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Relation
de Rooij BH, Ezendam N, Nicalaije K, et al. Effects of survival plans on patient-reported ovarian cancer outcomes during 2-year follow-up - The ROGY Care Study.Gynecological oncology. 2017;S0090-8258(17):30162-2.
Objective
To evaluate the long-term impact of automatically generated survival plans (SCPs) on the reported outcomes of patients with ovarian and endometrial cancer
Draft
Pragmatic cluster randomized trial with 12 hospitals in the southern Netherlands. Patients were randomly assigned to receive SCP care or usual care.
Participant
A total of 395 patients (221 endometrial and 174 ovarian patients) with an average age of 63.3 years and different stages of the disease took part in this study. All patients completed questionnaires immediately after initial treatment and then after 6, 12, and 24 months.
All patients in the SCP group received an automatically generated SCP during their treatment plan consultation. The SCP consisted of a detailed treatment summary that included diagnostic tests, type of cancer, stage, grade, and treatments received. It also included photographs of the affected organs as well as a detailed list of possible treatment effects, social and sexual side effects, possible signs of recurrence or secondary tumors, and resources for psychosocial support.
Outcome measurements
This study evaluated 3 primary outcomes: patient satisfaction with information provided, illness perception, and health care utilization.
Key insights
The key finding of this study was that ovarian cancer patients who received SCP had less confidence that their treatment would help or cure their disease compared to patients who did not receive SCP. Equally significant, in the endometrial group, those who received the SCPs unnecessarily had more concerns about symptoms and experienced negative emotional effects than patients who did not receive the SCPs.
Practice implications
In the United States, survivorship care plans respond to the unique health needs of the 15.5 million U.S. cancer survivors.1The American College of Surgeon's Commission on Cancer (CoC) has mandated that by 2019, cancer centers must issue an SCP to all survivors who have received treatment with curative intent.2According to the CHC mandate, an SCP must provide a treatment overview, describe recommended follow-up care, and provide information about lifestyle-based risk reduction. The SCP is intended to facilitate efficient continuity of care and provide survivors with a resource to address treatment-related symptoms and risk reduction.
Despite the intent of the SCP mandate, the results of this study are consistent with previous research showing that SCPs can increase patient anxiety and have negative emotional impacts.3One reason for this is that SCPs focus primarily on information about treatment and follow-up visits, but rarely provide even cursory information about self-directed lifestyle-based strategies that can reduce risks and optimize health.4In our experience, survivors report that focusing solely on a treatment summary and follow-up screening only serves to remind them of the challenges they face due to their diagnosis and treatment and can incite fear about the possibility of recurrence.
The majority of SCPs currently delivered to patients do not provide risk reduction strategies and cannot engage survivors in lifestyle modification. Despite the fact that the SCP mandate comes from survivors, research has shown that it does not meet their needs for continuity of care and proactive risk reduction. Instead, fulfilling this mandate adds to their plight.
In fact, previous research has shown that patients receiving SCPs experience more symptoms, seek medical help more frequently, and have increased levels of emotional distress.5.6These results are consistent with other reviews that have found that SCPs alone do not have a significant positive effect on survivors' burden or satisfaction with care.7.8
As the provision of SCPs has become part of the standard of care, it is important to modify their content to include tertiary prevention to engage patients in their ongoing healthcare. Addressing the suffering of cancer survivors with meaningful, proactive, and lifestyle-based strategies to reduce risk and optimize health remains a critical need.
Disclosure of Conflicts of Interest
The authors of this study have a managerial and financial interest in the iTHRIVE plan, an online wellness program for cancer survivors.