Commentary in the "Journal of the National Cancer Institute" co-authored by Catherine M. Alfano, PhD, our VP of survivorship, calls for the adoption of risk-stratified cancer care
The number of cancer patients in the U.S. is projected to rise from 15.5 million currently to 26 million by 2040, and these people will need ongoing follow-up care to screen for and treat recurrences and additional cancers; manage chronic and late effects of cancer and treatment; address psychological, social, economic, and family concerns; encourage healthy lifestyle behaviors; and increase adherence to long-term treatment and follow-up care regimens.
Currently, this care occurs during follow-up visits with the medical oncologist and /or primary care provider. However, current models of follow-up care fail to meet the needs of many survivors, and this will become worse as the number of survivors over age 65, who are more likely to have multiple health issues, grows, says the commentary by Catherine (pictured here) and Deborah K. Mayer, PhD, RN, AOCN, FAAN, director of cancer survivorship at the University of North Carolina Lineberger Comprehensive Cancer Center and the interim director of the National Cancer Institute's Office of Cancer Survivorship.
Compounding the problem will be a shortage of oncologists. An American Society of Clinical Oncology report in 2014 estimated there would be a shortage of 2,200 oncologists, or approximately a 10 percent gap in providers, by 2025.
To address this supply and demand gap, Catherine and Deborah recommend the development of risk-stratified cancer follow-up care, an approach others put forward a decade ago, and one that has been demonstrated to be effective in Australia, Canada, and the United Kingdom.
Risk-stratification involves assigning a person to a level of care management, or a "clinical pathway," based on a health assessment of current and projected complexity of their medical needs and the type of healthcare provider their care requires. The pathways are developed using evidence-based care guidelines, an approach informed by clinical study outcomes. The health assessment covers a range of issues, including overall prognosis; likelihood of cancer recurrence and new secondary cancers; the potential risk and impact of cancer treatment side-effects; psychosocial and socio-economic challenges; and the person's ability to navigate the healthcare system and manage their own health needs.
Patients deemed to have a low-risk of immediate or late-stage complications would receive follow-up care from their primary care provider. Patients experiencing moderate and ongoing problems would be followed by advanced practice providers. And, patients with complex care issues, or who were expected to experience significant cancer-related issues in the future, would receive their follow-up care from a multi-disciplinary team of caregivers, including an oncologist.
"We must start enacting plans to develop and test these new care models. Each stakeholder group should take on what they can do alone and collaborate with others to advance this agenda . . . We hope this commentary will provide direction on what needs to be done to take this from concept to implementation. We simply cannot afford to fail. The health of our survivors, the happiness of our clinicians, and the financial well-being of our health-care systems and our patients and families are at stake," the article concludes.