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Implementing survivorship care planning in two contrasting health systems: lessons learned from a randomized controlled trial

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Abstract

Objective

Survivorship care plans (SCPs) are recommended to promote appropriate follow-up care, but implementation has been limited. We conducted a randomized controlled trial comparing three SCP delivery models in two health systems. We utilize mixed methods to compare the feasibility and participants’ perceived value of the three models.

Methods

Patients completing treatment for stage I–III breast, prostate, or colorectal cancer from one urban-academic and one rural community cancer center were randomized to (1) mailed SCP, (2) SCP delivered during an in-person survivorship visit, or (3) SCP delivered during an in-person survivorship visit plus 6-month follow-up. Clinics had flexibility in intervention implementation. Quantitative data summarize intervention fidelity and protocol deviations. Qualitative interview data provide patients’ perspectives on feasibility and intervention value.

Results

Of 475 eligible participants approached, 378 (79%) were randomized. Of 345 SCPs delivered, 265 (76.8%) were by protocol. Protocol deviations were more common at the urban-academic center. In post-study qualitative interviews, participants recalled little about the SCP document or visit(s). SCPs were valued for information and care coordination, although their static nature was limiting, and sometimes SCP information differed from that provided elsewhere. Visits were opportunities for care and reassurance, but time and distance to the clinic were barriers.

Conclusions

SCP provision was challenging. Patients were interested in SCP, but not necessarily additional survivorship visits, particularly at the urban-academic hospital.

Implications for Cancer Survivors

These findings suggest that patients value careful consideration of health care needs during the transition out of treatment; SCP documents are one element of this. For many patients, models without additional visits and dynamic SCPs may be preferred.

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Availability of data and material (data transparency)

De-identified data are available by request

Code availability

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Funding

This study was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (IHS-1409-22534). The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins receives funding from the National Cancer Institute (P30CA006973).

Author information

Authors and Affiliations

  1. Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Katherine C. Smith, Sharon White, Jennifer DeSanto, Susan Hannum, Janice Bowie & Claire Snyder

  2. Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA

    Katherine C. Smith, Elissa Thorner, Phuoc Tran, Antonio Wolff & Claire Snyder

  3. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Rm 726, Baltimore, MD, 21215, USA

    Katherine C. Smith

  4. Tidal Health Richard A. Henson Research Institute, Salisbury, MD, USA

    Nancy Mayonado, David Cowall & Joan Mischtschuk

  5. Yale University Department of Surgery, New Haven, CT, USA

    Nita Ahuja

  6. Johns Hopkins School of Medicine, Baltimore, MD, USA

    Kimberly Peairs, Phuoc Tran, Antonio Wolff & Claire Snyder

Authors
  1. Katherine C. Smith
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  2. Sharon White
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  3. Jennifer DeSanto
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  4. Susan Hannum
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  5. Nancy Mayonado
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  6. Nita Ahuja
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  7. Janice Bowie
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  8. David Cowall
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  9. Joan Mischtschuk
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  10. Kimberly Peairs
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  11. Elissa Thorner
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  12. Phuoc Tran
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  13. Antonio Wolff
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  14. Claire Snyder
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Contributions

Conceptualization: KCS, CFS

Data curation: JDS, NM, SW, SH

Formal Analysis: KCS, SH

Funding acquisition: KCS, AW, PT, ET, JB, NA, KSP, ES-H, CFS

Investigation: KCS, SH, CFS

Methodology: KCS, SH, CFS

Project administration: CFS, KCS

Resources: not applicable

Software: not applicable

Supervision: CFS, KCS

Validation: SW, SH

Visualization: not applicable

Writing—original draft: KCS

Writing—review and editing: all authors

Corresponding author

Correspondence to Katherine C. Smith.

Ethics declarations

Ethical review

This study was reviewed and approved by the Johns Hopkins School of Medicine IRB (#110605).

Consent

All data are from individuals who provided written consent to participate.

Consent for publication

N/A

Conflict of Interest

Dr. Nita Ahuja has licensed methylation biomarkers to Cepheid (PATENT # 10167513) and is a member of the Van Andel Institute-Stand Up To Cancer Research Dream Team. Dr. Ahuja is a member of the Scientific Advisory Council to the No Stomach for Cancer Foundation and the Yale New Haven Hospital Board of Trustees.

Dr. Kimberly S. Peairs received research grant support from the Merck Foundation.

Dr. Claire Snyder currently receives research support through the institution from Pfizer and Genentech and previously received royalties from UptoDate for section authorship related to survivorship.

Dr. Phuoc T. Tran reports grants from Astellas Pharm, Bayer Healthcare, and RefleXion Medical; and advisory board/consulting for Noxopharm, Janssen- Taris Biomedical, AstraZeneca, and Myovant outside the submitted work. In addition, Dr. Tran has a patent 9114158—Compounds and Methods of Use in Ablative Radiotherapy licensed to Natsar Pharm.

The remaining authors declare that they have no conflict of interests.

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The statements in this publication are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors, or the Methodology Committee.

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Smith, K.C., White, S., DeSanto, J. et al. Implementing survivorship care planning in two contrasting health systems: lessons learned from a randomized controlled trial. J Cancer Surviv 16, 791–800 (2022). https://doi.org/10.1007/s11764-021-01073-z

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  • DOI: https://doi.org/10.1007/s11764-021-01073-z

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