Mandi Pratt-Chapman

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline

The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for Clinicians and Journal of Clinical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Cancer Society or the American Society of Clinical Oncology.

American Cancer Society prostate cancer survivorship care guidelines.

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American Cancer Society Head and Neck Cancer Survivorship Care Guideline

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American Cancer Society Colorectal Cancer Survivorship Care Guidelines.

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Advancing survivorship care through the National Cancer Survivorship Resource Center: developing American Cancer Society guidelines for primary care providers.

The National Cancer Survivorship Resource Center (The Survivorship Center) began in 2010 as a collaboration between the American Cancer Society and the George Washington University Cancer Institute and was funded by the Centers for Disease Control and Prevention. The Survivorship Center aims to improve the overall health and quality of life of posttreatment cancer survivors. One key to addressing the needs of this ever‐growing population is to develop clinical follow‐up care guidelines that emphasize not only the importance of surveillance for cancer recurrence, but also address the assessment and management of the physical and psychosocial long‐term and late effects that may result from having cancer and undergoing cancer treatment as well as highlight the importance of healthy behaviors that can reduce the risk of cancer recurrence, second primary cancers, and other chronic diseases. Currently, The Survivorship Center is coordinating the work of experts in oncology, primary care, and other health care professions to develop follow‐up care guidelines for 10 priority cancer sites. CA Cancer J Clin 2013.

Survivorship navigation outcome measures: a report from the ACS patient navigation working group on survivorship navigation.

Survivorship navigation is a relatively new concept in the field of patient navigation but an important one. This article highlights the essential functions of the survivorship navigator and defines core outcomes and measures for navigation in the survivorship period. Barriers to access to care experienced by patients during active cancer treatment can continue into the post‐treatment period, affecting quality follow‐up care for survivors. These barriers to care can be particularly acute for non‐English speakers, immigrants, the uninsured, the underinsured, and other vulnerable populations. The survivorship navigator can help reduce barriers and facilitate access to survivorship care and services through communication and information exchange for patients. Survivorship navigation may improve appropriate health care utilization through education and care coordination, potentially improving health outcomes and quality of life of survivors while reducing cost to the health care system. Survivorship navigators can also educate survivors on how to improve their overall wellness, thereby directly impacting the health of a growing population of cancer survivors. Cancer 2011;117(15 suppl):3573–82.

Advancing access and equity: the vision of a new generation in cancer control

172 www.thelancet.com/oncology Vol 18 February 2017 As the next generation of cancer advocates and leaders, we inherit a legacy that is in many ways, remarkable. The past few decades have seen rapid and unparalleled progress in cancer control. Investigative breakthroughs, such as those in cancer genomics and immunology, have transformed our understanding of the disease. New discoveries in cancer prevention have mitigated risk factors, and improvements in surgical techniques, radiotherapy technologies, and systemic agents have led to substantial improvements in cancer cure rates— an absolute survival increase of roughly 20% during the past three decades. This progress has been impressive, but its distribution has not been equitable. Signifi cant disparities in cancer outcomes persist between and within countries resulting in a so-called cancer divide, a deplorable situation compounded by the fact that the greatest burden of cancer aff ects low-and-middle-income countries (LMICs). It is the call of our generation to close this cancer divide, especially in view of the rapid acceleration of the global burden of cancer and its consequent strain on social, economic, and health systems. The challenges are many. Inadequate prioritisation of eff ective prevention strategies exacerbates the global burden. Early detection is complicated by limited primary care and pathology capacity; in many LMICs, even the most basic diagnostic and treatment services are inaccessible or unaff ordable. Supportive and palliative care is absent in most of the world, a startling inequity that permits the needless suff ering Advancing access and equity: the vision of a new generation in cancer control cost of signifi cant fi nancial strain, inadequate palliative care, and unmanaged existential suff ering, it would seem so. The question arises as to how physicians can better manage the care of patients with advanced cancer in an age of unlimited access to knowledge. It is crucial that from the very outset hope is balanced against realism. In this, physicians, patient advocates, the media, government agencies, and the pharmaceutical industry all have parts to play in the provision of honest, measured information for patients and their families. Realistically, we need to accept that many of our patients will seek a second opinion (if not more) online, and be prepared to engage with them in interpreting the results of their enquiries. And yes, we should celebrate the victories with our patients. But we should also temper their expectations. As we inform our patients that their time may be limited, we should ask—“Is there anything you want or need to do that you haven’t yet done? In order for me to best look after you, I need to know what matters to you.” Confronting yes, but it is questions such as these that can profoundly refocus the therapeutic relationship in a way that acknowledges not only the limits of our ability to defy death, but the intrinsic value of the life that has been lived. In the post-truth age our obligations as physicians remain the same. We should use information with precision and wisdom, much as a surgeon uses a scalpel. As we strive to provide compassionate care, it is up to us to ensure not only a steady hand, but that the knife is not wrested from our grasp.

Navigation Training, Tools, and Resources

Patient navigation has arisen quickly as a new health profession with great heterogeneity of background, training, roles, and practices. This chapter provides an overview of key tools and resources available to new and experienced navigators of various types, including core competencies, training, certificate and certification options, guides and toolkits, and evaluation support.

In their own words: patient navigator roles in culturally sensitive cancer care

PurposePatient navigation has emerged as a promising strategy in reducing disparities among diverse cancer patients. However, little is known about navigators’ own perspectives on their roles in providing culturally competent care. The purpose of the present study is to describe these self-identified roles.MethodsData were collected from an online survey with a convenience sample of cancer patient navigators. Using NVivo 10, qualitative content analysis was conducted on free text responses to the question: “In your opinion, what is the role of a patient navigator or nurse navigator in the provision of culturally sensitive care to patients?” Frequencies of each navigator-identified role mentioned were tabulated.ResultsOf 294 respondents, 50.7% (n = 149) provided a response to the question of interest. Respondents described the following 11 interrelated navigator roles in the provision of culturally competent care: (1) assess and understand patient needs, (2) tailor care to patient, (3) build rapport/open communication, (4) facilitate communication between patient and health care team, (5) educate/provide resources to the patient, (6) advocate, (7) self-motivated learning, (8) address barriers to care, (9) involve/meet the needs of family or support people, (10) educate/support health care team, and (11) support patient empowerment in care.ConclusionsPatient navigators are uniquely well-positioned to improve cultural competence of cancer care given their role as liaison to patients and providers. Cancer care settings should use navigators with direct knowledge of patient culture whenever possible; however, communication and cultural competence training is highly recommended for all navigators given the diversity of patient needs.

Quality Cancer Care

The cancer care system suffers from unevenly distributed resources, variability in practice, workforce constraints, and misaligned financial incentives. A quality cancer care system is equitable, patient-centered, safe, effective, and timely. Attaining this vision of quality care depends on a collaborative commitment to equity, transparency, and information sharing for ongoing quality improvement. This chapter focuses primarily on quality cancer care in the USA with implications for global expansion and attention to the navigator role in quality cancer care.