1. Health Provider Teams: How you can support cancer survivors after treatment Washington CARES about Cancer Partnership: Survivorship Taskforce June 2012

2. Presentation Outline Survivors in the U.S. Lost in transition Descriptions Certification/accreditation Reimbursement When to transition care Models of survivorship care Examples

3. Survivors in the U.S. More than 12 million cancer survivors in the U.S. This is a 400% increase in the past 40 years There are an estimated 250,000 cancer survivors in Washington State More than 2 out of 3 people diagnosed with cancer are alive more than 5 years later

4. Lost in Transition 2005 report released by The Institute of Medicine Titled “From Cancer Patient to Cancer Survivor: Lost in Transition” Recommends every cancer survivor receives a survivorship care plan Found: www.iom.edu.reports/2005/title

5. Survivorship Care Plan Set of documents the oncology team puts together for each patient to describe his/her cancer, all of the treatments received, and future needs to stay healthy. Includes: Ongoing care the patient will need (i.e. tests for recurrence, identifying and managing late and long-term effects of the cancer and treatments, etc). A personalized set of recommendations on how to stay healthy and take care of themselves after having cancer (i.e. healthy eating, active living, and emotional support). Full contact information for all of their doctors, nurses, and anyone else that took care of them.

6. Treatment Summary Includes the patient’s diagnostic evaluation and the treatment(s) received. These should include: Disease characteristics (site, stage, grade, marker information) Dates of treatment initiation and completion Types of treatments (surgery, radiation, chemotherapy, etc.) including drugs used, dosages, treatment response and major toxicities experienced Psychosocial, nutritional, and other supportive services provided

7. When to transition care After treatment Should include: Management of treatment side effects, including potential late effects of therapy Cancer surveillance Preventive care recommendations to maintain and improve patient’s health

8. Challenges in transition Survivors may not have services in their community Survivors may have barriers (i.e. insurance, disabilities, cultural and health disparities, etc) Survivors may not know what they need, or even know what to ask for. They may be afraid, feeling like they’re on their own. Providers may be making assumptions about coordination with one another Who orders follow-up tests? Are they talking to one another regularly?

9. Certification Providers do not need special certification to complete these In 2015, programs who have COC accreditation will need to provide survivors with a treatment summary/care plan in order to maintain their certification status. Now is a good time to setup processes in preparation. More details: American College of Surgeon’s Commission on Cancer (COC) http://www.facs.org/cancer/

10. Reimbursement Charge a (CPT) Level 5 Established Patient Office Visit under the Primary Cancer Diagnosis Code (ICD 9), including “more than 50% of time spent on counseling and coordination of care”

11. Models of Survivorship Care

13. Communication Whoever is completing the survivorship care plan and treatment summary should communicate back to: Primary oncologist Primary care provider

15. Templates: Survivorship CPs www.journeyforward.org www.journeyforward.org

22. Journey Forward www.journeyforward.org Lance Armstrong Survivorship www.livestrongcareplan.org American Society of Clinical Oncology www.cancer.net/patient/survivorship National Cancer Institute www.cancer.gov/cancertopics/coping/survivorship Templates

23. Support Services & Resources Prevention & risk factors Healthy eating Active living Preventive visits Psychosocial supportive care after treatment for survivors and family: healing emotionally, physically, and spiritually after treatment Support groups Individual Counseling Educational materials

24. Upcoming materials New website: www.wacancer.orgwww.wacancer.org DONE: Patient factsheet on cancer survivorship and treatment summaries Palliative Care: Provider fact sheet – Coming soon Palliative Care: Patient fact sheet – Coming soon

25. More information

26. References Calculated by applying national estimates to Washington’s 2011 population. See MMWR: www.cdc.gov/mmwr/preview/mmwrhtml/mm6009a1.htm www.cdc.gov/mmwr/preview/mmwrhtml/mm6009a1.htm Cancer survivor = Defined as a person who has been diagnosed and overcome any type of cancer. Time begins at diagnosis and lasts to the end of life. CDC and the Lance Armstrong Foundation (LAF) are leading a public health effort to address the issues faced by the growing number of cancer survivors living with, through, and beyond cancer. Through their collaboration, A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies was developed. The National Action Plan represents the combined effort of almost 100 experts in cancer survivorship and public health. Many cancer associations/societies, institutions, hospitals, cancer centers and individual physicians are moving forward with the development of Survivorship Programs across the nation. American College of Surgeons: Cancer Programs: www.facs.org/cancer/coc/programstandards2012.html. Website accessed on 2/1/12. www.facs.org/cancer/coc/programstandards2012.html. Website accessed on 2/1/12 www.asco.org/ascov2/Practice+&+Guidelines/Quality+Care/Quality+Measurement+&+Improvem ent/Chemotherapy+Treatment+Plan+and+Summary/Cancer+Treatment+Plan+and+Summary+Res ources www.asco.org/ascov2/Practice+&+Guidelines/Quality+Care/Quality+Measurement+&+Improvem ent/Chemotherapy+Treatment+Plan+and+Summary/Cancer+Treatment+Plan+and+Summary+Res ources www.cancer.net/patient/Publications+and+Resources/Support+and+Resource+Links/General+Can cer+Organizations+and+Resources/Support+Groups

27. Thank you! Special thanks to Dr. Scott Baker for contributing materials and slides