Results Summary
What was the research about?
Survivorship care is a type of care that patients get during and after cancer treatments. This care includes checking to see if the cancer has returned, screening for new cancers, and treating health problems related to cancer and its treatment.
The research team compared three types of survivorship care offered at cancer centers:
- One survivorship-specific visit. A clinician trained in survivorship care, such as a nurse practitioner or physician assistant, met with the patient once. The clinician created a care plan with the patient and provided many of the necessary services during the visit.
- Multiple survivorship-specific visits over time. A clinician trained in survivorship care met with the patient multiple times. The clinician created a care plan with the patient and worked with a team to provide most of the necessary services during these visits.
- Survivorship care integrated into typical cancer care. A cancer-care team provided survivorship care during and after the patient’s cancer treatments as needed. The clinician didn’t always create a care plan for the patient or provide survivorship care systematically. No single clinician oversaw survivorship care.
What were the results?
No one type of survivorship care performed better than the other types overall. For example, compared with patients who had one survivorship-specific visit
- Patients who got care from a cancer-care team reported better quality of care.
- Patients who had multiple survivorship-specific visits reported more physical health concerns but made fewer visits to cancer doctors.
Among the three types of survivorship care, satisfaction with care and patient confidence in managing health and health care were about the same. Patients were highly satisfied with all types of care.
Who was in the study?
The study included 991 patients who had finished treatment for breast, colorectal, or prostate cancer. The patients received care at 32 cancer centers across the United States. Of these patients, 85 percent were white, 8 percent were black, and 6 percent were other races. The average age was 60, and 86 percent were women.
What did the research team do?
The team followed patients as they received survivorship care at the cancer centers. Patients filled out a survey at their first visit right after they finished treatment and again one week, three months, and six months later. The survey included questions about
- Quality of care
- Quality of life
- Confidence in managing health and health care
- Frequency of visits to different types of doctors
- Satisfaction with the survivorship care
Cancer survivors, doctors, and members of patient groups gave input on the study design and analysis.
What were the limits of the study?
Because patients weren’t assigned by chance to the different types of survivorship care, the team can’t say for sure that it was differences in care that led to the survey results. For example, the differences may be due to patients’ backgrounds. Most patients in the study were white women. Results may be different for men or patients of other races.
Future research could look at other things that may affect patients’ well-being after cancer treatment, such as patients’ other health problems or where patients receive care.
How can people use the results?
Cancer centers can use the results when considering which types of survivorship care to offer to patients.
Professional Abstract
Objective
To compare three types of cancer survivorship care on patient-reported quality of care, quality of life, effectiveness in taking care of one’s own health and health care, healthcare utilization, and patient satisfaction
Study Design
| Design Elements | Description |
|---|---|
| Design | Observational: cohort study |
| Population | 991 breast, prostate, or colorectal cancer survivors who had completed care at 1 of 32 cancer centers |
| Interventions/ Comparators |
|
| Outcomes | Patient-reported quality of care, quality of life, self-efficacy, healthcare utilization, patient satisfaction with care |
| Timeframe | 6-month follow-up for study outcomes |
Cancer survivorship care includes surveillance for cancer recurrence or new cancers and treating health problems related to cancer and its treatment. Researchers monitored patients for six months as they received survivorship care at participating cancer centers. Each center offered one of three types of survivorship care:
- Specialized consultative post-treatment survivorship care. After treatment, the patient received one on-site survivorship care consultation with a cancer-care clinician trained in survivorship care. The clinician created a survivorship care plan with the patient and provided the majority of survivorship care services on-site.
- Specialized longitudinal post-treatment survivorship care. After treatment, the patient received multiple survivorship care consultations with a cancer-care clinician trained in survivorship care. The clinician created a survivorship care plan with the patient and coordinated with a survivorship care team to deliver the majority of survivorship care services on-site.
- Oncology embedded survivorship care during and after treatment. An oncology treatment team delivered survivorship care that started during and continued after treatment as needed. The patient did not necessarily receive a formal survivorship care plan. The patient’s treating oncologist, rather than a clinician with survivorship care training, generally provided survivorship care. Many survivorship care services were provided through referrals to other clinicians.
The study included 991 breast, prostate, or colorectal cancer patients who had completed cancer treatment at 32 cancer-care centers across the United States. Of these patients, 85% were white, 8% were black, and 6% were other races. The average age was 60, and 86% were female.
Researchers surveyed patients before a patient’s first survivorship care visit, after treatment had ended, and at one week, three months, and six months after the start of survivorship care.
An advisory board of cancer survivors, healthcare providers, patient advocates, and a researcher helped design the study and analyze the data.
Results
Different types of survivorship care performed better on different outcomes. For example, compared with patients who had specialized consultative survivorship care
- Patients who had embedded survivorship care reported better quality of care for six of nine indicators between the one-week and six-month timepoints (all p<0.05).
- Patients with specialized longitudinal care reported an increase in physical health concerns related to quality of life (p<0.001) but had fewer visits to oncologists (p<0.05) between the one-week and six-month timepoints.
Between the one-week and six-month timepoints, the three types of care did not differ in patient self-efficacy or satisfaction across the types of care. Over 90% of patients in each survivorship care group reported satisfaction with their care.
Limitations
Because patients were not randomly assigned to type of care, differences seen across the types of care may actually be because of differences across the cancer centers and the patient populations. Most study participants were white females. The results may be different for patients with other characteristics.
Conclusions and Relevance
No one type of care performed uniformly better than the others. However, cancer centers can use the results when considering the advantages of different cancer survivorship care alternatives.
Future Research Needs
Future studies could examine other factors that contribute to the outcomes measured in this study, including patient characteristics or the services provided.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:
- The reviewers said it would be important to validate the Survivorship Care Quality Framework Index used in the study. The researchers agreed that validation of this instrument is critical and that lack of its validation is a limitation of this study. In future work, the researchers hope to validate a short-form version of the index for use in clinical practice.
- Reviewers noted that the survey approach and study demographics limit the generalizability of this study. The researchers agreed, acknowledging that the sample skews toward white and insured patients. But the researchers noted that they focused on a sampling approach that would increase representation across cancer types such as the breast, prostate, and colorectal cancers in the study, rather than socioeconomic characteristics. The researchers also noted that their study may have limited generalizability since it drew on patients from high-performing cancer centers because such centers have developed programs for survivor care. In the future, the researchers hope to replicate these findings in a broader range of populations, including in low-income and underserved populations.
- Reviewers noted that the three survivorship care models tested overlap in some of their characteristics, such as providing psychosocial care and treatment management. But the researchers noted, the models vary in other characteristics, such as frequency of visits and outside referrals. The multifaceted nature of each model makes it hard to determine which specific elements of care are most effective. The researchers agreed that this is a limitation and proposed that future studies try to identify which specific components of the interventions are most important in improving patient-centered outcomes.