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Successful and Sustainable Implementation of a VA Cancer Survivorship Clinic
Background
There are an estimated 18 million cancer survivors in the US with unique needs including specific surveillance imaging, testing for recurrence, monitoring for and managing late effects of cancer treatments, and for second malignancies. Survivorship care is an unmet need in most VAHC. Purpose: Assess implementation outcomes of a Survivorship Clinic.
Methods
A Survivorship Clinic was initiated comprising of a Survivorship APRN and Nurse Navigator. A referral process and workflow were created. Medical and Radiation Oncology providers were educated regarding availability of survivorship services. We describe the results of the Survivorship Clinic 2021-2025 including demographics, diagnoses and referral patterns.
Results
1,332 visits were completed for 424 patients. 2021 (Oct-Dec): 21, 2022: 219, 2023: 424, 2024: 508, 2025 (Jan-Mar): 160. 364 men and 60 women. Cancer diagnoses seen: lung: 108, lymphoma: 62, colorectal: 52, breast: 45, head and neck: 40, melanoma: 28, NET: 23, testicular: 13, bladder: 13, esophageal: 10, renal: 7, sarcomas: 7, anal: 6, HCC: 6, hepatobiliary: 6, gastric/GIST: 5, leukemia: 5, pancreatic: 5, prostate: 5, Merkel cell: 3, SCC: 3, thymus: 3, uterine: 2, 1 each appendix, anaplastic astrocytoma, periosteal carcinoma, poorly differentiated basaloid chest wall carcinoma, and small intestine. For symptom management the following referrals were placed: Rehab (all departments) : 71, Psychology/Whole Health/THRIVE: 52, Gastroenterology: 43, Nutrition: 24, Dermatology: 20, Urology, ED: 16, Pulmonology: 15, Plastic Surgery: 15, ENT: 12, LIVESTRONG YMCA: 10, Genetics: 9, General Surgery: 4, Neurology: 4, Breast Clinic: 3, Dental: 3, Neurosurgery: 2, Ophthalmology: 2, Pain Management: 2, Radiation Oncology: 2, Wound Care: 2, Pharmacy: 1, and Rheumatology: 1. Survivorship care plans were created and provided to all patients.
Conclusions
Since 2021, the Cancer Survivorship Clinic, operated by an APRN, has successfully served 424 cancer survivors encompassing a wide range of cancers. The disproportionately low number of prostate cancer survivors referred may be reflective of their care being managed by Urology, and presents an opportunity for future growth.
Implications for VA
Having a Survivorship Clinic provides cancer survivors specialized services and meets their unique needs; at the same allowing for improved capacity for new active cancer referrals for the Oncology Clinics.
Background
There are an estimated 18 million cancer survivors in the US with unique needs including specific surveillance imaging, testing for recurrence, monitoring for and managing late effects of cancer treatments, and for second malignancies. Survivorship care is an unmet need in most VAHC. Purpose: Assess implementation outcomes of a Survivorship Clinic.
Methods
A Survivorship Clinic was initiated comprising of a Survivorship APRN and Nurse Navigator. A referral process and workflow were created. Medical and Radiation Oncology providers were educated regarding availability of survivorship services. We describe the results of the Survivorship Clinic 2021-2025 including demographics, diagnoses and referral patterns.
Results
1,332 visits were completed for 424 patients. 2021 (Oct-Dec): 21, 2022: 219, 2023: 424, 2024: 508, 2025 (Jan-Mar): 160. 364 men and 60 women. Cancer diagnoses seen: lung: 108, lymphoma: 62, colorectal: 52, breast: 45, head and neck: 40, melanoma: 28, NET: 23, testicular: 13, bladder: 13, esophageal: 10, renal: 7, sarcomas: 7, anal: 6, HCC: 6, hepatobiliary: 6, gastric/GIST: 5, leukemia: 5, pancreatic: 5, prostate: 5, Merkel cell: 3, SCC: 3, thymus: 3, uterine: 2, 1 each appendix, anaplastic astrocytoma, periosteal carcinoma, poorly differentiated basaloid chest wall carcinoma, and small intestine. For symptom management the following referrals were placed: Rehab (all departments) : 71, Psychology/Whole Health/THRIVE: 52, Gastroenterology: 43, Nutrition: 24, Dermatology: 20, Urology, ED: 16, Pulmonology: 15, Plastic Surgery: 15, ENT: 12, LIVESTRONG YMCA: 10, Genetics: 9, General Surgery: 4, Neurology: 4, Breast Clinic: 3, Dental: 3, Neurosurgery: 2, Ophthalmology: 2, Pain Management: 2, Radiation Oncology: 2, Wound Care: 2, Pharmacy: 1, and Rheumatology: 1. Survivorship care plans were created and provided to all patients.
Conclusions
Since 2021, the Cancer Survivorship Clinic, operated by an APRN, has successfully served 424 cancer survivors encompassing a wide range of cancers. The disproportionately low number of prostate cancer survivors referred may be reflective of their care being managed by Urology, and presents an opportunity for future growth.
Implications for VA
Having a Survivorship Clinic provides cancer survivors specialized services and meets their unique needs; at the same allowing for improved capacity for new active cancer referrals for the Oncology Clinics.
Background
There are an estimated 18 million cancer survivors in the US with unique needs including specific surveillance imaging, testing for recurrence, monitoring for and managing late effects of cancer treatments, and for second malignancies. Survivorship care is an unmet need in most VAHC. Purpose: Assess implementation outcomes of a Survivorship Clinic.
Methods
A Survivorship Clinic was initiated comprising of a Survivorship APRN and Nurse Navigator. A referral process and workflow were created. Medical and Radiation Oncology providers were educated regarding availability of survivorship services. We describe the results of the Survivorship Clinic 2021-2025 including demographics, diagnoses and referral patterns.
Results
1,332 visits were completed for 424 patients. 2021 (Oct-Dec): 21, 2022: 219, 2023: 424, 2024: 508, 2025 (Jan-Mar): 160. 364 men and 60 women. Cancer diagnoses seen: lung: 108, lymphoma: 62, colorectal: 52, breast: 45, head and neck: 40, melanoma: 28, NET: 23, testicular: 13, bladder: 13, esophageal: 10, renal: 7, sarcomas: 7, anal: 6, HCC: 6, hepatobiliary: 6, gastric/GIST: 5, leukemia: 5, pancreatic: 5, prostate: 5, Merkel cell: 3, SCC: 3, thymus: 3, uterine: 2, 1 each appendix, anaplastic astrocytoma, periosteal carcinoma, poorly differentiated basaloid chest wall carcinoma, and small intestine. For symptom management the following referrals were placed: Rehab (all departments) : 71, Psychology/Whole Health/THRIVE: 52, Gastroenterology: 43, Nutrition: 24, Dermatology: 20, Urology, ED: 16, Pulmonology: 15, Plastic Surgery: 15, ENT: 12, LIVESTRONG YMCA: 10, Genetics: 9, General Surgery: 4, Neurology: 4, Breast Clinic: 3, Dental: 3, Neurosurgery: 2, Ophthalmology: 2, Pain Management: 2, Radiation Oncology: 2, Wound Care: 2, Pharmacy: 1, and Rheumatology: 1. Survivorship care plans were created and provided to all patients.
Conclusions
Since 2021, the Cancer Survivorship Clinic, operated by an APRN, has successfully served 424 cancer survivors encompassing a wide range of cancers. The disproportionately low number of prostate cancer survivors referred may be reflective of their care being managed by Urology, and presents an opportunity for future growth.
Implications for VA
Having a Survivorship Clinic provides cancer survivors specialized services and meets their unique needs; at the same allowing for improved capacity for new active cancer referrals for the Oncology Clinics.