In this special profile in our ongoing series on survivorship care, Charles Shapiro, MD, Chair-Elect of the Survivorship Committee of the American Society of Clinical Oncology, talks about the next steps needed to improve survivorship care for cancer patients.
He is Professor of Medical Oncology and Director of Breast Medical Oncology at The Ohio State University Comprehensive Cancer Center—Arthur G. James Cancer Hospital and Richard J. Solve Institute and directs the Breast Cancer Research Program at the Wexner Medical Center there. His term as Chair of ASCO's Survivorship Committee will begin at the Annual Meeting in June.
He was Co-chair of ASCO's task force on survivorship guidelines and is a member of the Breast and Health Outcomes Committees of the Alliance for Clinical Trials in Oncology as well as the National Cancer Institute's Symptom Management and Health-Related Quality of Life Steering Committee.
How would you describe the current state of survivorship care for cancer patients—and the gaps in that care?
“We're making progress, but we have a substantial way to go to really integrate survivorship care into mainstream cancer care—instead of just as an afterthought. There is increasing recognition that survivorship is important, but we're still in transition away from solely focusing on treatment—both in terms of the survivors themselves and the physicians who treat them.
“People are in flux about the best model to deliver survivorship care, the best way to implement treatment summaries and survivorship care plans, and what the educational needs are. We need to find the best way to educate primary care doctors about survivorship needs. There's resistance too from some patients about transitioning out of oncology care because often they've been educated by us to depend solely on the oncology team.”
What makes integrating survivorship care into standard cancer care so challenging?
“The increasing population of survivors—who's going to take care of them? A good portion of them will be elderly—it takes a certain skill set to treat elderly patients as opposed to younger patients. And these patients have special needs because of their elderly age and their functional decline. What are the best practices for them?
“Plus, there's going to be a shortage of oncologists in the next 25 years, as well as a shortage of primary care providers. That means that mid-level providers—physician assistants, nurse practitioners—will more and more be the ones delivering survivorship care.
“Mid-levels can provide the care, which can be easily learned, but awareness is key. Awareness is half the battle: awareness of what is likely to occur as a result of treatments, what the appropriate screening tests are, and—importantly—what interventions work to treat or prevent treatment-related side effects.”
So what are the next steps to overcoming those challenges to improve survivorship care?
“We need to define the essential elements of survivorship care—a common denominator. I think if you asked 10 different people now, you would get 10 different answers. We're just beginning to think about this, but it's important now for everyone to be thinking about survivorship from the get-go—what is most feasible and most effective.
“Another important point is that we need to think about the community practice oncologists and the community practice primary care providers dealing with cancer patients, because most patients are treated in the community rather than in cancer centers. We need to design and test interventions that are feasible, simple, and cost effective not just in larger cancer centers, but in the community practices, too.
“And just as understanding in molecular tumor biology, genomic profiling, and targeted therapy is increasing, we need to apply more scientific research to survivorship care. We need to keep pace and find out more about polymorphisms, genetic profiles, pharmacogenomics, and genetics—because they can be important factors in predicting toxicities or predicting benefits from interventions. The biology is relevant to show who develops what side effect.”
What is the role for ASCO and the Survivorship Committee in making these changes?
“A particular focus is education: identifying the critical gaps in knowledge, which extends to primary care providers, oncologists, and patients, and whenever possible making that information easily accessible. In the ACSO Survivorship Committee, focused sub-committees are defining the essential elements of treatment summaries and survivorship care plans; developing a ‘Tool Box’ of survivorship resources; and developing and producing guidelines for common treatment related side-effects and education.
“One of the products we hope to create is an education curriculum of the essential elements that oncologists and primary care providers need to know about survivorship care. There's a fair amount of educational material already available, but it's not collected in one place in an accessible way.”
Earlier articles in this continuing series explored other key issues on survivorship care:
- Delivery models and care plans (9/10/12 issue),
- The nurse's role on the care team (10/10/12 Nursing Hem/Onc Spotlight),
- The persistent psychological effects survivors face (11/10/12 issue),
- The overlooked late effects of breast cancer survivors (4/10/13 issue), and
- How to keep survivors of childhood and AYA cancers in follow-up care (9/25/13 issue).
The award-winning series is also posted in this Collection on the OT website: http://bit.ly/OT-SurvivorshipSeries-SarahDiGiulio.