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.
Professional Abstract
Objective
To compare the effectiveness of three delivery models for survivorship care plans (SCPs) in improving receipt of recommended follow-up care among cancer survivors
Study Design
| Design Element | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 378 patients ages 21 and older with a previous diagnosis of (stage 1, 2, or 3) breast, prostate, or colorectal cancer who were receiving care from one of two health systems |
| Interventions/ Comparators |
|
| Outcomes |
Primary: receipt of follow-up care recommended in the patient’s SCP Secondary: receipt of non-recommended care; patient-reported outcomes including patient knowledge and confidence about survivorship care, and patient worry about cancer and general health |
| Timeframe | 18-month follow-up for primary outcome |
This randomized controlled trial compared the effectiveness of SCP delivery models in relation to patient use of recommended follow-up care; avoidance of non-recommended care; and influence on patient-reported outcomes, including knowledge and confidence about follow-up care and worry about cancer and general health. SCPs summarized treatments received, outlined follow-up healthcare needs to help patients transition from cancer treatment to survivorship, and included suggestions for health promotion activities.
Researchers randomized patients to one of three groups. Patients in each group received their SCPs within three months of completing treatment. In the first group, patients and their primary care providers (PCPs) received SCPs by mail. In the second group, patients received their SCPs in person during an office visit. At this visit, a nurse, nurse practitioner, or physician assistant reviewed the content of the SCPs, and patients could ask questions about the plans and follow-up treatments. In the third group, patients received their SCPs in person during an office visit and had an additional, in-person visit six months later. The second visit gave patients another opportunity to review the SCPs and discuss questions and health issues. PCPs received a copy of the patients’ SCPs by mail, and SCPs were added to patient electronic health records.
The study included 378 patients with a previous diagnosis of non-metastatic breast, prostate, or colorectal cancer who were receiving care at one of two health systems in Maryland. Patients completed cancer treatment one to three months prior to the start of the study. Of these patients, 77% were White, 20% were Black, and 3% were other races; 3% were Hispanic or Latino. The average age was 62, and 51% were female.
Researchers reviewed electronic health record data and interviewed patients to document the proportion of patients who received all follow-up care recommended in the SCPs. At baseline and again 6, 12, and 18 months later, researchers surveyed patients by phone about patients’ knowledge and confidence about follow-up care and patients’ worry about cancer and general health.
Patients, caregivers, and clinicians provided input on the study design, implementation, and analysis.
Results
The three SCP delivery groups did not differ significantly in the proportion of patients who received recommended follow-up care within 18 months, which ranged from 42% to 51%.
The SCP delivery groups did not differ significantly in use of non-recommended care or patient-reported outcomes.
Limitations
Patients in the study had health insurance, were English speakers, and received care in one state. Results may differ for patients from other backgrounds.
Conclusions and Relevance
In this study, the type of SCP delivery model did not affect the receipt of recommended care or patient-reported outcomes.
Future Research Needs
Future research could investigate how to incorporate SCPs into care in ways that are feasible and acceptable to patients, clinicians, and health systems.
Final Research Report
This project's final research report is expected to be available by December 2022.
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. 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.