Survivorship Tool Generates Effective Care Plans

Tailored care plans may offer head and neck cancer survivors more information focused on care after treatment to address late-term side effects, according to findings presented at the 2018 Cancer Survivorship Symposium.

Researchers from Hartford Hospital and Memorial Sloan Kettering (MSK) Cancer Center were interested in whether survivorship care plans (SCPs) for patients with head and neck cancer were acceptable and useful.

"Head and neck cancer survivors can be symptomatic with a lot of concern that affect their eating, speaking, breathing, body image and other issues," senior author Talya Salz, PhD, who is an assistant attending outcomes research scientist at MSK, said in an interview with CURE^© magazine, a sister publication of Oncology Nursing News^©. "Even these symptomatic patients—mainly who are elderly—are willing to use a computer interface to report their symptoms before a routine survivorship visit."

They developed a tool that not only helped assess these factors, but generated SCPs themselves, which consist of documents that summarize a person’s cancer diagnosis and treatment and outline an ongoing plan of care for survivors. The platform, called the Head and Neck Survivorship Tool: Assessments and Recommendations (HN-STAR), was designed based on guidelines issued by the American Cancer Society and endorsed by ASCO.

Survivors were asked to enter side effects into a computer—either in the waiting room or at home—and then a nurse separately entered treatment details.

Survivors reported on 22 late-term side effects prior to routine clinic visits. The most common were dry mouth (70%), neck or shoulder stiffness (65%), fatigue (65%), and insomnia (56%). Based on the information entered into the computer system, HN-STAR created an SCP to include a treatment summary, wellness recommendations and management of side effects. A nurse could then discuss the best plan of action with the survivor.

The surveys were completed by 47 survivors, made up of mostly white men who had an oropharynx tumor. The majority (81%) of survivors had received multimodality therapy and 51% had experienced at least 9 of the 22 late-term side effects in the month leading up to the survey.

Ninety-one percent of survivors found the SCP easy to follow and nearly all (98%) said they intended to follow the recommendations for side effect management. Similarly, 98% said they would refer to the SCP. The survey also revealed that head and neck cancer survivors (87%) planned to share their SCPs with their primary care providers.

"The idea is that this can help the survivor know who to visit next and help with self-management. And, we saw that they viewed the document very favorably," said Salz.

Surveyed primary care providers (23 patients) were also in favor of tailored SCPs. The researchers determined that 95% were satisfied with the SCP and 95% said they wanted to have 1 for every cancer patient.

"We asked, 'How comfortable are you preventing, diagnosing or managing these complicated late effects?' and there was a wide variety in their comfort," said Salz. "It seems like there is room to help primary care providers learn how best to help these complex cancer survivors and that this plan might be able to help them."

The researchers hope to get funding for a multicenter trial to see how well this can be implemented in more clinics.

"This study is 1 of the first steps in 'does this work?'" said Salz. "Survivors want more information. There is poor coordination of care for survivors and we need to help people move from an acute treatment focused care to survivor focused care."