Survivorship Care Plans in Cancer: A Meta-Analysis and Systematic Review of Care Plan Outcomes

Abstract

Background. The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta-analysis compares patient-reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision. Methods. We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient-reported outcomes for SCP recipients versus controls were eligible for the meta-analysis. We performed random-effects meta-analyses using pooled standardized mean differences for each patient-reported outcome.Results. Eight articles were eligible for the meta-analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on selfreported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or selfefficacy or at 12 months on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects. Conclusion. SCPs appear feasible but do not improve survivors' patient-reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies. The Oncologist 2020;25:e351-e372 Implications for Practice: Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient-reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.

Acceptability and feasibility of survivorship care plans and an accompanying mobile health intervention for adolescent and young adult survivors of childhood cancer

“…The AYA STEPS intervention had high retention (>85%) and high SCP uptake (88% read at least once). Further, this study demonstrated that SCP delivery to AYA survivors by nonclinical staff using a digital SCP generator is feasible with an average time of 32 minutes, thus challenging prior arguments of time being a barrier to SCP use 15,28–30 . As demonstrated, having a complete and accessible treatment summary as part of clinical care, as recommended by the Institutes of Medicine and American Society of Clinical Oncology, 31,32 should significantly reduce the time to create an SCP.…”

“…Perceived gains to knowledge, health awareness, and motivation to improve health were the most endorsed benefits of both the app and SCP. The literature on the knowledge benefits of SCPs has been largely inconclusive, 30 and we plan to provide further objective data on knowledge gains with our pending postintervention efficacy data. Regardless, these preliminary findings are promising as increasing knowledge, awareness, and motivation may be a precursor to better health behaviors and outcomes, 24 including better indices of self‐management, for AYA survivors.…”

“…Further, this study demonstrated that SCP delivery to AYA survivors by nonclinical staff using a digital SCP generator is feasible with an average time of 32 minutes, thus challenging prior arguments of time being a barrier to SCP use. 15,[28][29][30] As demonstrated, having a complete and accessible treatment summary as part of clinical care, as recommended by the Institutes of Medicine and American Society of Clinical Oncology, 31,32 should significantly reduce the time to create an SCP. The use of an app to support SCP uptake was also highly feasible with AYA having virtually ubiquitous smartphone ownership, all willing and able to download the app, and minimal time required for app orientation.…”

An integrative review: Women’s psychosocial vulnerability in relation to paid work after a breast cancer diagnosis

“…: In a review of the completeness of 20 breast cancer survivorship care plans, the psychosocial component was delivered in 40% and the work component in only 5% of the cases (Salz et al., 2012). While the feasibility of survivorship care plan implementation (Earle & Ganz, 2012; Ganz & Hahn, 2008; Klemanski et al., 2016; Runowicz et al., 2016) and the ability to achieve positive patient‐reported outcomes continue to be scrutinized (Hill et al, 2020), the underlying intent is consistent with the overarching goal of promoting quality cancer care that is both coordinated and patient‐centred (Bradley, 2015; IOM, 2006).…”

Exploring Interactive Survivorship Care Plans to Support Breast Cancer Survivors: Protocol for a Randomized Controlled Trial

“…However, for breast cancer survivors, SCPs in their current form, as a static paper document, provide little-to-no benefit over standard patient discharge procedures [ 5 ]. Furthermore, despite the inclusion of SCPs in standard oncology practice, the lack of evidence supporting improved health outcomes [ 6 , 7 ] may be attributed to them being passive and generic in nature, as well as their reliance on the patient to proactively check, analyze, interpret, and retain the information they contain on a routine basis [ 8 - 10 ]. Moreover, there is limited research studying the role of eHealth literacy among survivors.…”