Clinical Topics & News
As more and more patients with cancer become cancer survivors, the treatment landscape is changing. Increasingly, primary care providers bear much of the burden of care, but the lack of care coordination and clinical guidelines hamper efforts to care for the growing number of survivors. A number of speakers at the recent Association of VA Hematology/Oncology (AVAHO) sought to address these challenges and report on approaches to improving the quality of care for survivors.
Related: Putting the Focus on Quality of Life in Cancer Care
The VA Survivorship Interest Group (SIG) is trying to raise awareness and facilitate the delivery of high-quality survivorship care to veterans diagnosed with cancer, according to David A. Haggstrom, MD, MAS, of the Indianapolis VA Medical Center and Indiana University School of Medicine. Through monthly meetings, SIG is encouraging new research and promoting initiatives to develop survivorship related products and appropriate models of care delivery.
A Survivorship care plan that includes a treatment summary, and follow-up plan for a patient who has completed cancer treatment is one approach to improve care for cancer survivors. According to Haggstrom, the VA appears to be on track to meet the Commission on Care’s recommendation that ≥ 25% of eligible patients receive a survivorship care plan by the end of 2016, but more work needs to be done to get to the 2017 goal of ≥ 50%.
For example, the more than 2 million prostate cancer survivors have a number of complex problems that pose challenges to VA care providers, according to Ted A. Skolarus, MD, MPH, of the University of Michigan and VA Ann Arbor Healthcare System. Poor urinary control and sexual function can have a significant impact on quality of life for survivors. Furthermore, the lack of organized symptom assessment, clinical guidelines, and other support for patients and providers remains a challenge for providing high-quality care. Much of that burden is born by primary care providers, who are frequently uncomfortable addressing incontinence, impotence, and other psychosocial issues that are common among prostate cancer survivors.
Dr. Skolarus discussed an ongoing randomized self-management trial of veteran prostate cancer survivors, which tested self-management. Patients were assessed using an interactive voice response tool to administer a quality of life survey based on the Expanded Prostate Cancer Index Composite (EPIC), which measures urinary, sexual, bowel, and hormonal/vitality health. Patients are then provided with self-management tools that are specifically developed based on their EPIC responses. The trial is expected to close at the end of 2016.
Related: Cancer Survivorship Care
Sharon L. Bober, PhD, director of the Sexual Health Program at Dana-Farber Cancer Institute, delved in greater detail into the impact of sexual health on quality of life among cancer survivors. The majority of survivors are not prepared to deal with changes in sexual health, Dr. Bober reported, and “more than 50% have profound long lasting dysfunction.” Estimates of sexual dysfunction after cancer range from 40% to 100%, and while the issues for patients with breast or prostate cancer are more obvious, the sexual health problems are not limited to those types of cancer. Moreover, Dr. Bober argued, sexual health involves both physical and psychological aspects and proper treatment should address both.
