Meeting the Cancer Survivorship Needs of Colorectal Cancer: The Wellness Beyond Cancer Program, Ms. Robin Morash


Published on

Robin Morash's presentation from the 2013 Regional Oncology Conference.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Meeting the Cancer Survivorship Needs of Colorectal Cancer: The Wellness Beyond Cancer Program, Ms. Robin Morash

  1. 1. Meeting the Cancer Survivorship Needs of Colorectal Cancer Patients: Wellness Beyond Cancer Program Robin Morash RN, MHS The Ottawa Hospital Cancer Program Northeast Cancer Centre Regional Oncology Conference, 2013 Painting by P. Kenny – Cancer Survivor
  2. 2. Conflict of Interest Disclosure • None to disclose 2
  3. 3. Presentation Objectives 1. To describe the scope of our evidence-based survivorship program at The Ottawa Hospital – objectives, key components, knowledge translation initiatives and evaluation framework. 2. To identify program outcomes to date 3. To share early lessons learned in creating a new model of well followup cancer care. 3
  4. 4. Cancer Survivorship Definitions of Cancer Survivors From Cancer Patient to Cancer Survivor: Lost in Transition (IOM & NRC 2006): National Coalition for Cancer Survivorship (NCCS 2007): Lance Armstrong Foundation (LAF 2007): Centre for Disease Control and Prevention and LAF’s National Action Plan (CDC 2004): National Cancer Institute (NCI 2008): People Living with Cancer (2007): Prevention Following diagnosis and treatment and prior to the development of a recurrence of cancer or death. From the time of diagnosis and for the balance of life. NCCS has expanded its definition of survivor to include family, friends, and caregivers. From the time you find out you have cancer, through your treatment and for the rest of your life. The person diagnosed with cancer, as well as family members, friends and caregivers An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends, and caregivers are also impacted by the survivorship experience and are therefore included in this definition. The process of living with, through, and beyond cancer. By this definition, cancer survivorship begins at diagnosis. Screening Diagnosis Palliative & end-of-life care Treatment Recovery Definitions Commonly Used in Practice 1. Diagnosis to end-of-life 2. Post-treatment to recurrence 3. Specific number of years after treatment Reference: Environmental Scan of Cancer Survivorship in Canada: Conceptualization, Practice and Research, CPAC, 2008
  5. 5. Why change our model of follow-up care beyond cancer treatment? • Current model is not sustainable • Opportunity to: – improve access to quality cancer care across the care continuum – better meet the needs of cancer survivors – provide care closer to home – transition into wellness 5
  6. 6. What are the essential components of survivorship (follow-up) care? • Prevention of recurrent and new cancers and other late effects • Surveillance for cancer spread, recurrence, or second cancers; assessment of medical and psychosocial late effects • Intervention for consequences of cancer and its treatment • Coordination between specialist and primary care providers to ensure that all of the survivor’s health needs are met Canadian Partnership Against Cancer-Pan Canadian Guidance on Psychosocial and Supportive Care Services and Clinical Practices for Adult Cancer Survivors (2010) IoM – From Cancer patient to Cancer Survivor – Lost in Transition (2006) 6
  7. 7. Wellness Beyond Cancer Program Purpose Ensure that all people, at the end of their active cancer treatment, have access to appropriate follow-up care & the resources required to best meet individual needs. Objectives • Provide survivors and their health care providers with a care summary & follow-up plan • Empower patients to participate in the management of their care & well-being • Improve knowledge of health care providers regarding survivor needs, assessment & management strategies • Improve cancer system efficiency, & enhance transition & co-ordination of care for cancer survivors 7
  8. 8. Timelines • • • • • • • • Retreat – May 2010 CCO call for proposals – aligned with TOH program objectives WBCP team created Support from larger CRC community – MCC, Regional CoP, PFAC Education –internal, external partners Education –PCPs – regional sessions, GP yearly educational day CRC implementation – March 2012 Evaluation underway 9
  9. 9. Wellness Beyond Cancer Program • 3 follow-up scenarios based on risk and complexity while fostering appropriate use of health providers; • formalized partnerships with a community health centre, Maplesoft Center, an evidence-based integrative cancer centre and the Canadian Cancer Society; • a post treatment needs assessment to identify individual patient needs; • a wellness (survivorship) care plan supplemented with information about survivorship needs and available resources; • a discharge letter and accompanying care plan for patients and community-based family physicians and nurse practitioners; • group sessions for patients and families post-treatment to promote self care and empowerment; 10
  10. 10. Wellness Beyond Cancer Program • an exit appointment with oncologist and one on one counselling with a nurse as required; • a consultation service for family physicians/nurse practitioners of discharged patients including a rapid re-entry process; • assessment of adherence to recommended surveillance and late and long term effects; • a health professional educational strategy; • an aligned evaluation framework and plan for an evolving research agenda. 11
  11. 11. 12
  12. 12. Discharge Criteria: Cancer Program to Wellness Beyond Cancer Program Patients who have completed adjuvant treatment:  Primary Care Provider Stream o Early stage disease o No acute outstanding sequelae or side effects of treatment o No outstanding issues or concerns  NP Stream o Persistent and/ or unresolved acute effects of treatment and/or; o Requiring continued follow-up and care at the centre  Medical Specialist o Outstanding acute issues requiring medical management o Patients on clinical trials 13
  13. 13. Patient Resources • Program overview booklet • Late and long term effects education booklet • Education sessions • Wellness care plan • Web site 14
  14. 14. WBCP Education Classes • Generic Survivorship Class • Disease Site Specific – Colorectal – Breast – Endometrial • Future Direction – Videoconferencing – Group Discharge visits 15
  15. 15. • Demographics • Disease Summary • Cancer Team • Treatment Summary • Recommended followup • Summary of patient’s self identified needs
  16. 16. Follow-up Care for Survivors of CRC Test Timeline Medical History, Physical Exam, and CEA laboratory test  Every 6 months for 5 years Colonoscopy  One year after surgery Frequency of future colonoscopies based on findings of previous one, but in general to be done every five years. If complete colonoscopy was not done at diagnosis, one should be done within six months of completing primary treatment.   Abdominal CT Scan Once a year for 3 years* Chest CT Scan Once a year for 3 years* Pelvic CT Scan (For rectal cancer only) Once a year for 3 years* Additional Comments * If local resources and/or patient preferences preclude the use of CT: - An ultrasound can be substituted for CT abdomen or pelvis, and - Chest x-ray can be substituted for CT chest. These should be done every 6 to 12 months for 3 years then annually for 2 years (years 4 & 5). Follow-up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer. Cancer Care Ontario; 26-2 EBS: February 2012
  17. 17. Colorectal WBCP Referrals The First Year (March 2012 – March 2013) PCP NP Onc Total 251 (77%) 66 (20%) 7 (2%) 324 18
  18. 18. Evaluation Elements • • • • • • • • • • • • Patient satisfaction Patient needs and empowerment Wellness care plan usage by patient and primary care provider Discharges from cancer program (by physician) Wait time from referral to consult Follow up stream usage: family physician, nurse practitioner vs oncologist Adherence to recommended follow-up tests/care Incidence of late and long term effects Use of psychosocial and regional resources Health provider satisfaction (cancer program and primary care) Health provider knowledge (cancer program and primary care) Re-entry to cancer program 19
  19. 19. Patient Experience Results Needs Assessment: Top Ten – – – – – – – – – – Tingling/numbness Fear of recurrence Bowel/bladder Sleep disturbance Fatigue Weight changes Body changes Balance and mobility Sexual issues Managing emotions Empowerment – Capable of handling my illness – Family are supportive – Capable of helping reach decision about my care – Can adapt to changes in lifestyle – Health professionals include me in decision making – I still feel useful in my daily life – Friends are supportive – I have all the information I need 20
  20. 20. Education Classes Better idea of how care coordinated – Satisfied to Very Satisfied: 94% Importance of follow-up testing – Satisfied to Very Satisfied: 100% Better understand resources available – Satisfied to Very Satisfied: 100% Management of Late and Long Term effects – Satisfied to Very Satisfied: 96% What our patients said: • “Well presented & very informative” • “A class act” • “I learned a lot” 21
  21. 21. Health Care Provider Feedback “The WBCP has already demonstrated benefit to our patients by reassuring them that the Cancer Centre has a plan for followup and other survivorship issues, and will be educating both the patient and Primary Care Provider on these goals” - Dr. Tim Asmis, GI Medical Oncologist, TOHCP 22
  22. 22. Lessons Learned Consider incentives • Confidence in follow-up care • Appropriate use of expertise and skills  oncologists focus on new consults and patients on active treatment • Timing – wait time strategies • Access to evaluation data such as incidence of late and long term effects • Introduction of new clinical role – NP • Regional partnership enhancement –key stakeholder engagement • Research opportunities 23
  23. 23. Lessons Learned Recognize disincentives/barriers • Inadequate funding models • Sustainability • Lack of confidence in other care providers • Piloted a new process mapping tool • Oncologists desire to see patients doing well; balance of well patients and those requiring more intensive care • Patient reluctance to be discharged based on culture of long term follow-up in cancer program • Lack of regional integrated electronic patient record Keep the momentum! • Build sustainability into your plan! – Explore funding opportunities – Engage interested opinion leaders actively into the process 24
  24. 24. Key References Howell D, Hack T, Oliver TK, Chulak T, Mayo S, Aubin M, Chasen M, Earle C, Friedman A, Green E, Jones G, Jones JM, Parkinson M, Payeur N, Sinclair S, Sabiston CM, Tompson M. (2010). Pan-Canadian Guidance on Psychosocial and Supportive Care Services and Clinical Practices for Adult Cancer Survivors, Toronto: Canadian Partnership Against Cancer (Cancer Journey Advisory Group) and the Canadian Association of Psychosocial Oncology, Dec 2010. Environmental Scan of Cancer Survivorship in Canada: Conceptualization, Practice and Research (2008). BC Cancer Agency for the Canadian Partnership Against Cancer htm Canadian Invitational Cancer Survivorship Workshop: Creating an Agenda for Cancer Survivorship (2008). Canadian Partnership Against Cancer orship_0308_Final_E.pdf From Cancer Patient to Cancer Survivor: Lost in Transition (2005). Institute of Medicine and National Research Council of the National Academy 25
  25. 25. Thank you! 26