Survivorship Care Plan Implementation in US Cancer Programs: a National Survey of Cancer Care Providers

  • Sarah A. Birken
  • Sarah Raskin
  • Yuqing Zhang
  • Gema Lane
  • Alexandra Zizzi
  • Mandi Pratt-Chapman


Survivorship care plans (SCPs)—documents intended to improve care for cancer survivors who have completed active treatment—are required, yet implementation is poor. We sought to understand SCP implementation in cancer programs in the USA with the objective of identifying opportunities for improvement. We recruited cancer care providers in the USA via several cancer care networks to participate in a survey regarding SCP implementation. We used descriptive statistics to analyze the data. Three hundred ninety-five providers from diverse cancer programs in 47 states and Washington, DC responded to the survey. The timing of SCP implementation varied across and within cancer programs, with approximately 40% of respondents reporting developing SCPs more than 3 months after primary treatment or adjuvant therapy completion. Nurse navigators were responsible for 48–58% of each stage of SCP implementation. Processes that could have been automated often occurred in-person or via phone and vice versa. Respondents reported spending more than 2 h per SCP to complete all stages of implementation, of which less than a third was reimbursed by third-party payers. We identified several opportunities for improving SCP implementation, including broadening the base of responsibility, optimizing modes of communication, decreasing the time required and increasing the funding available, and limiting variation in SCP implementation across and within cancer programs. Future work should assess the influence of approaches to SCP implementation on desired outcomes.


Survivorship care plans Implementation Cancer care delivery Quality improvement 



The contents of this publication are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee, or the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. We appreciate the input of the Survivorship Special Interest Group, George Washington Cancer Center’s PCORI-funded Generation and Translation of Evidence: An Oncology Community of Practice, a group created as a result of PCORI Contract 1426-GWU, as well as collaborating organizations who contributed to sample recruitment.

Funding Information

This project was an outgrowth of engagement activities supported by a Patient-Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award (1426-GWU). This publication was supported by Award Number UL1TR001876 from the NIH National Center for Advancing Translational Sciences. Infrastructure that made this project possible was partially supported by Award Number UL1TR001876 from the NIH National Center for Advancing Translational Sciences. SB also received funding from the National Institutes of Health through Grant KL2TR001109.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Ganz PA (2001) Late effects of cancer and its treatment. Semin Oncol Nurse 17(4):241–248CrossRefGoogle Scholar
  2. 2.
    Hewitt M (2005) In: Greenfield S, Stovall E (eds) From cancer patient to cancer survivor: lost in transition. The National Academies Press, Washington, DCGoogle Scholar
  3. 3.
    Robin U, Folkes A, Porter G et al (2012) Population-based longitudinal study of follow-up care for colorectal cancer patients in Nova Scotia. J Oncol Pract 8(4):246–252CrossRefGoogle Scholar
  4. 4.
    Grunfeld E, Hodgson DC, Elisabeth Del Guidice M et al (2010) Population-based longitudinal study of follow-up care for breast cancer survivors. J Oncol Pract 6(4):174–181CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hahn EE, Hays RD, Kahn KL, Litwin MS, Ganz PA (2013) Use of imaging and biomarker tests for post-treatment care of early stage breast cancer survivors. Cancer 119(24):4316–4326CrossRefPubMedGoogle Scholar
  6. 6.
    Hahn EE, Tang T, Lee JS, Munoz-Plaza CE, Shen E, Rowley B, Maeda JL, Mosen DM, Ruckdeschel JC, Gould MK (2016) Use of post-treatment imaging and biomarkers in early stake breast cancer survivors: inappropriate surveillance or necessary care? Cancer 122(6):908–916CrossRefPubMedGoogle Scholar
  7. 7.
    Cheung WY, Neville BA, Cameron DB, Cook EF, Earle CC (2009) Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol 27(15):2489–2495CrossRefPubMedGoogle Scholar
  8. 8.
    Mallinger JB, Griggs JJ, Shields CG (2005) Patient-centered care and breast cancer survivors’ satisfaction with information. Patient Educ Couns 57(3):342–349CrossRefPubMedGoogle Scholar
  9. 9.
    Nicolaije KAH, Husson O, Ezendam NPM, Vos MC, Kruitwagen RFPM, Lybeert MLM, van de Poll-Franse LV (2012) Endometrial cancer survivors are unsatisfied with received information about diagnosis, treatment and follow-up: a study from the population-based PROFILES registry. Patient Educ Couns 88(3):427–435CrossRefPubMedGoogle Scholar
  10. 10.
    Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, Cooper D, Gansler T, Lerro C, Fedewa S, Lin C, Leach C, Cannady RS, Cho H, Scoppa S, Hachey M, Kirch R, Jemal A, Ward E (2012) Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 62(4):220–241CrossRefPubMedGoogle Scholar
  11. 11.
    Institute of Medicine (2013) In: Levit, Laura A et al (eds) Delivering high-quality cancer care: charting a new course for a system in crisis. National Academy of Sciences, Washington, DCGoogle Scholar
  12. 12.
    American College of Surgeons National Accreditation Program for Breast Cancers. Clarifications/changes to NAPBC standards. Accessed 12 October 2017
  13. 13.
    National Cancer Survivorship Resource Center (2011) Systems policy and practice: clinical survivorship care. Atlanta, GA: American Cancer Society. Accessed 12 October 2017
  14. 14.
    McCabe MS, Bhatia S, Oeffinger KC, Reaman GH, Tyne C, Wollins DS, Hudson MM (2013) American Society of Clinical Oncology statement: achieving high-quality cancer survivorship care. J Clin Oncol 31(5):631–640 Accessed 2 October 2017CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Commission on Cancer, American Cancer Society (2012) Cancer program standards 2012: ensuring patient-centered care. American College of Surgeons, Atlanta Accessed 12 October 2017Google Scholar
  16. 16.
    Shalom MM, Hah EE, Casillas J et al (2011) Do survivorship care plans make a difference? A primary care provider perspective. J Oncol Pract 7(5):314–318CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Grunfeld E, Julian JA, Pond G et al (2011) Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. J Clin Oncol 29(36):4755–4762CrossRefPubMedGoogle Scholar
  18. 18.
    Boekhout AH, Maunsell E, Pond GR et al (2015) A survivorship care plan for breast cancer survivors: extended results of a randomized clinical trial. J Cancer Surviv 9:683–691CrossRefPubMedGoogle Scholar
  19. 19.
    Coyle D, Grunfeld E, Coyle K et al (2013) Cost effectiveness of a survivorship care plan for breast cancer survivors. J Oncol Pract 10(2):e86–e92CrossRefPubMedGoogle Scholar
  20. 20.
    Brothers BM, Easley A, Salani R, Easley A, Salani R, Andersen BL (2013) Do survivorship care plans impact patients’ evaluations of care? A randomized evaluation with gynecologic oncology patients. Gynecol Oncol 129(3):554–558CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Hershman DL, Greenlee H, Awad D, Greenlee H, Awad D, Kalinsky K, Maurer M, Kranwinkel G, Brafman L, Jayasena R, Tsai W-Y, Neugut AI, Crew KD (2013) Randomized controlled trial of a clinic-based survivorship intervention following adjuvant therapy in breast cancer survivors. Breast Cancer Res Treat 138:795–806CrossRefPubMedGoogle Scholar
  22. 22.
    Nicolaije, Kim AH, Nicole PM, Ezendam M, Vos C et al (2015) Impact of an automatically generated cancer survivorship care plan on patient-reported outcomes in routine clinical practice: longitudinal outcomes of a pragmatic cluster randomized trial. J Clin Oncol 33(31):3550–3559CrossRefPubMedGoogle Scholar
  23. 23.
    de Rooij BH, Ezendam NPM, Nicolaije KAH, Caroline Vos M, Pijnenborg JMA, Boll D, Boss EA, Hermans RHM, Engelhart KCM, Haartsen JE, Pijlman BM, van Loon-Baelemans IEAM, Mertens HJMM, Nolting WE, van Beek JJ, Roukema JA, Kruitwagen RFPM, van de Poll-Franse LV (2017) Effects of survivorship care plans on patient reported outcomes in ovarian cancer during 2-year follow-up—the ROGY care trial. Gynecol Oncol 145(2):319–328CrossRefPubMedGoogle Scholar
  24. 24.
    Birken SA, Deal AM, Mayer DK, Weiner BJ (2014) Determinants of survivorship care plan use in United States programs. J Cancer Educ 29(4):720–727CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Birken SA, Deal AM, Mayer DK, Weiner BJ (2014) Following through: the consistency of survivorship care plan use in United States cancer programs. J Cancer Educ 29(4):689–697CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Birken SA, Mayer DK, Weiner BJ (2013) Survivorship care plans: prevalence and barriers to use. J Cancer Educ 28(2):290–296CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Salz T, Oeffinger KC, McCabe MS et al (2012) Survivorship care plans in research and practice. CA Cancer J Clin 62:101–117CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Merport A, Lemon SC, Nyambose J, Prout MN (2012) The use of cancer treatment summaries and care plans among Massachusetts physicians. Support Care Cancer 20:1579–1584CrossRefPubMedGoogle Scholar
  29. 29.
    Forsythe LP, Parry C, Alfano CM et al (2013) Gaps in survivorship care plan delivery and potential benefits to survivorship care [abstract]. J Clin Oncol 31(suppl; abstr 9594)Google Scholar
  30. 30.
    Hewitt ME, Bamundo A, Day R, Harvey C (2007) Perspectives on post-treatment cancer care: qualitative research with survivors, nurses, and physicians. J Clin Oncol 25:2270–2273CrossRefPubMedGoogle Scholar
  31. 31.
    Campbell BH, Massey BL, Myers KB (2012) Survivorship care plans for patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 138:1116–1119CrossRefPubMedGoogle Scholar
  32. 32.
    Dillman DA (1978) Mail and telephone surveys: the total design method. Wiley, New YorkGoogle Scholar
  33. 33.
    Solet DJ, Michael Norvell J, Rutan GH, Frankel RM (2005) Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med 80(12):1094–1099CrossRefPubMedGoogle Scholar
  34. 34.
    Jefford M, Lotfi-Jam K, Baravelli C, Grogan S, Rogers M, Krishnasamy M, Pezaro C, Milne D, Aranda S, King D, Shaw B, Schofield P (2011) Development and pilot testing of a nurse-led posttreatment support package for bowel cancer survivors. Cancer Nurs 34(3):E1–E10Google Scholar

Copyright information

© American Association for Cancer Education 2018

Authors and Affiliations

  1. 1.Department of Health Policy and Management, Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillUSA
  2. 2.L. Douglas Wilder School of Government and Public AffairsVirginia Commonwealth UniversityRichmondUSA
  3. 3.Institute for Patient-Centered Initiatives & Health EquityThe George Washington University Cancer CenterWashingtonUSA

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