ALL THE GOOD REASONS FOR A CANCER SURVIVOR PROGRAM!

Cancer: The Newest Chronic Disease (FROM MEDSCAPE)

Hello. I'm Dr. Sandra Fryhofer. Welcome to Medicine Matters.
The topic: achieving high-quality cancer survivorship care and the American Society of Clinical Oncology's (ASCO®) new blueprint for improving care for cancer survivors, published in the Journal of Clinical Oncology.^[1] Here's why it matters.
More and more patients are living with cancer and they're living longer. Right now, more than 13.5 million people are cancer survivors. The 3 most prevalent cancers for men are prostate, colorectal, and melanoma; for women they are breast, uterine, and colorectal cancers.^[2]

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Over the next 10 years, by 2022, the number of cancer survivors is expected to increase to nearly 18 million.^[2] The Centers for Disease Control and Prevention (CDC) points out that about two thirds of people with cancer are expected to live at least 5 years after diagnosis.^[3] These are patients who have had cancer and they've survived it. They've completed cancer treatments and now need continued follow-up care for cancer and other chronic diseases. ASCO has issued a new set of recommendations to help improve this care and to keep cancer survivors from falling through the cracks. Achieving this goal will require enhanced communication and coordination of care.
First, ASCO wants cancer to be considered a chronic disease. This is because the Affordable Care Act calls for Accountable Care Organizations (ACOs) and patient-centered medical homes to promote coordinated care for chronic diseases. Calling cancer survival a chronic disease would promote patient-centered coordinated care based on shared care models and would enhance collaboration.

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Next: Cancer: The Newest Chronic Disease

Cancer: The Newest Chronic Disease

Every patient needs a plan. In 2005, the Institute of Medicine championed the development of a treatment summary and survivorship care plan as a focal point of care coordination.^[4] ASCO agrees and has even provided online templates to facilitate development of these care plans. Communication plays a key role. The treatment summary includes the type of cancer, interventions and treatment details, as well as a plan for ongoing surveillance. Executing this plan requires collaboration: a partnership between the primary care physician and the oncologist. After all, oncologists know cancer best but primary care physicians are usually more familiar with preventive and routine health monitoring. Psychosocial consequences must also be addressed.
Some cancer treatments exacerbate or may increase risk for other chronic conditions, including heart disease and osteoporosis. Educational materials for providers are also available at www.cancer.net and www.survivorshipguidelines.org.
That's not all. Clinical guidelines on the best ways to address long-term and late effects of treatments, as well as guidelines on secondary and recurrent cancer surveillance, are needed. Patients also need to be onboard and can help facilitate care coordination. The first step may be supporting and empowering patients to say, "I want a plan to keep me healthy."
Enhanced coordination services take time and resources and must be recognized in Medicare payment reform plans. However, the ASCO report recognizes that healthcare costs are spiraling and that a more parsimonious approach is needed. ASCO also supports development and implementation of quality measures for survivor care.
In summary, ASCO's recommendations for achieving high-quality cancer survivorship care come under 6 major headings:

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• Clinical guidance;
• Models of care;
• Assuring high-quality care;
• Provider education;
• Education for cancer survivors and their families; and
• Research and both policy and advocacy initiatives.

[The last point is] necessary to make it all happen. For more information, read the full report for all the details.^[1]
For Medicine Matters, I'm Dr. Sandra Fryhofer.