• Lack of evidence-based guidelines for survivorship care
• Lack of integration in survivorship care into cancer treatment planning
• The multifaceted nature of cancer treatment itself

The IOM also identified four components as essential to comprehensive survivorship care:

• Prevention (using methods that are effective in preventing the recurrence of the original cancer, the occurrence of new cancers, and the occurrence of late effects)
• Surveillance (using methods effective in monitoring for cancer spread, recurrence, or second cancers, including assessments to find medical and psychosocial late effects)
• Intervention (using methods effective in addressing the consequences of cancer and its treatment)
• Coordination of care (integrating necessary follow-up care between appropriate care providers, including specialists and primary care, to ensure that the cancer survivor’s health needs are met)

The IOM report also identified the importance of treatment summaries and survivorship care plans.

The American Society of Clinical Oncology (ASCO) has developed CRC surveillance guidelines which call for colonoscopy in the first year post-treatment, carcinoembyonic antigen (CEA) testing every three months within the initial three years post-treatment, and routine medical visits, every three to six months in the first three years post-treatment.3.

The ASCO Cancer Survivorship Expert Panel has also developed a two-page fillable template of a treatment summary and survivorship care plan for colon cancer which provides details on cancer diagnosis and stage as well as details of surgery received, CEA levels, nodal status and co-morbidities.3. The plan also notes therapy received, toxicities, performance status and nutritional status. 

The ASCO Colon Cancer Survivorship care plan is a short, one page form that notes the essential components of follow-up care, including physician’s visit, CEA testing, CT scans, and colonoscopy, with the appropriate timing included. These forms can help to provide tools to increase communication among health care providers and improve coordination of care. Long term benefits may include prevention or reduction of late effects, improved adherence to surveillance recommendations and longer survival due to communication and coordination of care.1

The authors note that CRC survivors represent a unique group for additional study post-treatment, particularly because the disease is so common and many patients survive when diagnosed with early-stage disease. Additionally, the frequency of recommended follow-up care provides ample opportunity to study additional factors which can affect patient outcome and survivorship needs. Further studies are needed to optimally determine how outcomes of cancer survivors can be improved by better survivorship care planning.

References