Johns Hopkins, Baltimore, MD
Alaina Chodoff, Katherine Clegg Smith, Aishwarya Shukla, Amanda L. Blackford, Nita Ahuja, Fabian McCartney Johnston, Kimberly S. Peairs, Justinian R. Ngaiza, Tam Warczynski, Brenda Nettles, Eden Stotsky-Himelfarb, Adrian Gerard Murphy, Nancy Mayonado, Jennifer DeSanto, Claire Frances Snyder, Youngjee Choi
Background: Survivorship care plans (SCPs) outline pertinent information about a cancer survivor’s treatment and follow-up care. We describe the content of colorectal cancer (CRC) SCPs, completed as part of a randomized controlled trial of SCPs, and evaluate whether follow-up recommendations are guideline concordant. Methods: We analyzed 74 CRC SCPs from an academic and community cancer center. Frequency distributions and descriptive statistics were calculated for the entire cohort and separately by recruiting site. Follow-up recommendations were compared to American Cancer Society (ACS), American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines (Table). Results: Content routinely provided in SCPs (>80%) included patient demographics, cancer diagnosis, treatment details (surgery, chemotherapy, radiation therapy) as well as treatment-related side effects. SCP content specified less frequently included cancer stage, cancer risk (predisposing conditions), and recommendations for genetic counseling/testing and health promotion. Nearly all SCPs from the community site provided uniform, guideline-concordant follow-up. At the academic site, on average, more than 15 follow-up recommendations were listed for each surveillance modality, except colonoscopy. Among the SCPs that specified the frequency of follow-up care, the rate of guideline-concordant recommendations was 15/42 (36%) for follow-up visits, 29/43 (67%) for imaging, 12/45 (27%) for laboratory and 39/39 (100%) for colonoscopy. Conclusions: SCPs consistently provided information about CRC diagnosis and treatment, but often omitted information about cancer risk, staging and prognosis. There was considerable variation between cancer centers in the follow-up recommendations suggested for CRC survivors. Future work to improve the consistency of SCP follow-up recommendations with guidelines may be needed. Clinical trial information: NCT03035773.
Follow-up Visit | Carcinoembryonic antigen | CT scan | Colonoscopy | ||||
---|---|---|---|---|---|---|---|
ASCO | Y1-5 | Q3-6 mo | Y1-5 | Q3-6 mo | Y1-3 | Q12 mo | Y1* |
ACS | Y1-2 | Q3-6 mo | Y1-2 | Q3-6 mo | Y1-5 | Q12 mo | Y1* |
NCCN | Y3-5 | Q6 mo | Y3-5 | Q6 mo | Y1-5^ | Q6-12 mo | Y1* |
Q: every; Y: years; mo: months *Repeat based on findings (may differ for patients with rectal cancer) ^ For rectal cancer, CT scan Q3-6 mo Y1-2, Q6-12 mo Y3-5
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