Oncology Rounds

The CoC clarifies the survivorship care plan standard: What you need to know

by Marisa Deline

In our 2017 Trending Now in Cancer Care survey, cancer program leaders ranked the Commission on Cancer (CoC) Standard 3.3, Survivorship Care Plan, as the most difficult standard to achieve. 80% of respondents told us that meeting this standard is "somewhat challenging" or "very challenging."

CoC surveys of its accredited organizations have identified similar levels of concern since the standard's introduction. In response, the CoC issued clarifications about the standard in April 2016 and an update in December 2017. Here's what you need to know.

Standard 3.3 targets only patients receiving curative treatment

The CoC supports the Institute of Medicine, National Coalition for Cancer Survivorship, and the NCI Office of Cancer Survivorship in the idea that “an individual is considered a cancer survivor from the time of cancer diagnosis through the balance of his or her life.”

However, it clarifies that its standard is intended to cover those patients who have completed “active therapy (other than long-term hormonal treatment).” Patients should receive a plan, regardless of their disease site, but patients with metastatic disease are not targeted by the standard.

Survivorship care plan requirement will be rolled out gradually over five years

A CoC survey of accredited programs found that just 37% of responding cancer programs felt "completely confident" that their program would be able to implement Standard 3.3 by 2015. Only 21% indicated that a survivorship care plan process had been developed.

In response, the CoC updated the scope and timing of its standard in 2016:

  • Dec. 31, 2016: Provide survivorship care plans to 25% of eligible patients
  • Dec. 31, 2017: Provide survivorship care plans to 50% of eligible patients
  • Dec. 31, 2018 (updated 2017): Provide survivorship care plans to 50% of eligible patients

In 2017, the CoC announced that effective December 11, 2017, the percentage of eligible patients that cancer programs must deliver survivorship care plans to by the end of 2018 has been lowered to 50%. This announcement replaces the 2016 CoC clarification that required cancer programs to provide survivorship care plans to 75% of eligible patients by Dec. 31, 2018.

Cancer programs granted flexibility in determining parties responsible for care plan creation, delivery

Any organization must answer two important questions about their survivorship care plan: who should create the plan, and who should deliver information to patients.

In response, the CoC notes that “models of health care delivery vary across the nation and often within institutions” and that there is no one evidence-based best practice for survivorship care.

Related: Survivorship program resource guide

As a result, the CoC gives programs flexibility in assigning responsibilities, including care plan delivery. While cancer committees need to develop a policy of identifying a team member to be accountable for discussing the care plan with a patient, the title of that team member can vary.

In 2016, the CoC broadened its definition of eligible candidates from physicians and advanced practice partners to physicians, registered nurses, advanced practitioners, and credentialed clinical navigators.

Clarification outlines minimum information to include in treatment summaries, care plans

A few weeks ago, we shared in a blog post that a multi-disciplinary ASCO working group issued recommendations on critical treatment summary and care plan components.

The CoC is following ASCO’s lead. Its clarification lists the minimum components required for both treatment summaries and care plans. Since new ASCO templates haven’t yet been released and the CoC’s announcement isn’t available online, we’ve include the key elements here.

Treatment summary:

  • Contact information of the treating institutions and providers.
  • Specific diagnosis (e.g. breast cancer), including histologic subtype (e.g. non-small cell lung cancer) when relevant.
  • Specific diagnosis (e.g. breast cancer), including histologic subtype (e.g. non-small cell lung cancer) when relevant.
  • Surgery (yes/no). If yes:
    • Surgical procedure with location on the body
    • Date(s) of surgery (year required, month optional, day not required)
  • Chemotherapy (yes/no). If yes:
    • Names of systemic therapy agents administered (listing individual names rather than regimens)
    • End date(s) of chemotherapy treatment (year required, month optional, day not required)
  • Radiation (yes/no). If yes:
    • Anatomical area treated by radiation
    • End date(s) of radiation treatment (year required, month optional, day not required)
  • Ongoing toxicity or side-effects of all treatments received (including those from surgery, systemic therapy and/or radiation) at the completion of treatment, and any information concerning the likely course of recovery from these toxicities.
  • For selected cancers, genetic/hereditary risk factor(s) or predisposing conditions and genetic testing results if performed.

Follow-up care plan:

  • Oncology team member contacts with location of the treatment facility (repeat if separate document).
  • Need for ongoing adjuvant therapy for cancer:
    • Adjuvant therapy name
    • Planned duration
    • Expected side effects
  • Schedule of follow up related clinical visits, presented in table format including:
    • Who will provide the follow-up visit
    • How often and where this will take place
  • Cancer surveillance tests for recurrence, presented in table format including:
    • Who is responsible for ordering/carrying out the test
    • Frequency of testing
    • Where testing will take place
  • Cancer screening for early detection of new primaries—to be included only if different from the general population, presented in table format including:
    • Who is responsible for carrying out the screening
    • Frequency of testing
    • Where testing will take place
  • Other periodic testing and examinations. Rather than outlining specific testing, the group suggested an inclusion of a general statement to "continue all standard non-cancer related health care with your primary care provider, with the following exceptions (if there are any)."
  • Possible symptoms of cancer recurrence. Rather than including a list of possible symptoms, the group suggested inclusion of a general statement, "Any new, unusual and/or persistent symptoms should be brought to the attention of your provider."
  • A list of likely or rare but clinically significant late- and/or long-term effects that a survivor may experience based on his or her individual diagnosis and treatment if known, including symptoms that may indicate the presence of such conditions.
  • A list of areas in which survivors have experienced issues, e.g. emotional or mental health, parenting, work/employment, financial issues, and insurance. This list will be used to ensure that the patient speaks with his or her oncologist and/or PCP if having related concerns. This should also include a list of local and national resources to assist the patient in obtaining proper services.
  • A general statement emphasizing the importance of healthy diet, exercise, smoking cessation and alcohol use reduction may be included. Statements may be tailored if particularly pertinent to the individual.

Survivorship program metric types

Use our metric table to evaluate the success of your current survivorship services and to guide future strategy. See the resource

Survivorship program resources from Advocate Lutheran General

Access the resources Advocate Lutheran used to plan and develop their survivorship program. Read more