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Cancer Survivorship: Optimizing Care and Outcomes through Continuing Medical Education

Jan 05, 2015

By Larissa Nekhlyudov, MD, MPH, and Ann Partridge, MD, MPH, Dana-Farber Cancer Institute, Harvard Medical School

 Larissa Nekhlyudov,
 Ann Partridge,

Traditional approaches to caring for cancer survivors have focused primarily on surveillance for recurrence. In recent years, sparked by the 2006 Institute of Medicine report, this focus has expanded to include health promotion, prevention, and surveillance to reduce the risk of second cancers, and management of cancer treatment–related late and long-term effects.

The care of cancer survivors brings together oncology specialists and primary care and other specialty providers with the goal of creating a coordinated effort focused on the survivor's long-term health. However, such care requires that all providers become knowledgeable about specific aspects of cancer survivorship care, stay updated on the latest advances, and work collaboratively to provide patients with coordinated, comprehensive care.

In November 2014, we conducted a Dana-Farber/Harvard Medical School Continuing Medical Education conference aimed at educating providers who care for cancer survivors. We focused the educational agenda on the medical and psychosocial aspects of cancer survivorship, the latest research regarding prevention and management, and strategies for implementation in clinical practice to enhance individual provider’s and/or practice's ability to provide high-quality care for cancer survivors.

Learning 0bjectives

The learning objects of this conference included the following:

  1. Review the trends in cancer survivorship and the role of providers after initial cancer treatment;
  2. Recognize and determine the medical and psychosocial needs of cancer survivors;
  3. Analyze the long-term sequalae of cancer treatment;
  4. Evaluate the evidence and incorporate consensus-based optimal strategies for surveillance for recurrences and secondary malignancies, including germline genetic risk; and
  5. Apply the skills and tools to enhance delivery of care and coordination of care for cancer survivors.

The course was organized into the following sections: disease recurrence and new primary cancer, late effects of cancer and cancer treatment, and psychosocial concerns after cancer.

Speakers addressed specific subtopics within each section, combining their own clinical and research experience. Each talk included pre- and post-audience response system questions, ensuring that learning improvement had occurred. Interactive panel discussions concluding each section focused on cases involving various treatments, therapies, stages of cancer, symptoms, and long-term late-effect management, providing the audience more insights regarding optimal care of specific kinds of cancer survivors.

Of the approximately 140 participants, the majority of attendees came from local New England states, although other regions of the U.S. were represented, and almost 10% were from outside countries. The attendees included physicians and nurse practitioners (in the fields of primary care, oncology, surgery, and radiation oncology), nurses, and social workers, among others.

   Planning Continuing Medical Programs in Cancer Survivorship 
  1. Develop clear objectives for the course and organize sessions accordingly.
  2. Review slides in advance to make sure consistent with content, not duplicative, and potentially too long.
  3. Choose speakers with solid presentation skills, research/clinical expertise alone may not be optimal.
  4. Consider depth versus breath of content under time constraints.
  5. Use pre- post-lecture questions to assess learning, but make content consistent with the questions.
  6. Panel discussion of cases may offer a broad based discussion of medical, psychosocial, and logistical issues.
  7. Consider adding resources/references for topics not covered.
  8. Handouts in printed form and electronic format may be preferred.
  9. Videotaping may be used, but need to consider speaker preferences and discussion of specific patient cases.
  10. Practice makes perfect. Assess, learn and do it again.

The course received high ratings for up-to-date, evidence-based content, and most of the talks were given scores above four (out of five) for quality and relevance to practice. However, some commented on the complexity of certain material, deeming it “too technical” at times. And when asked if the educational activity did not meet expectations, people stated that they wanted to “learn more about how to implement survivorship programs.” Others suggested topics included additional focus on oncology rehabilitation, pain and symptom management, and community outreach.

The format of the course received positive responses; though, because it was only a two-day course with more than 20 topics, participants reported that the amount of time allocated to each talk was not sufficient enough. One attendee suggested that this could have been solved by having “fewer sessions or a choice of sessions that were longer.”The course received positive reviews overall from faculty and participants. Specifically, the attendees reported that the topics were “engaging” and the material was “clear and to the point.”

Nonetheless, there was a great deal to take away from the course. When asked, “Will you make clinical, teaching, research, or administrative changes as a result of taking this course,” a staggering 93% of participants answered “yes.” Audience members reported that they better understood “the challenges that survivors face more fully and can ask more guided questions to patients.” More specifically, participants “were inspired” to look into starting cancer survivorship programs in their own fields of practice.

As the field of cancer survivorship continues to grow, there is a need for expansion of continuing medical education programs. While our course is certainly one of several recently organized, we wanted to share our observations and lessons learned. We hope that these are helpful to others as they plan future programs.

Dr. Larissa Nekhlyudov is a General Internist at Harvard Vanguard Medical Associates and Clinical Director, Internal Medicine for Cancer Survivors at the David B. Perini Quality of Life Clinic at the Dana-Farber Cancer Institute in Boston MA. She is an Associate Professor at Harvard Medical School.

Dr. Ann Partridge is Director of the Adult Survivorship Program at Dana-Farber/Brigham and Women’s Cancer Center and Associate Professor of Medicine at Harvard Medical School.

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