The cancer center is hoping to add survivorship programs in head and neck cancer and gynecologic oncology, she said, encouraging meeting attendees from other cancer centers to establish their own survivorship programs. "You have to start somewhere, or you can’t succeed or fail," she told them.
City of Hope: Research Opportunity
At City of Hope in Duarte, Calif., there had been a long-standing pediatric survivorship program, but the comprehensive cancer center has added breast and prostate cancer, and is developing programs in gastrointestinal, gynecologic, lung, and hematologic cancers, said Denice Economou, a registered nurse and project director for survivorship education for quality cancer care.
The breast cancer program was difficult to get up and running because the oncologists wanted to wait at least 10 years post diagnosis before referring a patient, said Ms. Economou. But now, patients are eligible starting from diagnosis. They get a yearly follow-up visit with a nurse practitioner and medical oncologist, in collaboration with the primary breast oncologist. Patients are assessed for therapy-related complications such as premature menopause, osteoporosis, and depression, among other issues, Ms. Economou said.
Prostate cancer patients are eligible if they are at least 1 year out from initial surgery. They are seen every 6 months for 5 years, and then yearly after that. The focus is on health promotion.
All survivors are given a survivorship care plan, with a summary of the treatment they received for their cancer. It gives the patients something to take to any and all clinicians who may see them throughout their life, she said. And it is all done without the benefit of an electronic medical record.
The survivorship visits also provide an opportunity to enroll patients in research protocols, said Ms. Economou.
CTCA: $18 million in Income
Survivorship programs are also an important part of care at the four hospitals that make up the for-profit Cancer Treatment Centers of America, said Tom Lay, director of the survivorship support program at the company.
CTCA provides a wide range of support services, including patient education; coping strategies; wellness, referral and medical services; and aesthetic services (for breast cancer patients and others needing that type of support). As at the other programs, patients are given a treatment summary and a wellness plan, which is similar to the passport that M.D. Anderson patients receive, said Mr. Lay.
The survivorship program costs about $150,000 a year, but brings in $18 million to CTCA, he said. There are some 1,200 visits a year to physicians and nurse practitioners, resulting in about $150,000 in evaluation and management reimbursement. There is also indirect reimbursement from imaging services, pathology, nutrition, physical therapy, and same-day surgeries such as colonoscopies.
Many community physicians have now begun to refer survivors to CTCA for its program. Those handfuls of referrals are worth some $6.2 million, based on the lifetime costs of caring for cancer survivors, Mr. Lay said.
In the future, CTCA’s survivorship program is looking to take over more of the care for low-risk survivors from oncologists. That frees up the medical oncologist to take on additional new patients, he said.