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National Cancer Institute

Realizing IOM Care Recommendations in Practice

Patricia Ganz, M.D.
Division of Cancer Prevention and Control, Jonsson Comprehensive Cancer Center
UCLA Schools of Medicine and Public Health
Los Angeles, CA

  • Cancer survivorship, which begins at diagnosis and includes families and caregivers, is a neglected phase of the cancer care trajectory. Few guidelines exist, and most health care providers lack education and training in caring for this population. Survivors themselves often are unaware of the health risks and issues they face and usually are not provided with a plan for follow-up care after treatment is complete. Cancer care in the United States also is changing—many cancers are treated as chronic diseases (i.e., long-term endocrine treatment for breast cancer patients). Additionally, the growing population of survivors means more people are at risk for recurrence or second cancers; one-sixth of all new cancers in the United States are second cancers.
  • To achieve better survivor care, primary care and specialty care should be coordinated, ideally resulting in an informed and "activated" patient and a prepared and proactive practice team, both aware of the risks for second cancers and other health issues. Development of a Survivorship Care Plan will inform patients and health care providers of possible short- and long-term effects of cancer treatment. In response to these needs, ASCO established a Survivorship Task Force in 2004. The Task Force focuses on developing a blueprint for moving the IOM's recommendations concerning cancer survivor care into the clinical, research, and policy arenas.
  • Challenges to integrating IOM recommendations into cancer survivor care include the complexity, toxicity, and high cost of cancer care; isolation of cancer treatment from the primary health care delivery system; limited studies of late effects and the effects of follow-up care; and lack of coordination among cancer caregivers. Proposed solutions to these challenges include development of mobile electronic medical records, use of patient navigators to assist with accessing and understanding treatment options, and consultation planning.
  • ASCO proposes to further test and revise a recent version of the treatment summary and survivorship care plan and use of evidence-based guidelines to develop recommendations for survivorship care. Guidelines for care will include topics such as fertility, cardiac and pulmonary effects of treatment, and neurocognitive issues. ASCO hopes to make templates for electronic treatment summaries for the most common cancers available to vendors by 2007.
  • The mission of the UCLA-LIVESTRONG™ Survivorship Center of Excellence is to facilitate improvements in the quality of life and quality of care of cancer survivors in the Los Angeles region and wherever they may reside. The focus of the Center is the development/evaluation of diverse models of cancer survivorship health care delivery. LAF funding is facilitating the development and coordination of translational clinical programs that will improve survivorship care.

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