Rosenthal, Eric T.
Less than seven months before the American College of Surgeons' Commission on Cancer's (CoC) survivorship care plan is scheduled to become a requirement for certification of some 1,500 member cancer centers and hospitals across the country, OT has learned that both the CoC and American Society of Clinical Oncology are revisiting the requirement since many institutions have been having trouble complying.
In 2012 the Commission on Cancer issued three to-be-phased-in patient-centered standards that had to be instituted by January 1, 2015 for accreditation.
According to CoC officials, members have been making headway on the patient navigation and psychosocial-distress management mandates, but have been less successful getting ready to implement meaningful survivorship care plans.
A recent study in the Journal of Clinical Oncology found that despite the nine-year-old recommendation by the Institute of Medicine that cancer patients completing primary treatment receive a survivorship care plan, only about five percent of oncologists are actually providing them (OT 5/25/14 issue).
That prompted me to contact Daniel P. McKellar, MD, CoC Chair, to see whether he would be available to meet at this year's ASCO Annual Meeting to discuss progress to date with compliance. We arranged to meet at the Commission's Chicago-based headquarters, along with M. Asa Carter, CTR, Manager of Accreditation and Standards for CoC's Division of Research and Optimal Patient Care; and Erica J. McNamara, MPH, National Cancer Database Information Analyst.
Late last summer the CoC surveyed 1,390 of its member programs on their readiness to implement the three Continuum of Care Standards (Numbers 3.1-3.3), as well as the perceived barriers for implementation and the preferred outlets for accessing resources to aid programs in implementing these standards.
The surveys were sent to registrars and psychosocial representatives at each CoC program. In addition to the CoC, survey sponsors included the LIVESTRONG Foundation, American Cancer Society, Cancer Support Community, and National Coalition for Cancer Survivorship. About half of those receiving the survey responded, with 71 percent representing community-based programs.
Regarding standard 3.1, the Patient Navigation Process, 54 percent of respondents reported they are addressing the entire standard that deals with health care disparities and barriers to care.
More than 58 percent of the programs said they are fully addressing Standard 3.2, which involves developing and implementing a process to integrate and monitor on-site psychosocial screening and referral.
However, only 40 percent of CoC programs thought they would be able to meet Standard 3.3, which requires an institution's cancer committee to develop and implement a process for disseminating a comprehensive care summary and follow-up plan to cancer patients completing treatment.
During the discussion at CoC headquarters, CoC staff summarized these results as: [Member institutions were doing] “well with navigation, better with psychosocial distress, but were really struggling with survivorship care plans.”
They explained that centers were complaining about the amount of work needed to meet the standard in a meaningful way, and Carter added that there were also complications because of varying institutional definitions of when cancer survivorship begins.
Concerns were also voiced by centers that although reimbursement was available for a patient visit related to a survivorship plan, no payment was made for the time required to put the information into the system.
“The available tools haven't quite met up with the standards,” said McKellar, who is also Director of the Cancer Program at Wayne HealthCare in Greenville, Ohio. “You have to earn accreditation, you can't just buy it,” he added.
McNamara noted that institutions can build a survivorship care plan from cancer registries or electronic medical records, and can use the American College of Surgeons' Rapid Quality Reporting System (RQRS), a data quality tool available to CoC-accredited cancer programs.
There is currently a LIVESTRONG Care Plan pilot project under way at both the University of Pennsylvania's Abramson Cancer Center and Baptist Memorial Hospital in Memphis to create a program for instituting survivorship plans, according to the CoC. Lawrence N. Shulman, MD, Chair of CoC's Quality Integration Committee, is serving as an advisor.
The Penn team—led by James Metz, MD, Editor-in-Chief of OncoLink, and Linda A. Jacobs, PhD, RN, Director of Abramson's LIVESTRONG Survivorship Center of Excellence Living Well After Cancer Program—will, among other things, translate cancer registry codes into information that patients can easily understand.
Baptist Memorial's role is to generate electronic information through cancer registry data and electronic medical records. The principal investigator is Stephen B. Edge, MD, Director of Baptist's Cancer Center, and Immediate Past-chair of the CoC. Edge began the work when he was at Roswell Park Cancer Institute.
The CoC team would not say whether the survivorship care plan deadline might be extended, as had happened with the rollout of the Affordable Care Act.
However, when I followed up with Shulman by telephone at Dana-Farber Cancer Institute—where he is Chief of Staff, Senior Vice President for Medical Affairs, and Director of Regional Strategy Development and Director of the Center for Global Medicine—he said that ASCO and the CoC had just decided to reevaluate the survivorship care plan standards.
Shulman, who had previously chaired ASCO's Quality Committee, and been involved in a survivorship summit convened by the Society last fall, said that with recent concerns about what “can be and should be done” regarding implementing the standards by the January 1 deadline, ASCO had created an ad hoc committee with representatives from both its Quality and Survivorship committees to better define the survivorship standards.
“They are not as clearly defined as they could be to give hospitals guidance, and ASCO felt that it needed to go back to the drawing board for recommendations that will be feasible in the context of practice and of value to patients,” he said.
He said that the CoC would review ASCO's recommendations before making any further decisions.
First in a series of articles about the implementation of the Commission on Cancer's Survivorship Care Plan standard.