Preventive Health in Cancer Survivors: What Should We Be Recommending?

Individuals with a history of cancer, often referred to as cancer survivors, may experience late and long-term effects of their treatment. Because these individuals live longer in the survivorship phase, some of these late effects may also be considered risk factors for other chronic conditions. With cancer and cardiovascular disease now the top 2 leading causes of death in the United States and with common risk factors for both, as well as the morbidity that can occur after cancer treatment, preventive health is becoming an important issue in cancer survivorship care. Multimorbidity is also becoming increasingly commonplace. Along with an ever-expanding number of guidelines available to help guide care and treatment in the noncancer population comes the need to consider where these guidelines overlap or intersect when considering preventive health recommendations specific to cancer survivors. Counseling for health promotion in survivors is lacking. Many currently available guidelines may not apply to this population, and an evidence base is building to help supplement clinical judgement. An interdisciplinary approach will be necessary to help implement preventive care decision-making early in the survivorship trajectory and to ensure that cancer survivors are receiving consistent messages, and patient preferences and priorities should be taken into account when doing so. Incorporating preventive health into collaborative survivorship care can help maintain a high quality of life for individuals living after a cancer diagnosis.

Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care.

PURPOSE: This study describes the experiences of early implementers of primary care-focused cancer survivorship delivery models. METHODS: Snowball sampling was used to identify innovators. Twelve participants (five cancer survivorship primary care innovators and seven content experts) attended a working conference focused on cancer survivorship population strategies and primary care transformation. Data included meeting discussion transcripts/field notes, transcribed in-depth innovator interviews, and innovators' summaries of care models. We used a multistep immersion/crystallization analytic approach, guided by a primary care organizational change model. RESULTS: Innovative practice models included: (1) a consultative model in a primary care setting; (2) a primary care physician (PCP)-led, blended consultative/panel-based model in an oncology setting; (3) an oncology nurse navigator in a primary care practice; and (4) two subspecialty models where PCPs in a general medical practice dedicated part of their patient panel to cancer survivors. Implementation challenges included (1) lack of key stakeholder buy-in; (2) practice resources allocated to competing (non-survivorship) change efforts; and (3) competition with higher priority initiatives incentivized by payers. CONCLUSIONS: Cancer survivorship delivery models are potentially feasible in primary care; however, significant barriers to widespread implementation exist. Implementation efforts would benefit from increasing the awareness and potential value-add of primary care-focused strategies to address survivors' needs. IMPLICATIONS FOR CANCER SURVIVORS: Current models of primary care-based cancer survivorship care may not be sustainable. Innovative strategies to provide quality care to this growing population of survivors need to be developed and integrated into primary care settings.

Development of a Primary Care-Based Clinic to Support Adults With a History of Childhood Cancer: The Tactic Clinic.

PURPOSE: Describe the development and evolution of a primary-care-based, multidisciplinary clinic to support the ongoing care of adult survivors of childhood cancer. METHODS: A consultative clinic for adult survivors of childhood cancer has been developed that is located in an adult, academic internal medicine setting and is based on a long-term follow-up clinic model available at Children's Hospital Colorado. RESULTS: The clinic opened in July 2008. One hundred thirty-five patients have been seen as of April 2014. Referrals and clinic capacity have gradually increased over time, and a template has been developed in the electronic medical record to help facilitate completion of individualized care plan letters. CONCLUSIONS: A primary care-based, multidisciplinary consultative clinic for adults with a history of childhood cancer survivor is feasible and actively engages adult primary care resources to provide risk-based care for long-term pediatric cancer survivors. This model of care planning can help support adult survivors of pediatric cancer and their primary care providers in non-academic, community settings as well.