Study sets national benchmark for cancer survivorship care

With the number of adult cancer survivors in the United States expected to reach 23 million by 2032, the long-term needs of this population are increasing but are often poorly understood and addressed. A new survey study of cancer care facilities accredited by the American College of Surgeons (ACS) Commission on Cancer (CoC) indicates that having survivorship standards in place helps centers provide services that meet the distinct needs of cancer survivors. However, only a minority of patients are likely to have access to such services, and some specialist services to address fertility and sexual health concerns are most lacking.

We found that most facilities actually have a reasonable number of life support services available to their patients. This is encouraging because it means we have a foundation to work from when trying to advance survivorship care. Where we have started to see differences is in the specific services available and how institutions provide them. »

David R. Freyer, DO, MS, lead study author and director of cancer survivorship programs at Children’s Hospital Los Angeles and the Norris Comprehensive Cancer Center at the University of Southern California (USC)

The study, published this week in Open JAMA Networksets a national benchmark for the delivery of survivorship care in CoC-accredited facilities, which treat more than 74% of all cancer patients across the country.

Since 2015, CoC accreditation standards have incorporated survivorship care. From 2021, centers must offer a survivorship program to adults treated for cancer with a high probability of cure. To determine the prevalence, types, and outcomes of cancer survivorship services available at accredited facilities, Dr. Freyer and USC researchers Kimberly A. Miller, PhD, MPH, and Julia Stal, PhD, collaborated with the CoC and ACS Cancer Research Program members to understand how cancer programs have implemented their survivorship services, what key challenges they have faced, and what additional resources would help them achieve their goals .

“Treatment across the cancer care continuum, including through survivorship, is paramount to helping patients achieve optimal clinical outcomes,” said Timothy Mullett, MD, MBA, FACS, chair of the CoC , co-author of the study and medical director of the Markey Cancer Center. Networks at the University of Kentucky. “We know that adult cancer survivors can develop a variety of physical and psychosocial late effects related to cancer treatment that should be treated with evidence-based care. Treatment should not stop once cancer healed.”

Main findings of the study

Of approximately 1,400 eligible programs, 384 (27.4%) CoC-accredited institutions responded to the survey. The survey represented all geographic regions and categories of CoC programs, including academic and community programs. Programs were asked to identify the services (cancer care delivery, clinical care, psychosocial services) they offered to patients at their centers.

• Value of Survivor Care Standards: A total of 335 programs (87.2%) agreed that the 2021 CoC-implemented Survival Standard 4.8 helped advance their institution’s survival programs. “The take-home message is that CoC standards work and are a very important quality indicator,” Dr Freyer said. “We believe that current and future CoC survivorship standards can provide an effective framework for advancing survivorship care at the facility level. »
• Wide spectrum of services: The services most accessible to survivors included screening for new cancers (87.5%), nutritional counseling (85.3%), and referral to specialists (84.7%). These survivorship services were generally provided by cancer treatment teams (63.3%) rather than specialized survivorship clinics (31.3%). While access to specialized survivorship clinics is more common in the pediatric cancer community, these clinics are particularly resource-intensive and the authors note that survivorship care provided directly by cancer treatment teams may be more feasible for the very large number of adult cancer survivors.
• Fertility and sexual health services are often outsourced: Survivorship services addressing sexual health (57.3%) and fertility (56.9%) were the least offered to patients, indicating the need to prioritize these areas and discuss barriers to care, such as limited insurance coverage, suboptimal access to specialists, and more training to better equip oncology providers to discuss these issues with their patients.
• Gaps in care: Programs noted that the most significant barriers preventing patients from taking advantage of survivorship services are lack of referrals to survivorship programs from treating oncologists and low patient awareness of survivorship services when available.

Understanding the landscape of these services will help identify gaps, strengths, and opportunities for intervention to improve survivorship care for the large and growing population of cancer survivors, the authors write.

“Our goal is to help institutions advance survival programs in the field,” said Dr. Freyer. “This research already demonstrates good engagement in survivorship care in CoC accredited facilities, so we’re certainly not starting from scratch. That’s the good news. The important question is: how can we leverage this and help institutions expand the services they offer, improve their quality and increase their adoption by survivors themselves?

Dr. Mullett added: “We look forward to using the results of this study, and others to follow, to improve the effectiveness of our critical survival standards. The CoC strives to ensure that all of our programs realize the value of survivorship care for our patients. “.

Co-authors of the study with Dr. Freyer and Dr. Mullett are Julia Stal, PhD; Kimberly A. Miller, PhD, MPH; Judy C. Boughey, MD, FACS; Amanda B. Francescatti, MS; Elizabeth Funk, MSW; and Heidi Nelson, MD, FACS.