful for guest blogger Nina Miller from the American College of Surgeons’ Commission on Cancer. In this blog she’s provided insights for Fight CRC readers into how the medical community is recognizing the need to establish standards of care for cancer survivors. With a growing population of survivors, the need for healthcare providers to help survivors navigate the waters of remission is growing. Fight CRC applauds groups like the American College of Surgeons and professionals like Nina who are dedicated to establishing a standard of care and addressing the needs of all patients – from those in active treatment to those who’ve been “no evidence of disease” for decades. Nina’s work does not only recognize survivorship but also helps mandate this area, ensuring cancer survivorship programming is truly implemented in cancer centers. 

by Nina Miller, MSSW, OSW-C

Cancer Liaison Initiatives

American College of Surgeons Commission on Cancer

Chicago, IL

The Commission on Cancer, an accreditation program of the American College of Surgeons, rolled out three standards the first of this year that converge to provide a set of programs/services designed to enhance the psychosocial care of the cancer survivor.

Patient Navigator Process

cancer-survivor-commission-on-cancer-postThe first standard by the Commission is a patient navigation process that sets programs on a mission to assess their community and determine who in that community is at risk for experiencing health inequities.

Learn more about health equity.

This process looks carefully at why inequities may occur and assesses resources available to help patients navigate the healthcare/cancer care system. This also identifies gaps in resources that can/should be addressed through collaborations with community partners.

Screening for Distress and Psychosocial Needs

The second standard of care includes screening patients to identify distress and any psychosocial needs. Screening can help cancer program staff triage their patients appropriately to care providers who will complete a full assessment and determine an appropriate psychosocial intervention plan.

Formalized psychosocial care providers and/or supportive care services have been provided in cancer programs since the early 1980s but this is the first time that a formalized way of screening and triaging patients has been systematically put into place in cancer programs throughout the country.

Screening for distress is a critical standard of care. A statement released jointly by the American Psychosocial Oncology Society (APOS), Association of Oncology Social Work (AOSW) and Oncology Nursing Society (ONS) regarding Implementing Screening for Distress states,

“Distress can occur at multiple time points from a cancer diagnosis onward and may go unrecognized if screening is conducted at only one time.”

Screening is recommended at key times in the cancer continuum, including when a patient completes treatment. Screening is identified to help:

  • provide an opportunity for providers to intervene with persons who may be at risk for becoming ‘lost in transition’ to critical follow-up care
  • provide information, resources, and support to patients who are transitioning from active treatment to rehabilitation, end of life, or health and wellness

Survivorship Care Plans

The third Commission on Cancer standard mandates delivery of a Survivorship Care Plan to all patients. This standard is being implemented in a graduated rollout starting with delivery to about 10 percent of patients in treatment programs. The Survivorship Care Plan has two major parts:

  1. a summary of the cancer treatment that the patient recently completed
  2. a snapshot of the recommendations of follow-up care

Some also include a psychosocial care plan that is recommended by the professional(s) who participated in the delivery of psychosocial care to the patient or a plan written by the patients themselves.

Treatment Summary of Care

The treatment summary is fairly straight forward and involves the completion of a very specific list of items including the diagnosis, stage or extent of disease and the specifics on the surgery, chemotherapy, radiation or other therapies they received. This information helps to inform the patient and any healthcare providers that may follow the patient in the days, months and years to come. It’s a historical document that provides useful information to patients, family members, concerned others and care providers that may not have ready-access to the patient’s medical records.

Follow-Up Care Recommendations

The follow-up care recommendations that are part of the Survivorship Care Plan can include specifics on adjuvant treatment recommendations, recommended clinic visits, cancer surveillance recommendations and recommendations for healthy living after diagnosis. Support needs and service programs available can be provided to the patient at this time as well.

Potential Late Effects from Therapy

One of the most important pieces of information to include in the Survivorship Care Plan is, in my opinion, a section describing potential late effects from the therapy. As an 18-year cancer survivor myself, I can point to a number of times in the past several years when my health concerns became real questions:

“Is my back pain really metastatic disease to my bones?”

“What do I need to tell my primary care doctor about the amount of Adriamycin I received when discussing my risk for heart disease?”

“What can I do about those annoying hot flashes as someone who had ER positive disease?”

The right responses to these questions require my primary care provider’s awareness of the care and treatment I received. A medical record can do that but an informed patient can also be empowered with the right information given by the right source at the right time.

Resources Offered by Navigation Experts

I started this blog post by saying that these accreditation standards converge to enhance the psychosocial care of the cancer survivor. Resources offered by navigation experts can be critical to the provision and care of patients and involve tactical help like:

  • Addressing a transportation need to allow caregivers a break from daily trips to radiation
  • Mental health services for families in crisis struggling with a difficult diagnosis or course of treatment
  • Answers from nurses willing to help patients navigate their many questions about prognosis and outcomes.

A well-developed Survivorship Care Plan may give an individual just the right mindset to start their post-treatment life with a positive outlook on the future, working to achieve their life goals with the guidance, information and resources they need to do just that.

About the Commission on Cancer

The Commission on Cancer standards set the stage for cancer programs to provide patient-centered care defined by the Institute of Medicine in Crossing the Quality Chasm: A New Health System for the 21st Century, March 2001 as respect for the values, preferences and expressed needs of patients with coordinated and integrated care across system boundaries and with the information, communication, and education provided that people need and want and a guarantee of physical comfort, emotional support, and involvement of family and friends.

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