Simplifying Survivorship Care Planning: A Randomized Controlled Trial Comparing 3 Care Plan Delivery Approaches

Abstract

Background Survivorship care plans seek to improve the transition to survivorship, but the required resources present implementation barriers. This randomized controlled trial aimed to identify the simplest, most effective approach for survivorship care planning. Methods Stage 1-3 breast, colorectal, and prostate cancer patients aged 21+ completing treatment were recruited from an urban-academic and rural-community cancer center. Participants were randomized, stratified by recruitment site and cancer type, 1:1:1 to (a)mailed plan, (b)plan delivered during one-time transition visit, or (c)plan delivered during transition visit plus 6-month follow-up visit. Health service use data were collected from participants and medical records for 18 months. The primary outcome, receipt of all plan-recommended care, was compared across intervention arms using logistic regression adjusting for cancer type and recruitment site with p < 0.05 considered statistically significant. Results Of 378 participants randomized, 159 (42.1%) were breast, 142 (37.6%) prostate, 77 (20.4%) colorectal cancer survivors; 207 (54.8%) from the academic site, 171 (45.2%) from the community site; 316 analyzable for the primary outcome. There was no difference across arms in the proportion of participants receiving all plan-recommended care: 45.2% mail, 50.5% one-visit, 42.7% two-visit (2-sided P = 0.60). Adherence by cancer type for mail, one-visit, and two-visit, respectively, was 52.2%, 53.3%, 40.0% for breast cancer; 48.6%, 64.1%, 57.1% for prostate cancer; and 23.8%, 19.0%, 26.1% for colorectal cancer. There were no statistically significant interactions by recruitment site or cancer type. Conclusions This study did not find differences in receipt of recommended follow-up care by plan delivery approach. Feasibility and other factors may determine the best approach for survivorship care planning.

Feasibility of delivering survivorship care via lay health educators: A pilot randomized controlled trial among rural cancer survivors

“…However, during qualitative interviews, participants discussed how they were unaware of the importance of screening practices in the survivorship period. More detailed follow‐up of participants’ poststudy behaviors may reveal changes in health‐seeking behaviors; however, a recent randomized controlled trial (RCT) that compared different SCP delivery strategies found no effect on receipt of an SCP on uptake of recommended care over an 18‐month follow‐up period 30 …”

“…More detailed follow-up of participants' poststudy behaviors may reveal changes in health-seeking behaviors; however, a recent randomized controlled trial (RCT) that compared different SCP delivery strategies found no effect on receipt of an SCP on uptake of recommended care over an 18-month follow-up period. 30 Scoping reviews and meta-analyses have found limited or no benefit to the delivery of SCPs to patients on either health outcomes or health care delivery. [18][19][20]7 A recent meta-analysis found no effects on SCP delivery on self-reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self-efficacy, at 6 months, or on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care at 12 months.…”