Cancer Survivorship Programs Key To Serving Patients

WASHINGTON– Establishing a cancer survivorship program can be rewarding for patients and physicians – and for the cancer center as well – according to representatives from large and small centers that have started such programs.

Cancer survivors are a large and growing population with long-term medical and psychosocial needs. The National Cancer Institute estimates that there are 11.7 million cancer survivors in the United States.

Under the NCI definition, "an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life." In addition, the NCI calls attention to family members, friends, and caregivers who also feel the impact of survivorship.

M.D. Anderson: ‘Graduate’ Certificates

Survivorship programs should be an integral part of any cancer center, said Fran Zandstra, director of cancer survivorship program at the University of Texas M.D. Anderson Cancer Center in Houston. These programs should address the acute phase of illness; the intermediate phase, which includes monitoring and rehabilitation; and the long term, covering wellness and a patient’s reintegration into the world outside the health system, she said at the annual national meeting of the association of community cancer centers.

M.D. Anderson started its survivorship program in 2008, and now has specialized programs for stem cell transplants, head and neck cancers, and gynecologic, breast, thyroid and colorectal cancers. Next up will be lymphoma, said Ms. Zandstra.

This is no small undertaking. M.D. Anderson saw 100,000 patients in 2010. Of those, 32,000 were new patients and 19,000 were long-term survivors, she said. The organization also has 18,000 employees.

Getting physicians on board was not easy, at least initially, said Ms. Zandstra, who is also a registered nurse. She and the colleagues who helped build the program surveyed physicians to ask what they would want to see in terms of transitioning patients to a survivorship program.

Some physicians said that their patients would not want to leave them for care from another doctor, which is a valid concern, said Ms. Zandstra. To get past that, the program created a "graduate" certificate for patients who were transitioning out of oncology and into survivorship.

Survivors are tiered according to risk: Surgical patients are at the lowest risk for complications or relapse, and thus are considered "tier 1." Next are tier 2 patients, who are at risk of complications or a second malignancy after chemotherapy or radiation. Finally, tier 3 contains the highest-risk patients, who have metastatic disease or are deemed at risk for other reasons.

Each disease has an algorithm that clearly states the expectations for how a patient will make his or her way through the survivorship system, including the expected components of each visit, said Ms. Zandstra.

The data collected at every visit go into a care summary that’s called the "Passport Plan for Health." This 2-page document is available for patients through M.D. Anderson’s patient portal, and also to physicians through a Web portal specifically for physicians. The patients are also told to take a paper copy of the care summary to each physician visit, whether it’s at M.D. Anderson or elsewhere.

The cancer center is gauging the program’s success by measuring patient and physician satisfaction, the number of patients eligible for survivorship who are seen, how many are referred for appropriate surveillance, the types and number of services used (such as bone density scans), and the number of passports issued.

Sanford Health: ID Patient Needs

A center does not have to be as big as M.D. Anderson to build such a program, said Becky Ball, a registered nurse and clinical services manager at Sanford Oncology Cancer Clinic, which is part of Sanford Health in Sioux Falls, S.D., and serves an average of 1,400 new cancer patients each year, according to its Web site.

The Sanford staff began with a program in breast cancer. That cancer is a common starting point because the patients are motivated, and there are many survivors. According to the NCI, the most common cancer sites for survivors are female breast (22%), prostate (19%), colorectal (9%), and gynecologic (9%).

At Sanford, staff sought to identify needs from a patient perspective from the outset. One way they did that was by surveying patients during chemotherapy infusions, said Ms. Ball. The cancer center has also collaborated with community organizations to help identify areas of need, and a patient navigator from the American Cancer Society is on campus to help survivors find resources.

The survivorship program is designed to give patients a perception of control and progress; it also coordinates care among the various providers, and helps patients gain an understanding of the process of care, she said. Because Sanford is not a huge institution, it has to maximize its resources. One way it does that is by using midlevel providers to deliver care. Sanford has also strived to differentiate the survivorship visits from regular surveillance visits, said Ms. Ball.

The cancer center is hoping to add survivorship programs in head and neck cancer and gynecologic oncology, she said, encouraging meeting attendees from other cancer centers to establish their own survivorship programs. "You have to start somewhere, or you can’t succeed or fail," she told them.

City of Hope: Research Opportunity

At City of Hope in Duarte, Calif., there had been a long-standing pediatric survivorship program, but the comprehensive cancer center has added breast and prostate cancer, and is developing programs in gastrointestinal, gynecologic, lung, and hematologic cancers, said Denice Economou, a registered nurse and project director for survivorship education for quality cancer care.

The breast cancer program was difficult to get up and running because the oncologists wanted to wait at least 10 years post diagnosis before referring a patient, said Ms. Economou. But now, patients are eligible starting from diagnosis. They get a yearly follow-up visit with a nurse practitioner and medical oncologist, in collaboration with the primary breast oncologist. Patients are assessed for therapy-related complications such as premature menopause, osteoporosis, and depression, among other issues, Ms. Economou said.

Prostate cancer patients are eligible if they are at least 1 year out from initial surgery. They are seen every 6 months for 5 years, and then yearly after that. The focus is on health promotion.

All survivors are given a survivorship care plan, with a summary of the treatment they received for their cancer. It gives the patients something to take to any and all clinicians who may see them throughout their life, she said. And it is all done without the benefit of an electronic medical record.

The survivorship visits also provide an opportunity to enroll patients in research protocols, said Ms. Economou.

CTCA: $18 million in Income

Survivorship programs are also an important part of care at the four hospitals that make up the for-profit Cancer Treatment Centers of America, said Tom Lay, director of the survivorship support program at the company.

CTCA provides a wide range of support services, including patient education; coping strategies; wellness, referral and medical services; and aesthetic services (for breast cancer patients and others needing that type of support). As at the other programs, patients are given a treatment summary and a wellness plan, which is similar to the passport that M.D. Anderson patients receive, said Mr. Lay.

The survivorship program costs about $150,000 a year, but brings in $18 million to CTCA, he said. There are some 1,200 visits a year to physicians and nurse practitioners, resulting in about $150,000 in evaluation and management reimbursement. There is also indirect reimbursement from imaging services, pathology, nutrition, physical therapy, and same-day surgeries such as colonoscopies.

Many community physicians have now begun to refer survivors to CTCA for its program. Those handfuls of referrals are worth some $6.2 million, based on the lifetime costs of caring for cancer survivors, Mr. Lay said.

In the future, CTCA’s survivorship program is looking to take over more of the care for low-risk survivors from oncologists. That frees up the medical oncologist to take on additional new patients, he said.

WASHINGTON– Establishing a cancer survivorship program can be rewarding for patients and physicians – and for the cancer center as well – according to representatives from large and small centers that have started such programs.

Cancer survivors are a large and growing population with long-term medical and psychosocial needs. The National Cancer Institute estimates that there are 11.7 million cancer survivors in the United States.

Under the NCI definition, "an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life." In addition, the NCI calls attention to family members, friends, and caregivers who also feel the impact of survivorship.

M.D. Anderson: ‘Graduate’ Certificates

Survivorship programs should be an integral part of any cancer center, said Fran Zandstra, director of cancer survivorship program at the University of Texas M.D. Anderson Cancer Center in Houston. These programs should address the acute phase of illness; the intermediate phase, which includes monitoring and rehabilitation; and the long term, covering wellness and a patient’s reintegration into the world outside the health system, she said at the annual national meeting of the association of community cancer centers.

M.D. Anderson started its survivorship program in 2008, and now has specialized programs for stem cell transplants, head and neck cancers, and gynecologic, breast, thyroid and colorectal cancers. Next up will be lymphoma, said Ms. Zandstra.

This is no small undertaking. M.D. Anderson saw 100,000 patients in 2010. Of those, 32,000 were new patients and 19,000 were long-term survivors, she said. The organization also has 18,000 employees.

Getting physicians on board was not easy, at least initially, said Ms. Zandstra, who is also a registered nurse. She and the colleagues who helped build the program surveyed physicians to ask what they would want to see in terms of transitioning patients to a survivorship program.

Some physicians said that their patients would not want to leave them for care from another doctor, which is a valid concern, said Ms. Zandstra. To get past that, the program created a "graduate" certificate for patients who were transitioning out of oncology and into survivorship.

Survivors are tiered according to risk: Surgical patients are at the lowest risk for complications or relapse, and thus are considered "tier 1." Next are tier 2 patients, who are at risk of complications or a second malignancy after chemotherapy or radiation. Finally, tier 3 contains the highest-risk patients, who have metastatic disease or are deemed at risk for other reasons.

Each disease has an algorithm that clearly states the expectations for how a patient will make his or her way through the survivorship system, including the expected components of each visit, said Ms. Zandstra.

The data collected at every visit go into a care summary that’s called the "Passport Plan for Health." This 2-page document is available for patients through M.D. Anderson’s patient portal, and also to physicians through a Web portal specifically for physicians. The patients are also told to take a paper copy of the care summary to each physician visit, whether it’s at M.D. Anderson or elsewhere.

The cancer center is gauging the program’s success by measuring patient and physician satisfaction, the number of patients eligible for survivorship who are seen, how many are referred for appropriate surveillance, the types and number of services used (such as bone density scans), and the number of passports issued.

Sanford Health: ID Patient Needs

A center does not have to be as big as M.D. Anderson to build such a program, said Becky Ball, a registered nurse and clinical services manager at Sanford Oncology Cancer Clinic, which is part of Sanford Health in Sioux Falls, S.D., and serves an average of 1,400 new cancer patients each year, according to its Web site.

The Sanford staff began with a program in breast cancer. That cancer is a common starting point because the patients are motivated, and there are many survivors. According to the NCI, the most common cancer sites for survivors are female breast (22%), prostate (19%), colorectal (9%), and gynecologic (9%).

At Sanford, staff sought to identify needs from a patient perspective from the outset. One way they did that was by surveying patients during chemotherapy infusions, said Ms. Ball. The cancer center has also collaborated with community organizations to help identify areas of need, and a patient navigator from the American Cancer Society is on campus to help survivors find resources.

The survivorship program is designed to give patients a perception of control and progress; it also coordinates care among the various providers, and helps patients gain an understanding of the process of care, she said. Because Sanford is not a huge institution, it has to maximize its resources. One way it does that is by using midlevel providers to deliver care. Sanford has also strived to differentiate the survivorship visits from regular surveillance visits, said Ms. Ball.

The cancer center is hoping to add survivorship programs in head and neck cancer and gynecologic oncology, she said, encouraging meeting attendees from other cancer centers to establish their own survivorship programs. "You have to start somewhere, or you can’t succeed or fail," she told them.

City of Hope: Research Opportunity

At City of Hope in Duarte, Calif., there had been a long-standing pediatric survivorship program, but the comprehensive cancer center has added breast and prostate cancer, and is developing programs in gastrointestinal, gynecologic, lung, and hematologic cancers, said Denice Economou, a registered nurse and project director for survivorship education for quality cancer care.

The breast cancer program was difficult to get up and running because the oncologists wanted to wait at least 10 years post diagnosis before referring a patient, said Ms. Economou. But now, patients are eligible starting from diagnosis. They get a yearly follow-up visit with a nurse practitioner and medical oncologist, in collaboration with the primary breast oncologist. Patients are assessed for therapy-related complications such as premature menopause, osteoporosis, and depression, among other issues, Ms. Economou said.

Prostate cancer patients are eligible if they are at least 1 year out from initial surgery. They are seen every 6 months for 5 years, and then yearly after that. The focus is on health promotion.

All survivors are given a survivorship care plan, with a summary of the treatment they received for their cancer. It gives the patients something to take to any and all clinicians who may see them throughout their life, she said. And it is all done without the benefit of an electronic medical record.

The survivorship visits also provide an opportunity to enroll patients in research protocols, said Ms. Economou.

CTCA: $18 million in Income

Survivorship programs are also an important part of care at the four hospitals that make up the for-profit Cancer Treatment Centers of America, said Tom Lay, director of the survivorship support program at the company.

CTCA provides a wide range of support services, including patient education; coping strategies; wellness, referral and medical services; and aesthetic services (for breast cancer patients and others needing that type of support). As at the other programs, patients are given a treatment summary and a wellness plan, which is similar to the passport that M.D. Anderson patients receive, said Mr. Lay.

The survivorship program costs about $150,000 a year, but brings in $18 million to CTCA, he said. There are some 1,200 visits a year to physicians and nurse practitioners, resulting in about $150,000 in evaluation and management reimbursement. There is also indirect reimbursement from imaging services, pathology, nutrition, physical therapy, and same-day surgeries such as colonoscopies.

Many community physicians have now begun to refer survivors to CTCA for its program. Those handfuls of referrals are worth some $6.2 million, based on the lifetime costs of caring for cancer survivors, Mr. Lay said.

In the future, CTCA’s survivorship program is looking to take over more of the care for low-risk survivors from oncologists. That frees up the medical oncologist to take on additional new patients, he said.

WASHINGTON– Establishing a cancer survivorship program can be rewarding for patients and physicians – and for the cancer center as well – according to representatives from large and small centers that have started such programs.

Cancer survivors are a large and growing population with long-term medical and psychosocial needs. The National Cancer Institute estimates that there are 11.7 million cancer survivors in the United States.

Under the NCI definition, "an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life." In addition, the NCI calls attention to family members, friends, and caregivers who also feel the impact of survivorship.

M.D. Anderson: ‘Graduate’ Certificates

Survivorship programs should be an integral part of any cancer center, said Fran Zandstra, director of cancer survivorship program at the University of Texas M.D. Anderson Cancer Center in Houston. These programs should address the acute phase of illness; the intermediate phase, which includes monitoring and rehabilitation; and the long term, covering wellness and a patient’s reintegration into the world outside the health system, she said at the annual national meeting of the association of community cancer centers.

M.D. Anderson started its survivorship program in 2008, and now has specialized programs for stem cell transplants, head and neck cancers, and gynecologic, breast, thyroid and colorectal cancers. Next up will be lymphoma, said Ms. Zandstra.

This is no small undertaking. M.D. Anderson saw 100,000 patients in 2010. Of those, 32,000 were new patients and 19,000 were long-term survivors, she said. The organization also has 18,000 employees.

Getting physicians on board was not easy, at least initially, said Ms. Zandstra, who is also a registered nurse. She and the colleagues who helped build the program surveyed physicians to ask what they would want to see in terms of transitioning patients to a survivorship program.

Some physicians said that their patients would not want to leave them for care from another doctor, which is a valid concern, said Ms. Zandstra. To get past that, the program created a "graduate" certificate for patients who were transitioning out of oncology and into survivorship.

Survivors are tiered according to risk: Surgical patients are at the lowest risk for complications or relapse, and thus are considered "tier 1." Next are tier 2 patients, who are at risk of complications or a second malignancy after chemotherapy or radiation. Finally, tier 3 contains the highest-risk patients, who have metastatic disease or are deemed at risk for other reasons.

Each disease has an algorithm that clearly states the expectations for how a patient will make his or her way through the survivorship system, including the expected components of each visit, said Ms. Zandstra.

The data collected at every visit go into a care summary that’s called the "Passport Plan for Health." This 2-page document is available for patients through M.D. Anderson’s patient portal, and also to physicians through a Web portal specifically for physicians. The patients are also told to take a paper copy of the care summary to each physician visit, whether it’s at M.D. Anderson or elsewhere.

The cancer center is gauging the program’s success by measuring patient and physician satisfaction, the number of patients eligible for survivorship who are seen, how many are referred for appropriate surveillance, the types and number of services used (such as bone density scans), and the number of passports issued.

Sanford Health: ID Patient Needs

A center does not have to be as big as M.D. Anderson to build such a program, said Becky Ball, a registered nurse and clinical services manager at Sanford Oncology Cancer Clinic, which is part of Sanford Health in Sioux Falls, S.D., and serves an average of 1,400 new cancer patients each year, according to its Web site.

The Sanford staff began with a program in breast cancer. That cancer is a common starting point because the patients are motivated, and there are many survivors. According to the NCI, the most common cancer sites for survivors are female breast (22%), prostate (19%), colorectal (9%), and gynecologic (9%).

At Sanford, staff sought to identify needs from a patient perspective from the outset. One way they did that was by surveying patients during chemotherapy infusions, said Ms. Ball. The cancer center has also collaborated with community organizations to help identify areas of need, and a patient navigator from the American Cancer Society is on campus to help survivors find resources.

The survivorship program is designed to give patients a perception of control and progress; it also coordinates care among the various providers, and helps patients gain an understanding of the process of care, she said. Because Sanford is not a huge institution, it has to maximize its resources. One way it does that is by using midlevel providers to deliver care. Sanford has also strived to differentiate the survivorship visits from regular surveillance visits, said Ms. Ball.

The cancer center is hoping to add survivorship programs in head and neck cancer and gynecologic oncology, she said, encouraging meeting attendees from other cancer centers to establish their own survivorship programs. "You have to start somewhere, or you can’t succeed or fail," she told them.

City of Hope: Research Opportunity

At City of Hope in Duarte, Calif., there had been a long-standing pediatric survivorship program, but the comprehensive cancer center has added breast and prostate cancer, and is developing programs in gastrointestinal, gynecologic, lung, and hematologic cancers, said Denice Economou, a registered nurse and project director for survivorship education for quality cancer care.

The breast cancer program was difficult to get up and running because the oncologists wanted to wait at least 10 years post diagnosis before referring a patient, said Ms. Economou. But now, patients are eligible starting from diagnosis. They get a yearly follow-up visit with a nurse practitioner and medical oncologist, in collaboration with the primary breast oncologist. Patients are assessed for therapy-related complications such as premature menopause, osteoporosis, and depression, among other issues, Ms. Economou said.

Prostate cancer patients are eligible if they are at least 1 year out from initial surgery. They are seen every 6 months for 5 years, and then yearly after that. The focus is on health promotion.

All survivors are given a survivorship care plan, with a summary of the treatment they received for their cancer. It gives the patients something to take to any and all clinicians who may see them throughout their life, she said. And it is all done without the benefit of an electronic medical record.

The survivorship visits also provide an opportunity to enroll patients in research protocols, said Ms. Economou.

CTCA: $18 million in Income

Survivorship programs are also an important part of care at the four hospitals that make up the for-profit Cancer Treatment Centers of America, said Tom Lay, director of the survivorship support program at the company.

CTCA provides a wide range of support services, including patient education; coping strategies; wellness, referral and medical services; and aesthetic services (for breast cancer patients and others needing that type of support). As at the other programs, patients are given a treatment summary and a wellness plan, which is similar to the passport that M.D. Anderson patients receive, said Mr. Lay.

The survivorship program costs about $150,000 a year, but brings in $18 million to CTCA, he said. There are some 1,200 visits a year to physicians and nurse practitioners, resulting in about $150,000 in evaluation and management reimbursement. There is also indirect reimbursement from imaging services, pathology, nutrition, physical therapy, and same-day surgeries such as colonoscopies.

Many community physicians have now begun to refer survivors to CTCA for its program. Those handfuls of referrals are worth some $6.2 million, based on the lifetime costs of caring for cancer survivors, Mr. Lay said.

In the future, CTCA’s survivorship program is looking to take over more of the care for low-risk survivors from oncologists. That frees up the medical oncologist to take on additional new patients, he said.