This document discusses cancer survivorship visits and care plans. It begins by introducing the presenter and their background in breast cancer care. It then describes what a typical survivorship visit entails, including a history and physical, symptom assessment, review of the survivorship care plan, and health promotion discussion. The document reviews guidelines around who receives survivorship care and when, focusing on providing the visit and care plan after active treatment is completed. It outlines the components and structure of the survivorship visit.

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/