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Models of Cancer Survivorship Care
Technical Briefs, No. 14
Investigators: Meera Viswanathan, PhD, Michael Halpern, MD, PhD, Tammeka Swinson Evans, MOP, Sarah A Birken, MSPH, PhD, Deborah K Mayer, PhD, RN, AOCN, FAAN, and Ethan Basch, MD.
Author Information and AffiliationsStructured Abstract
Background:
The number of cancer survivors in the United States is projected to grow to 18 million by 2020. In addition to the unique post-treatment needs faced by all cancer survivors, adult cancer survivors have an increased risk for comorbidities that result in significant care coordination challenges. Few publications have described the structure, process, or outcomes of adult survivorship care models for this growing population with complex needs. The purpose of this Technical Brief is to describe existing and proposed models of survivorship care for survivors with adult-onset cancer who have completed active treatment.
Methods:
The Technical Brief integrates discussions with Key Informants and targeted searches of published and gray literature on questions of background, context, research gaps, and future research directions. We also conducted a comprehensive and systematic search of the evidence to answer questions on outcomes associated with models of survivorship care.
Results:
The literature review and Key Informant information consistently indicated considerable heterogeneity in models of survivorship care, components of models, survivor populations, and target outcomes. Models of survivorship care are highly individualized to the institution or setting where they are provided. Broad-based “usual care” for survivors does not exist. Although competing considerations and incentives may lead oncologists or oncology providers in many instances to continue seeing cancer survivors long after treatment ends, anticipated shortages in the oncology workforce may require other approaches such as the expanded use of nurse practitioners and physician assistants, shared care with primary care providers, and patient navigators. Concerns associated with these alternatives include payment considerations, adequacy of training, and the potential for fragmented care. Our systematic review of the literature for the Technical Brief identified nine empirical studies of survivorship care models, covering nurse-led models, physician-led models, models in which survivorship care plan development is a key component, and individual or group counseling models. Future research is needed to explore the optimal timing of survivorship models, tailoring of models based on patient characteristics and risk factors, and key outcomes.
Conclusions:
The optimal nature, timing, intensity, format, and outcome of survivorship care models continue to be uncertain. The paucity of evidence limits our ability to make conclusions about the effectiveness of survivorship care models. Further research regarding survivorship care models, focusing on issues including settings, processes and continuity of care, payments, types of health care providers involved, collaborations and communications, outcomes, and differences associated with cancer type or patient sociodemographic characteristics, is needed before recommendations and conclusions regarding model development, implementation, and evaluation can be made.
Contents
- Preface
- Acknowledgments
- Key Informants
- Peer Reviewers
- Background
- Methods
- Findings
- Summary and Implications
- References
- Appendix A Key Informant Interview Methodology, Guiding Questions, Search Terms, and Gray Literature Methodology
- Appendix B Sample Data Abstraction Forms
- Appendix C List of Excluded Studies
- Appendix D Evidence Tables
- Appendix E Glossary of Terms
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2012-00008-I. Prepared by: RTI-UNC Evidence-based Practice Center, Research Triangle Park, NC
Suggested citation:
Viswanathan M, Halpern M, Swinson Evans T, Birken SA, Mayer DK, Basch E. Models of Cancer Survivorship Care. Technical Brief. No. 14. (Prepared by the RTI-UNC Evidence-based Practice Center under Contract No. 290-2012-00008-I.) AHRQ Publication No. 14-EHC011-EF. Rockville, MD: Agency for Healthcare Research and Quality; March 2014. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the RTI International-University of North Carolina at Chapel Hill (RTI-UNC) Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00008-I).
The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and providers, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliation or financial involvement that conflicts with the material presented in this report.
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.ahrq.gov
- Review Models of Cancer Survivorship Care: Overview and Summary of Current Evidence.[J Oncol Pract. 2015]Review Models of Cancer Survivorship Care: Overview and Summary of Current Evidence.Halpern MT, Viswanathan M, Evans TS, Birken SA, Basch E, Mayer DK. J Oncol Pract. 2015 Jan; 11(1):e19-27. Epub 2014 Sep 9.
- Review Disparities and Barriers to Pediatric Cancer Survivorship Care[ 2021]Review Disparities and Barriers to Pediatric Cancer Survivorship CareMobley EM, Moke DJ, Milam J, Ochoa CY, Stal J, Osazuwa N, Bolshakova M, Kemp J, Dinalo JE, Motala A, et al. 2021 Mar
- Survivorship care models for breast cancer, colorectal cancer, and adolescent and young adult (AYA) cancer survivors: a systematic review.[Support Care Cancer. 2018]Survivorship care models for breast cancer, colorectal cancer, and adolescent and young adult (AYA) cancer survivors: a systematic review.Ke Y, Ng T, Chan A. Support Care Cancer. 2018 Jul; 26(7):2125-2141. Epub 2018 Apr 25.
- Review Survivorship: adult cancer survivors.[Prim Care. 2009]Review Survivorship: adult cancer survivors.Ganz PA. Prim Care. 2009 Dec; 36(4):721-41.
- Review A comprehensive framework and key guideline recommendations for the provision of evidence-based breast cancer survivorship care within the primary care setting.[Fam Pract. 2015]Review A comprehensive framework and key guideline recommendations for the provision of evidence-based breast cancer survivorship care within the primary care setting.Luctkar-Flude M, Aiken A, McColl MA, Tranmer J. Fam Pract. 2015 Apr; 32(2):129-40. Epub 2014 Dec 14.
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