Advanced Practice Providers and Survivorship Care: They Can Deliver

Abstract

INTRODUCTION: As the number of cancer survivors grows, new models of survivorship care are being implemented, but there is limited evaluation to date. This retrospective review assesses the concordance of care provided to adult-onset cancer survivors by advanced practice providers (nurse practitioners and physician assistants) with Institute of Medicine guidelines for survivorship care. METHODS: Records from three survivorship clinics at a single institution were reviewed for frequency of recurrence surveillance, screening for second cancers, symptom management (physical, psychological), health promotion education (alcohol, tobacco, cholesterol, and bone density screenings; diet/exercise discussion), care coordination, and provision of care plan. Data were characterized using descriptive statistics. RESULTS: Over 2 years, 9,052 unique survivorship visits occurred; 210 breast, 208 prostate, and 204 colorectal visits were randomly selected for review. All patients with breast cancer underwent surveillance for recurrence; 99% were screened for new cancers. Discussion of health promotion activities ranged from 83% to 100%; 91% of patients were reviewed for physical symptoms, and 93% were reviewed for psychological symptoms. All patients with prostate cancer underwent recurrence surveillance; 97% were screened for new primaries. Health promotion activities ranged from 70% to 97%, and symptoms were discussed in 89% of visits. All patients with colorectal cancer underwent a surveillance colonoscopy for recurrence; 97% had a carcinoembryonic antigen test. Among women, 97% had mammograms, and 96% had a Papanicolaou test; 83% of men had a prostate-specific antigen test. Health promotion activities ranged from 69% to 100%, and symptoms were discussed in 93% to 97% of visits. CONCLUSIONS: Findings suggest that advanced practice providers can provide survivorship care in accordance with Institute of Medicine standards, which provide a normative standard. This assessment is an important step in evaluating survivorship outcomes.

Head and neck cancer survivorship consensus statement from the American Head and Neck Society

“…29 Data from other tumor types also support the involvement of advanced practice providers in survivorship care. 30 In part due to these findings, survivorship care is often transitioned to nurses or advanced practice providers at multiple centers throughout the United States. In lieu of organized survivorship care plans, primary care providers sometimes become de facto survivorship care providers.…”

Rationale and Design of a Telehealth Self-Management, Shared Care Intervention for Post-treatment Survivors of Lung and Colorectal Cancer

“…The clinical care structure for the intervention is APRN-driven and disease-specific (lung, colorectal). This structure was selected because APRNs have adequate training and skills to address follow-up care issues [33]. In follow-up care, APRNs often serve as care coordinators and the communication bridge between multiple specialties.…”

Impact of Physical and Functional Limitations on Health Care Utilization in Older Cancer Survivors: A Medicare Current Beneficiary Survey

“…A multidisciplinary care infrastructure along with a cross-cutting model of care applicable to all practice settings is required for high-quality cancer survivorship care (Mayer, Nasso, & Earp, 2017;McCabe et al, 2013). The survivorship shared care model in concordance with the Institute of Medicine standards should be implemented by advanced practitioners to provide better survivorship care to older cancer survivors (Thom et al, 2019). Shared care models with unified and holistic clinical approach may help curb the excess health care utilization among cancer survivors (Levit et al, 2013).…”