Feature article

Improving Cancer Survivorship Programs for Better Post-Treatment Outcomes

How strategic planning and advanced technologies can help improve patient adherence among survivors

As more breast cancer patients survive their disease thanks to innovative technologies, surgical procedures, and therapeutics, they’re not following through with one of the best ways to protect against cancer recurrence. According to a report in the Journal of the National Comprehensive Cancer Network (JNCCC), only one in two breast cancer survivors underwent annual mammography screenings within five years after their surgery.1

A need for survivor support

Those rates are in stark contrast to the National Comprehensive Cancer Network Guidelines®2, which recommend annual mammograms for breast cancer survivors to detect recurrence. Breast cancer survivors who don’t undergo recommended screenings risk undetected recurrence along with an absence of post-surgery baseline scans, the American Cancer Society (ACS) notes.3

Such adherence gaps point to the need for additional support and encouragement for patients. To bridge that gap, survivorship care must be expanded and providers should vigilantly follow-up with their patients.1

The patient, provider, and racial challenges of streamlining care

By 2026, the number of American cancer survivors will reach more than 20 million, with more than 3.5 million of them breast cancer patients.4 To accommodate them, the implementation of survivorship care is only half of the puzzle.

According to a survivorship program development guide in the Clinical Journal of Oncology Nursing, for those programs to meet their aims, they need to be backed by strategy, institutional support, and structured documentation, which suggested the following traits for any well-rounded survivorship care plan:

  • Record, track, and support patients with their unique goals;
  • Educate survivors about recurrence identifiers, post-treatment guidance, healthy lifestyles, and patient empowerment;
  • Involve providers across disciplines, including nurses, administrative coordinators, oncologists, and social workers;
  • Encourage patients to continue seeing their primary care doctors, even after their participation in the survivorship program is over;
  • Efficiently document pathways as patients transition from treatment to survival to streamline contact between providers and build a connected ecosystem of care.5

However, building those strategic traits into survivorship programs also comes with a fair amount of barriers. In one study from the Journal of Cancer Education, survey respondents reported myriad challenges that thwarted their good intentions related to systemic survivorship care. Among them are:

  • Limited time, money, and personnel;
  • Inadequate training for survivorship providers;
  • An absence of technology and systems to track and coordinate survivorship care.6

The American Society of Clinical Oncology (ASCO) echoed those same barriers, adding that patient adherence and compliance adds another dimension to the problem that can compound those difficulties. For example, ASCO pointed to the tendency for patients to fear recurrence, wanting to keep their diagnosis in the past, and not understanding the importance of follow-up care.7

On top of that lies another central challenge to success with survivorship program design—serving minority communities. In the JNCCC paper, for example, researchers found that African American survivors underwent breast screenings at lower rates than their Caucasian counterparts. With that finding, authors noted that such racial disparities could be a reason for higher death rates in those populations of breast cancer patients.1

Efficient, comprehensive solutions to meet survivors’ needs

Solving those many challenges requires a multi-faceted approach, which, according to ASCO’s recommendations, leans on patient-centered, systemically coordinated care. That approach blends the power of technological efficiency with compassionate care for the following potential solutions:

  • Upfront and early communication with survivors and family members about survivorship, recurrence, expectations, and follow-up;
  • Coordinated training to ensure providers feel confident in their participation of survivorship activities and communications;
  • Outreach programs and satellite clinics to serve remote and minority communities;
  • Integrated recordkeeping and provider communication through electronic health records (EHRs), patient portals, and digitized care plans.7

Innovative, connected technology makes it possible

With the wealth of data involved as a patient transitions from treatment to survival, systems that keep track of it all become essential — not only to help patients take part in their own post-treatment care, but to connect inpatient and outpatient providers. That way, everyone can quickly communicate each patient’s individual workup as efficiently as possible.

On the EHR side, workflow systems like Centricity can do just that — transitioning images, records, reporting, and surveillance from provider to provider regardless of their location without the need for duplication or re-entry. Such dashboard technology could bridge much of the burdens of lost information and survivorship documentation linked with the success or failure of survivorship programs.8

Ensuring a more comfortable mammogram experience should be paramount for all providers in order to encourage follow-up compliance. That’s why new, innovative mammography technologies, such as the Pristina Mammography System, designed in part by patients themselves, have helped reshape the mammography experience.

Thanks to modernized lighting, ergonomic features, and soft-curved surfaces, the newer imaging systems represent a significant upgrade to the older machines that can be bulky and intimidating; they also offer improved diagnostic accuracy.9

Supporting the survivorship journey

Given the fact that most cases of breast cancer recurrence happen within five years after diagnosis,10 and that only one in two of those patients are getting annual mammograms within that timeframe,simply stepping up follow-up vigilance in the five-years after survival could lead to better outcomes. 

Though these many solutions combined may not lead to complete survivor compliance with follow-up care, they can give providers and healthcare systems more tools to support and encourage patients throughout their survivorship journey.

References:

  1. Adherence to Guidelines for Breast Surveillance in Breast Cancer Survivors. Journal of the National Comprehensive Cancer Network. http://www.jnccn.org/content/16/5/526.full?sid=e44bc069-65de-435c-8ece-c7937336bc8a. Accessed September 5, 2018.
  2. NCCN Guidelines® & Clinical Resources. National Comprehensive Cancer Network. https://www.nccn.org/professionals/default.aspx. Accessed September 5, 2018.
  3. Having a Mammogram After You’ve Had Breast Cancer Surgery. American Cancer Society. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/having-a-mammogram-after-youve-had-breast-cancer-surgery.html. Accessed September 5, 2018.  
  4. Cancer Survivors: A Growing Population. American Cancer Society. http://pressroom.cancer.org/SurvivorshipStats2016. Accessed September 5, 2018.
  5. Development of a Survivorship Program. Clinical Journal of Oncology Nursing. https://cjon.ons.org/file/8296/download. Accessed September 5, 2018.  
  6. Survivorship Care Plans: Prevalence and Barriers to Use. Journal of Cancer Education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665729/. Accessed September 5, 2018.
  7. Challenges to Implementing a Survivorship Program. American Society of Clinical Oncology. https://www.asco.org/practice-guidelines/cancer-care-initiatives/prevention-survivorship/survivorship/survivorship-4. Accessed September 5, 2018.  
  8. Centricity – Healthcare IT. GE Healthcare. http://www3.gehealthcare.com/en/products/categories/healthcare_it. Accessed September 5, 2018.
  9. Senographe Pristina Mammography System. GE Healthcare. https://www.gehealthcare.com/products/mammography/senographe-pristina. Accessed September 5, 2018.
  10. Survival and Risk of Recurrence After Treatment. Susan G. Komen. https://ww5.komen.org/BreastCancer/SurvivalandRiskofHavingCancerReturnAfterTreatment.htm. Accessed September 5, 2018.