American Head & Neck Society

Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.

Cancer Survivorship – Patient Education on Post-Treatment Care

Topical Reviews – click the links below for more information:

Introduction to Topical Reviews

Survivorship continues to develop into a distinct focus area within head and neck oncology. Recognizing this, the American Head and Neck Society (AHNS) has commissioned a committee on survivorship. A principal charge of this committee is to develop educational materials targeted at survivors of head and neck cancers and those who care for them. Central to this particular mission is providing patients and physicians with resources to understand and navigate the non-oncologic aspects of post-treatment care. In keeping with this, the committee has developed a series of guideline-style reviews for survivorship care across a number of different subject areas. Other outlets – most notably the American Cancer Society (ACS) – have published comprehensive head and neck survivorship care guidelines.1 However, as we have noted previously, the target audience of the ACS guidelines is primary care physicians rather than patients or oncologic specialists. Additionally, evidence and recommendations for identification and management of the sequelae of cancer and cancer-directed therapies have been sparse. Consequently, we have very few standardized approaches to and limited resources for patient education surrounding late effects and supportive care services2. The series introduced herein was primarily undertaken in an attempt to address this shortfall.

At the same time, topical reviews of  this nature are of particular and eminent importance as we consider the American College of Surgeons Commission on Cancer (CoC) standards for survivorship care. While not all institutions fall under CoC accreditation, their standards reflect best practices for oncology care. Moreover, their survivorship standards are in line with those outlined in the seminal monograph – “Lost In Transition”3 and the recommendations of the American Society for Clinical Oncology (ASCO)4. CoC standard 3.3 stipulates that CoC accredited programs provide all cancer survivors with a cancer treatment summary (CTS) and survivorship care plan (SCP). The timeline and scope are to be phased in – mandating that a CTS and SCP will be provided to 50% of eligible patients by by January 1 2017, 75% of eligible patients by January 1 2018, and 100% of eligible patients by January 1 20195.  Unfortunately, a number of centers continue to have difficulty meeting these standards6. The lack of research and evidence-based guidelines and the inability to define the most important focus elements are both major barriers to providing care recommendations and developing/distributing SCPs7. It is hoped that this series will help to bridge those divides as head and neck-specific care plans are developed.   The AHNS has already developed a comprehensive treatment summary template and has made this available for public consumption2,8. A care plan template is in development with the AHNS Survivorship Committee and will soon be made available as well.

The initial set of topics completed for this series were done so with SCP development in mind. However, the compendium is intended to serve as a reference library for patients along the survivorship continuum. As such, it will be updated on an ongoing basis. It is hoped that this will be a resource for providers and patients who desire a concise overview of a particular issue germane to survivorship care. As stand-alone topics, these can and will be revised individually as new information becomes available.  Each is designed for patient consumption and organized in a manner that will facilitate communication with the treating physician(s). For each topic, the issue at hand will be defined in lay terms. It will be discussed in the context of its relevance and prevalence among head and neck cancer patients. Where applicable, its signs and symptoms will be outlined (including photographic examples when available). Diagnosis and treatment paradigms will be presented. A list of associated signs/symptoms which should prompt the patient to call their physician will also be included. Finally, each topic will include a list of resources where patients and providers can obtain additional information on the topic. Each topic has been researched and developed by a member of the AHNS survivorship committee and vetted by the committee as a whole. These have been reviewed by patient-comprised advisory committees for content and for meeting health literacy standards.

References:

  1. Cohen EE, LaMonte SJ, Erb NL, et al.American cancer society head and neck cancer survivorship care guideline. CA Cancer J Clin. 2016;66(3):203-239.
  2. Miller MC, Shuman AG. Survivorship in head and neck cancer: a primer. JAMA Otolaryngol Head Neck Surg. 2016;142(10):1002-1008.
  3. Hewitt ME,Ganz PA; Institute of Medicine; American Society of Clinical Oncology. From cancer patient to cancer survivor: lost in transition: an American Society of Clinical Oncology and Institute of Medicine Symposium. Washington, DC: National Academies Press; 2006.
  4. ASCO Survivorship Compendium. asco.org/practice-guidelines/cancer-care-initiatives/prevention-survivorship/survivorship-compendium-0. Accessed March 1, 2017.
  5. Cancer Program Standards (2016 Edition). https://www.facs.org/quality-programs/cancer/coc/standards. Accessed March 1, 2017.
  6. Birken SA, Presseau J, Ellis SD, Gerstel AA, Mayer DK. Potential determinants of health-care professionals’ use of survivorship care plans: a qualitative study using the theoretical domains framework. Implementation Science : IS. 2014; 9: 167.
  7. Stricker CT, O’Brien M. Implementing the commission on cancer standards for survivorship care plans. Clin J Oncol Nurs.2014;18 Suppl:15-22.
  8. American Head and Neck Society Head and Neck Cancer Treatment Summary. https://www.ahns.info/wp-content/uploads/2016/08/Treatment-Summary-AHNS-July-2016.pdf?x72164. Accessed March 1, 2017.
  9. American College of Surgeons – https://www.facs.org/quality-programs/cancer/coc/standards