Models of Care for Adult Cancer SurvivorsLinda A. Jacobs, Ph.D., R.N.
Director, Lance Armstrong Foundation Living Well After Cancer Program
Abramson Cancer Center, University of Pennsylvania
- To improve treatment outcomes and quality of life for the over 10 million cancer survivors in the United States at risk for late effects, the most common late effects and those at highest risk for these effects must be identified. In addition, efforts should be made to determine if treatment-related injury to normal tissue can be prevented or reversed. "Optimal surveillance" needs to be determined, including who should provide surveillance; the cost of surveillance and follow-up care; and whether medical, psychosocial, and behavioral interventions can reduce morbidity in cancer survivors. Challenges for survivorship research include a current lack of guidelines, a diverse population of survivors, multiple care providers, reimbursement and insurance issues, privacy issues related to the Health Insurance Portability & Accountability Act (HIPAA), and funding.
- The LIVESTRONG™ Survivorship Centers of Excellence Network sponsors adult cancer survivorship programs. Goals of the Network include fostering progress in the field of cancer survivorship as well as meeting the needs of survivors and their families across the country. The Network aims to develop models of clinical care and survivorship care plans and also sponsors research activities such as database development, clinical trials collaborations, and surveillance guideline development. The Network provides education with the goal of standardizing information for survivors and health care providers.
- Two survivorship care models in development include the practice model and the consultative model. The practice model is a clinical program that provides direct care to survivors as well as a platform for clinical research. Current populations involved in this approach are testicular cancer survivors and adult survivors of childhood cancer. The consultative model is a clinical research program whose major focus is research and education; it also provides recommendations to survivors. Investigators work with care providers (oncologists, primary care physicians) to incorporate survivorship recommendations into routine follow-up care. Current populations under investigation include breast cancer and lymphoma survivors and patients who receive bone marrow transplants. Data are collected from patients, including those with poor prognoses, at time of entry into the program.
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