By Stephanie Downton, MSN, NP-C, OCN

1. Cancer Survivorship Visit
Putting It Together In One Visit
June 10, 2016

2. Who am I ?
Stephanie Downton, MSN, NP-C, OCN
Eskenazi Health
Center of Excellence: Breast Care Clinic
Breast Surgical Oncology, High Risk Breast Cancer,
Benign Breast Disease
Breast Cancer Survivorship Care Program
Member: Midwest Consortium for Cancer Survivorship
Breast Cancer Survivor
Mom

4. What Does A Typical Breast Cancer
Survivorship Visit Look Like?

5. But Wait…

6. When is a cancer pa,ent a cancer “survivor?”
• At diagnosis?
• A7er ac,ve treatment?
Photo credit: Hope, Love, Thrive
h?p://hopelovethrive.com/hopelovethrive/?p=615

7. Show of Hands:
When is a cancer pa7ent a cancer “survivor?”
A. At the 7me of a cancer diagnosis
B. Upon comple7on of all short and long-term treatments
C. Upon the comple7on of ac7ve treatment with cura7ve
intent (not including long-term hormonal therapies)
D. It just depends

8. When is a cancer pa,ent a cancer “survivor?”
A. At the ,me of a cancer diagnosis
B. Upon comple,on of all short and long-term treatments
C. Upon the comple,on of ac,ve treatment with cura,ve
intent (not including long-term hormonal therapies)
D. It just depends
But don’t worry…there are some general rules,
and those are what I follow when providing the
SV and SCP.

9. Most agree one is a cancer survivor
at the time of diagnosis.
“The phrase ‘cancer survivorship’ was created to
describe [a] broad experience on the cancer
con,nuum — living with, through, and beyond a
cancer diagnosis.”
National Coalition for Cancer Survivorship (NCCS, 2014). Defining Cancer Survivorship. Retrieved
from http://www.canceradvocacy.org/news/defining-cancer-survivorship/

10. We have established who is
considered a cancer survivor, but
when do survivors receive their
SCP and SV?

11. Who Gets SVs? And When?:
IOM Recommendations

12. The CoC & The Survivorship Center: Two among many…
Upon comple,on of ac,ve treatment ; most experts agree
SCPs should be provided a7er the conclusion of ac,ve
treatment.
• Commission on Cancer [CoC] 2012, Standard 3.3 Survivorship
Care Plan: “…focused on the subset of survivors who are
treated with cura,ve intent, and have completed ac,ve
therapy (other than long-term hormonal therapy).”
• The Na,onal Cancer Survivorship Resource Center’s (The
Survivorship Center) Clinical Survivorship Care Overview: “The
workgroup …recommends that the provision of survivorship
care plans for each survivor transi,oning to the post-treatment
period become a rou,ne aspect of clinical oncology prac,ce. “
American College of Surgeons (2014). Accreditation committee clarifications for Standard 3.3
survivorship care plan. Retrieved from
https://www.facs.org/publications/newsletters/coc-source/special-source/standard33
National Cancer Survivorship Resource Center (n.d.). Systems Policy and practice: Clinical
survivorship care: Expert panel summit workgroup overview. Retrieved from
http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-031408.pdf

13. At Eskenazi Health:
• The individual who has completed active
treatment with curative intent and is without
clinical evidence of disease
• 3 months post-treatment – Initial SV
• Routine follow-up intervals
• All follow-up after a predetermined duration
of time
• Alternating visits with MD/NP
• Risk stratification

14. Survivorship Visit (SV) Structure
• Guidelines for SV Content: ASCO, ACS, NCCN,
Others
• 90 minutes – Initial SV
• History & Physical
• Breast Cancer Survivor Symptom Assessment
• Review Personalized Survivorship Care Plan (SCP)
• Time for Questions
• 30 minutes – Follow-Up SV
• History & Physical
• Symptom Assessment/Follow-up on goals
• Time for Questions

15. History & Physical
Same H&P done at routine follow-up visits.
Special attention directed to:
1. Late and long-term effects of cancer and its
treatment and
2. Surveillance for disease recurrence (physical
exam, imaging, lab work).

16. Symptom Assessment
• Breast Cancer Survivor Symptom Assessment Tool
• Evidence-based
• 15 most commonly reported symptoms/concerns
• Completed by patient after H&P
• Same tool used at follow-up SVs to evaluate progress
toward goals/improved quality of life

18. Reviewing the SCP; Health Promotion
• Cancer Screenings, lifestyle modification, living
healthy, preventive care, symptoms of
recurrence
• Techniques from Motivational Interviewing (MI)
• Evidence-based approach
• Involve the survivor, identify survivor’s
priorities, trust-building
• Identify possible areas of change (based on
H&P, symptom assessment, and/or patient
values, desire to make changes.)
• Create a plan; keeping the survivor engaged
• Small, practical steps to implement changes
• American Cancer Society (ACS)/American Society of
Clinical Oncology (ASCO) 2015 guidelines

22. Thank you for your attention!
Questions?

23. Resources
American Cancer Society/American Society of Clinical Oncology (2015). American Cancer Society/American
Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. Retrieved from
h?p://onlinelibrary.wiley.com/doi/10.3322/caac.21319/epdf
American College of Surgeons (2014). Accreditation committee clarifications for
Standard 3.3 survivorship care plan. Retrieved from
https://www.facs.org/publications/newsletters/coc-source/special-source/
standard33
Levensky, E.R., Forcehimes, A., O’Donohue, W.T., Beitz, K. (2007). Motivational
interviewing: An evidence-based approach to counseling helps patients follow
treatment recommendations. Am J Nurs Oct;107(10);50-58.
National Cancer Survivorship Resource Center (n.d.). Systems Policy and practice:
Clinical survivorship care: Expert panel summit workgroup overview. Retrieved
from
http://www.cancer.org/acs/groups/content/@editorial/documents/document/
acspc-031408.pdf
National Coalition for Cancer Survivorship (2014). Defining Cancer Survivorship.
Retrieved from
http://www.canceradvocacy.org/news/defining-cancer-survivorship/