Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery

Abstract

Purpose Numerous organizations recommend that patients with cancer receive a survivorship care plan (SCP) comprising a treatment summary and follow-up care plans. Among current barriers to implementation are providers' concerns about the strength of evidence that SCPs improve outcomes. This systematic review evaluates whether delivery of SCPs has a positive impact on health outcomes and health care delivery for cancer survivors. Methods Randomized and nonrandomized studies evaluating patient-reported outcomes, health care use, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Data extracted by independent raters were summarized on the basis of qualitative synthesis. Results Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer types, SCP delivery timing and method, SCP recipients and content, SCP-related counseling, and outcomes assessed. Nonrandomized study findings yielded descriptive information on satisfaction with care and reactions to SCPs. Randomized study findings were generally negative for the most commonly assessed outcomes (ie, physical, functional, and psychological well-being); findings were positive in single studies for other outcomes, including amount of information received, satisfaction with care, and physician implementation of recommended care. Conclusion Existing research provides little evidence that SCPs improve health outcomes and health care delivery. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal outcomes. Findings are limited but more positive for proximal outcomes (eg, information received) and for care delivery, particularly when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. Recommendations for future research include focusing to a greater extent on evaluating ways to ensure SCP recommendations are subsequently acted on as part of ongoing care.

Patients’ information coping styles influence the benefit of a survivorship care plan in the ROGY Care Trial: New insights for tailored delivery

“…Although it has been demonstrated that information coping style is fairly stable over a 1-month period, 25,35 we observed that patients who had ovarian cancer with higher stage cancer more often had a monitoring coping style. 3,37 It is important to note that the SCPs provided in our trial were extensive documents (ie, up to 25 pages) containing detailed information about potential long-term and late effects and explicit information about the chance of recurrence. However, the distribution of monitors and blunters did not differ between trial arms, indicating that this probably did not affect our results, although it does suggest that repeated assessments of information coping style may be needed to provide appropriate information when needs have been changed.…”

“…Furthermore, there is no consensus on whether the outcomes in our analysis (eg, patient satisfaction) are the most relevant for evaluating SCPs. 3 Hence, either withholding information or providing information to all patients uniformly would not achieve patient satisfaction. 3,37 It is important to note that the SCPs provided in our trial were extensive documents (ie, up to 25 pages) containing detailed information about potential long-term and late effects and explicit information about the chance of recurrence.…”

“…1 Since the first recommendation by the US Institute of Medicine in 2006, 1 SCPs have been the focus of survivorship care research. 3 Randomized controlled trials (RTCs) have failed to identify the benefits of SCP delivery on patient satisfaction, quality of life, and distress in various patient populations, including those with breast, 4,5 gynecologic, 6-8 colorectal, 9 and prostate 10 cancers. 3 Randomized controlled trials (RTCs) have failed to identify the benefits of SCP delivery on patient satisfaction, quality of life, and distress in various patient populations, including those with breast, 4,5 gynecologic, 6-8 colorectal, 9 and prostate 10 cancers.…”

A randomized trial of immediate versus delayed survivorship care plan receipt on patient satisfaction and knowledge of diagnosis and treatment

“…Thus the assumption that SCPs would act to improve survivor knowledge on these topics is an eminently reasonable one that underlies the intent of providing them. 29,30 This was precluded by our study's short timeframe. knowledge using surveys before and after SCP receipt.…”

Accuracy and acceptability of survivorship care plans: results of a pilot study

“…Despite their increasing adoption, there is limited evidence that TS and CP improve survivors' health outcomes . Attempts to increase their impact have mostly focused on improving the process of plan development, with less attention to the content of CP and how well they meet patients' needs.…”