New ASCO Committee Works to Improve Survivor Care

Jun 01, 2011

Twelve million people in the United States are a living testament to the compassionate care of their physicians and nurses and the astonishing advances in oncology research—they are cancer survivors. It is the wish of every ASCO member to see this number continue to increase. In order to help oncologists and other medical professionals provide the best care to meet the specific needs of survivors, the Society has convened a new Cancer Survivorship Committee. The committee will provide leadership and oversight of ASCO’s survivorship activities, work with appropriate committees and groups to enhance the quality and quantity of cancer survivorship efforts, and provide leadership in joint efforts with other societies.ASCO has been active in survivorship for several years (see timeline below), and the new committee will ensure that survivorship issues remain a focus and that efforts are not duplicated or diluted among ASCO’s other priorities.

“I hope that our committee can help address some of the issues facing survivors, inform the clinical management of survivors in the absence of high-quality evidence to direct their care, and work to improve awareness among providers, particularly community providers who are not oncologists, about the health issues that survivors face,” said Melissa M. Hudson, MD, of St. Jude Children’s Research Hospital and Chair of the committee. “I also hope that our efforts can impact legislation that facilitates appropriate reimbursement to oncologists delivering survivorship care.”

The Cancer Survivorship Committee held its first meeting in February 2011 and developed four primary goals for the next year:
  • Codify the best practices of clinical management of cancer survivors and provide guidelines; Collaborate with pediatric and medical oncology cooperative groups to establish and collect uniform minimum sets of data related to survivorship as patients are entering protocols;
  • Examine models of survivorship care and consider how to best transition and share care between oncology practices and primary care providers; and
  • Improve the utility and uptake of treatment plans and treatment summaries to help transition survivorship information between providers.
Health care issues

Although each cancer survivor is unique, many face serious health care issues. In addition to the risk of progressive or recurrent disease, cancer survivors are at increased risk for other conditions, including diabetes, cardiovascular disease, osteoporosis, and decreased functional status; it is critical that survivors receive risk assessment and prevention services.

Survivorship care has been a consistent part of pediatric cancer care for more than two decades for several reasons: the high rates of survival of pediatric cancers, the likelihood that a pediatric patient will be treated in a multidisciplinary center with onsite services, and a reasonably rich research literature examining the late effects of treatment for common childhood cancers. Survivorship care for adult cancers, however, is not yet consistently applied.

“Most adult cancer survivors are treated in the community, and a practice simply may not have the resources to follow most survivors and provide recommendations for screening. We don’t know the best model of care—who to transition from the oncologist or academic center to the primary care physician, when that transition should happen, or what information is needed to make that transition happen,” said Kevin C. Oeffinger, MD, of Memorial Sloan-Kettering Cancer Center and a member of the committee.

Dr. Oeffinger, who will lead the committee’s efforts related to survivorship care models, expects that several different models will emerge as successful, depending on practice resources and patient needs. “There are different models that are applicable based on the resources available in that center or office, the medical infrastructure around that particular survivor, and the patient’s level of risk. There won’t be one ideal model for all situations,” he said.

Best practices

A knowledge gap has resulted in relatively few evidence-based guidelines to direct the screening and treatment of adult cancer survivors. “We need to give the same level of attention to our adult cancer survivors as we have to our pediatric cancer survivors—we need to know what the morbidity burden is and how it relates to the treatments they received, the comorbidities they experienced, their physiologic condition, their genetic makeup, etc.,” said Smita Bhatia, MD, of City of Hope National Medical Center, who will lead committee efforts to examine best practices for clinical management.

“If you were to do a survey of the entire country, you would find that there are pockets of excellence where good, state-of-the-art care is being provided to adult cancer survivors. What we want to do is glean from them what works and what doesn’t,” she said. “We need to know who the patients at the highest risk are, so we can develop recommendations for best practices, such as offering alternative treatments or instituting high levels of surveillance.”

The committee is hopeful that their efforts will result in improved care and better quality of life for all survivors. “For many cancers, our patients will die of something other than their cancer because of the excellent lifesaving therapy that they receive,” Dr. Oeffinger said. “Our ultimate goal is to maximize the livelihood of our survivors in the short- and the long term.”

ASCO thanks the following survivorship experts for volunteering to serve on the Cancer Survivorship Committee:

Melissa M. Hudson, MD—Chair
Smita Bhatia, MD, MPH
Diane Blum, MSW
Susan G. Braun
Susan Lerner Cohn, MD
Wendy Demark-Wahnefried
Patricia A. Ganz, MD
Eva Grunfeld, MD, PhD
Wendy S.Harpham, MD
Aparna C. Jotwani, MD
Larissa A. Korde, MD
Mary S. McCabe, RN, MA
Kevin C. Oeffinger, MD
Ann Hart Partridge, MD
Eliezer Robinson, MD
Leslie L. Robison, PhD
Maria Alma Rodriguez, MD
Julia Rowland, MD
Thomas P. Sellers, MPA
James R. Waisman, MD
Ex officio: Michael P. Link, MD—ASCO President

ASCO Cancer Survivorship Initiatives

2004: ASCO Survivorship Task Force is established to address the growing issues related to cancer survivorship; ASCO holds survivorship-focused Meet the Expert media event in New York to highlight progress against cancer and cancer survivorship

2005: ASCO, Institute of Medicine, and National Coalition for Cancer Survivorship cosponsor Symposium on Cancer Survivorship to chart a course for the care of cancer survivors

2006: Patient and Survivor Care Track established as part of the ASCO Annual Meeting program; Journal of Clinical Oncology (JCO) and Journal of Oncology Practice (JOP) publish special issues dedicated to survivorship; ASCO Guideline on Fertility Preservation in People Treated for Cancer published in JCO

Cancer.Net adds section on Survivorship: Next Steps to Take, with resources for patients who have completed active treatment

JCO publishes special issue on pediatric cancer survivorship; ASCO supports the introduction of three bills intended to improve/expand care for survivors of childhood cancers (HR 2109), to establish a new Medicare service for care planning (HR 1844), and to establish quality metrics and align payment incentives in the areas of treatment planning/follow-up care (HR 2872)

2010: ASCO Board formally approves establishment of a committee dedicated to survivorship

2011: ASCO Cancer Survivorship Committee created
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