FROM JOURNAL OF CLINICAL ONCOLOGY
A cancer survivorship care plan increased the information patients received yet failed to increase patient satisfaction with cancer care. Moreover, patients who received care plans experienced more symptoms, were more concerned about their illness, and were more affected emotionally than were those who did not, according to a study published online Aug. 24 in Journal of Clinical Oncology.
The Institute of Medicine and other groups recommend survivorship care plans (SCPs) for all cancer survivors to help them deal with the challenges they face after diagnosis. Yet few studies have examined SCPs’ effectiveness. To do so, researchers performed what they described as the first pragmatic, cluster-randomized longitudinal trial comparing an automatically generated SCP against usual care in routine clinical practice.
The study involved 221 women with newly diagnosed endometrial cancer treated at 12 medical centers in the Netherlands. Six of the hospitals were randomly assigned to provide usual care (102 patients) and six to provide SCPs (119 patients) immediately after initial surgery, with updated SCPs offered 6 and 12 months later, said Kim A. H. Nicolaije of Tilburg University and the Comprehensive Cancer Center the Netherlands, Eindhoven, and her associates.
Usual care included verbal and written information about diagnosis and treatment, the recovery period, signs of recurrence, and hospital contacts; no additional information was given during follow-up, except for referrals when indicated.
The SCP entailed a treatment summary tailored to each patient’s diagnostic test results, tumor stage and grade, comorbidities, and evolving complications. It addressed possible short- and long-term effects of the cancer and its treatments on physical, social, and sexual life; signs of recurrence and secondary tumors; services such as rehabilitation, psychosocial support, and supportive care; and contact information for hospital personnel and outside specialists.
At follow-up, participants in the SCP group said they’d received more information about their disease, its treatments, other services available to them, different places where they could seek care, and ways they could help themselves get well, compared with the usual-care group. Yet there were no significant differences between the two study groups in several measures of satisfaction with the information provided or with the care itself. Furthermore, patients in the SCP group said they experienced more symptoms, were more concerned about their illness, and were more affected emotionally than were those in the usual-care group.
The SCPs called for including patients’ primary care physicians in the plans while usual care did not, and patients in the SCP group reported having more cancer-related contact with their primary-care physicians than those in the usual-care group. Yet this increased contact did not lead to better patient satisfaction, Ms. Nicolaije and her associates said (J Clin Oncol 2015 Aug 24. doi:10.1200/JCO.2014.60.3399).
It is unclear whether these effects are harmful or beneficial for patients. “One could argue that receiving an SCP raises patients’ awareness of cancer-related symptoms and empowers them to find the necessary support,” even if they don’t recognize this as a benefit, the investigators added.
The Dutch Cancer Society supported the study. Ms. Nicolaije reported having no conflicts of interest; a coauthor reported receiving research funding and reimbursement for expenses from Janssen Pharmaceuticals.