Accredited Program Data May Set Benchmark for Adult Cancer Survivor Care

Fertility and sexual health services appear to be offered to cancer survivors less often than other services at CoC-accredited practices.

Enforcing survivorship standards may help centers provide services to address the needs of cancer survivors, according to findings from an online, cross-sectional survey of American College of Surgeons (ACS) Commission on Cancer (CoC)-accredited programs published in JAMA Network.¹

Although numerous institutions have services endorsed by CoC survivorship standards, only a minority of patients may receive access to them. As the number of adult cancer survivors in the United States expands, this population’s long-terms needs may remain inadequately understood or addressed, particularly in specialized services for fertility and sexual health.

Treatment summaries (n = 242) or survivorship care plans (n = 173) were offered at approximately 90% of accredited programs. Screening for new and/or recurrent cancers (n = 330), nutritional services (n = 325), rehabilitation (n = 319), and genetics counseling (n = 305) were frequently available for all survivors. Sexual health and fertility services were available at less than 60% of programs for all survivors and were subsequently offered to specific patient subsets (sexual health: 76 programs; fertility: 91 programs) or were unavailable (57 programs; 49 programs).

Of respondents who filled out survey data on the proportion of eligible patients receiving survivorship care (n = 377), more than 80% endorsed some (n = 229), few (n = 77), or none (n = 1). The most common barrier to receiving survivorship services included lack of referral (n = 106) and a lack of awareness of services (n = 86).

“We found that most institutions actually have a reasonable number of survivorship services available to their patients—that’s encouraging because it means we have a foundation to work with when trying to advance survivorship care,” senior study author David R. Freyer, DO, MS, director of the cancer survivorship programs at Children’s Hospital Los Angeles and the University of Southern California (USC) Norris Comprehensive Cancer Center, said in a press release on these findings.² “Where we started to see differences is in which specific services were available and how institutions provide them.”

Of the 1353 eligible programs reached for response, 439 responses were received, with 380 fully completed and 59 partially completed. Of the partial responses, 4 were retained to bring the final analytic sample to 384 programs, which yielded a response rate of 27.4%.

Of the analytic sample, 371 reported their program category, of which 122 were comprehensive community cancer programs and 84 were community cancer programs. Two-thirds of programs reported analytic caseloads of 500 to 999 patients (n = 80) or 1000 to 4999 patients (n = 161). Surveys were primarily completed by cancer program administrators (n = 187) or survivorship program coordinators (n = 141).

Common team members included nurses in 334 programs, social workers in 278, program coordinators in 275, advanced practice clinicians (APCs) in 252, nutritionists in 250, and physicians in 243 programs. Physical and occupational therapists appeared in 180 and 87 programs, respectively. Survivorship team composition was consistent across CoC program categories expect for a greater proportion of physicians and APCs in Integrated Cancer Network, Academic Comprehensive Cancer, and National Cancer Institute (NCI)–Designated Cancer programs.

Additionally, 120 programs offered a specialized survivorship clinic, with 58 offering clinics for all survivors and 57 offering to certain patient subsets. The most endorsed survivorship program components included delivery of survivorship by the same cancer treatment team (n = 243) and having regular team meetings (n = 228). Furthermore, 31 programs reported having survivorship research staff members.

The 5 most endorsed resources needed to advance survivorship programs were APCs with dedicated survivorship effort at 205 programs, survivorship enhancements for the electronic health record system at 185 programs, increased patient referrals from cancer clinics at 172 programs, increased internal awareness of the program at 167 programs, and survivorship office staff at 140 programs.

References

1. Stal J, Miller KA, Mullett TW, et al. Cancer survivorship care in the United States at facilities accredited by the Commission on Cancer. JAMA Oncol. 2024;7(7): e2418736. doi:10.1001/jamanetworkopen.2024.18736
2. Survivorship standards help address the distinct needs of adult cancer survivors. News release. American College of Surgeons. Published July 3, 2024. Accessed July 8, 2024. https://tinyurl.com/3av2r5tk