A More Personalized Approach to Survivorship Care?

Since the 2005 publication of From Cancer Patient to Cancer Survivor: Lost in Transition by the Institute of Medicine (now the National Academy of Medicine), the healthcare community has become more aware of the needs of cancer survivors and responded by developing survivorship services and programs. Though these survivorship programs incorporate different models of care, the backbone is providing the patient with a survivorship care plan, a document that intuitively should enhance understanding of both the care received and the transition back to primary care and ultimately improve outcomes. Yet, there is limited evidence that survivorship care plans do so. A recently published article in The Oncologist may shed some light on why and guide us on future design of survivorship programs.¹

The study, a cross-sectional needs assessment of cancer survivors, found heterogeneity in the survivors' needs that fell into four clusters:

•	Low needs
•	Mainly physical needs
•	Mainly psychological needs
•	Both physical and psychological needs.

The low-needs cluster of survivors was the largest, representing 40 percent of the 292 respondents, and half of this group (20 percent) had no needs identified. The authors concluded that a measurable benefit of survivorship care plans in randomized trials may be diluted by this population of survivors with low or no needs.

More importantly, this study highlights the need for a tailored approach to survivorship care that would identify those survivors with physical and psychological needs and direct resources toward this population. A survivorship screening tool—like a distress screening tool—could help triage survivors so that low- and no-need survivors could be provided a survivorship care plan as part of a regular follow-up visit and high-need survivors could be referred to a survivorship specialist for a more intensive counseling session. This approach would help cancer programs provide survivorship care tailored to the individual patient's needs and concentrate valuable resources where they are most needed.

The provision of survivorship care can also be challenging for cancer programs. From inadequate reimbursement for survivorship care services to overly burdensome accreditation standards and requirements, cancer programs struggle to provide survivorship care in the most impactful, cost-effective manner to an exponentially expanding patient population. To help ease some of these burdens and better align with patient-centered care delivery, accrediting organizations should use these data to develop more appropriate survivorship standards that truly meet the needs of cancer survivors rather than assuming a one-size-fits-all approach.