Results Summary

What was the research about?

A survivorship care plan, or SCP, helps patients know what follow-up care they need after cancer treatment. Follow-up care includes visits and tests that patients should get in the future and steps they can take to reduce the risk that their cancer will come back.

In this study, the research team wanted to learn if the way patients received the SCP affected whether they received all of the follow-up care in the plan. The team compared three ways patients could receive their SCP:

  • By mail
  • In person during a clinic visit
  • In person during a clinic visit, plus at a six-month follow-up clinic visit

What were the results?

In the 18 months after cancer treatment, the percentage of patients who received all follow-up care didn’t differ much based on how patients received an SCP. On average, less than half of patients received this care.

The way patients received an SCP also didn’t affect their:

  • Knowledge and confidence about follow-up care
  • Worry about cancer and about general health

Who was in the study?

The study included 378 patients ages 21 and older who received treatment for breast, prostate, or colorectal cancer. Patients completed cancer treatment one to three months before the study began. All received care at one of two health systems in Maryland. Of these patients, 77 percent were White, 20 percent were Black, and 3 percent were another race; also, 3 percent were Hispanic. The average age was 62, and 51 percent were women.

What did the research team do?

The research team assigned patients by chance to receive an SCP by mail; in person at an office visit; or in person at an office visit, plus at a visit six months later to review the plan. During the in-person visit, a nurse or physician assistant reviewed the content of the SCPs with patients. Patients could ask questions about the plans and follow-up care. The six-month visit gave patients another chance to ask questions about the plans or care.

Patients’ primary care providers received a copy of the patients’ SCPs by mail, and a copy of the SCP was placed in the patient’s health record.

To determine the number of patients who received all care recommended in the SCPs, the research team looked at patients’ health records and interviewed patients. Patients took phone surveys at the start of the study and again 6, 12, and 18 months later.

Cancer survivors, caregivers, and doctors and nurses who treat patients with cancer gave input that helped the research team design and carry out the study.

What were the limits of the study?

Patients in the study had health insurance, were English speakers, and received care in one state. Results may differ for patients from other backgrounds.

Future research can see how best to include SCPs in standard patient care.

How can people use the results?

Health systems can use these results when considering ways to help cancer survivors plan for follow-up care after treatment.

Final Research Report

This project's final research report is expected to be available by December 2022.

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. Those comments and responses included the following:

  • The reviewers questioned the consistency of the survivorship care plans (SCP) that were used in this study since practitioners could adapt the SCP template to their needs and whether differences among the care plans had an effect on their successful use in the three implementation strategies.  The researchers explained that all participating providers used the same basic SCP template, but that template included only general recommendations. Providers were expected to add patient-specific recommendations to the SCPs and the analyses were performed based on patients receiving those specific recommendations. The SCPs were never meant to be uniform, said the researchers.
  • The reviewers noted that the report did not present information on oral medication use. The researchers explained that although they had initially planned to include adherence to oral medications in their analyses, they found the data collection method for oral medications—patient recall—was not as reliable as data collection for other health service use by medical record. They stated that including the oral medication data could have significantly affected how much data they were able to include in their analyses.
  • The reviewers asked the researchers to discuss the possibility of cross contamination, where providers might use skills that are part of one study arm with patients in another study arm, given that randomization was at the patient level. The researchers agreed that this was not an ideal randomization scheme for this study, but noted that alternate schemes where they might randomize by health system, clinic, or provider could create even more bias and confounding by community type or by clinic specialty.

Conflict of Interest Disclosures

Project Information

Katherine Clegg Smith, PhD
Johns Hopkins University
$3,999,796
Simplifying Survivorship Care Planning; Comparing the Efficacy and Patient-Centeredness of Three Care Delivery Models

Key Dates

April 2015
May 2022
2015
2022

Study Registration Information

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Last updated: January 31, 2023