National Standards for Cancer Survivorship Care

The National Cancer Institute (NCI), in partnership with the Department of Veterans Affairs (VA) and other Health and Human Services Agencies, led a consensus-building process with subject matter experts to develop the National Standards for Cancer Survivorship Care. This collaboration defined standards for (1) essential health system policy and process components of survivorship care programs; and (2) evaluation of the quality of survivorship care. The effort was undertaken as part of the Biden Cancer Moonshot, President Biden’s whole of government response to accelerate progress against cancer and end cancer as we know it, and the President’s Cancer Cabinet.

This project was co-chaired by Michelle Mollica, PhD, MPH, RN, OCN, deputy director of the National Cancer Institute Office of Cancer Survivorship (OCS); Gina McWhirter, MBA, MSN, RN, director of National TeleOncology at the VA; and Vida Passero, MD, MBA, chief medical officer of National TeleOncology at the VA.

Background

Cancer survivors have unique needs. Many survivors experience physical and psychosocial symptoms during and long after their treatment has ended. In addition, they are at risk for recurrence of their cancer and subsequent cancers, and often need support to promote healthy behaviors (e.g., avoiding smoking and excessive alcohol use, and increasing physical activity). As a result, most survivors require long-term follow-up care to manage their diverse needs.

Survivorship care is complex and multifaceted and includes prevention and detection of recurrence and new cancers, monitoring and amelioration of symptoms related to cancer and its treatment, and management of chronic conditions. These components of care necessitate coordination, often among multiple providers. Though recommendations and long-term follow-up guidelines do exist for some cancers (e.g., breast, colorectal, head and neck, and childhood cancers), the delivery of survivorship care, including who delivers the care (e.g., oncologist, primary care provider, or other healthcare provider) and what care is delivered, varies widely based on care setting, geographical area, and personal resources. In some cases, survivors receive long-term follow-up care delivered by their oncologist, which is not sustainable nor appropriate for many survivors, given the overburdened workforce. Other survivors may receive follow-up care from their primary care provider, which also has challenges, including the fact that providers often do not have actionable information on diagnosis, treatment history, or recommendations for follow-up care.

Current survivorship care for many people is suboptimal, leaving survivors with persistent symptoms, unmet needs, and lack of access to comprehensive survivorship care. Overall, the lack of a national standard for cancer survivorship care has impeded research and clinical care, especially related to supporting reimbursement, measuring care quality, and ensuring equitable care for all survivors. These and other factors led to a pressing need to define a national standard for quality survivorship care in the United States.

Announcement of the National Standards for Cancer Survivorship Care

In spring 2024, NCI and other Health and Human Services agencies announced the National Standards for Cancer Survivorship Care. This announcement coincided with this published article in the Journal of Cancer SurvivorshipDeveloping National Cancer Survivorship Standards to Inform Quality of Care in the United States Using a Consensus Approach.

Cancer survivorship care standards represent recommendations for health systems to apply to the survivors they serve. These new standards can be utilized to assess the quality of existing survivorship care and to guide the development of new programs.

Funding Opportunity

NOT-CA-24-041: Notice of Special Interest (NOSI): Administrative Supplements for Assessing and Enhancing Survivorship Care

In March 2024, the NCI Division of Cancer Control and Population Sciences (DCCPS) announced a Notice of Special Interest (NOSI) to encourage current grant or cooperative agreement awardees to apply for administrative supplement funds to support research with an overall goal of examining and improving survivorship care to align with the recently developed National Standards for Cancer Survivorship Care.

Funded supplement awards will assess alignment of these standards with an existing survivorship program within a healthcare system or center; evaluate the extent to which the survivorship program is available and utilized by survivors; characterize barriers and facilitators to accessing survivorship care; and identify gap areas for future development.

The expiration date for this funding opportunity was June 5, 2024.

Process to Develop Standards

A list of potential indicators was developed through a comprehensive review of survivorship and cancer-specific guidelines, the Commission on Cancer survivorship standard, existing survivorship quality frameworks, U.S. state cancer control plans, and relevant literature. NCI and VA held three iterative, virtual meetings with survivorship subject matter experts to prioritize the most important and feasible indicators and identify additional indicators; input was also solicited from meeting observers. The final set of indicators was then developed. The National Standards for Cancer Survivorship Care are available on the NCI OCS website for health systems and organizations to assess survivorship care quality and align current and future survivorship services.

Key Definitions

Meeting Recordings and Executive Summary

National Standards for Cancer Survivorship Care

National Standards for Cancer Survivorship Care Table

Co-Chairs

  • Michelle Mollica, PhD, MPH, RN, OCN
    Deputy Director, Office of Cancer Survivorship
    National Cancer Institute
     
  • Gina McWhirter, MBA, MSN, RN
    Director, National TeleOncology
    US Department of Veterans Affairs
     
  • Vida Passero, MD, MBA
    Chief Medical Officer, National TeleOncology
    US Department of Veterans Affairs
Last Updated
June 13, 2024