There are currently an estimated 15.5 million cancer survivors in the U.S., which is expected to increase in number and racial/ethnic diversity. Cancer survivors face many unique challenges, including late and long-term health effects, emotional and financial hardships, and a greater risk for developing second cancers and other serious health conditions. These challenges may be even more prevalent among underserved populations. In 2006, the Institute of Medicine (IOM) recommended the widespread implementation of survivorship care plans (SCPs) to facilitate the transition from active treatment to cancer survivorship, from oncology care to primary care. SCPs are intended to encompass the details of cancer treatment, which can be shared with current and future medical providers; anticipatory education for survivors; and provision of information about available resources relating to survivorship needs. The recommendations call for oncology treatment teams to review SCPs with patients at the conclusion of their cancer treatment. Early research in the years since the IOM recommendations has shown that implementation of SCPs is not widespread, evidence of improved survivor outcomes is limited, and there is considerable variation in the content of SCPs, with many plans failing to adhere to all of the IOM recommendations. Moreover, there is virtually no research on whether existing SCPs are culturally- or linguistically-tailored to patients and whether they address key social determinant barriers among underserved patients. More research is needed to thoroughly explore the efficacy and viability of SCPs in real-world settings. Specifically, while previous research has uncovered key cultural differences in survivorship experiences, we still know little about the appropriateness, effectiveness, and implementation of SCPs among cancer survivors from diverse racial/ethnic, cultural, and socioeconomic backgrounds. The overarching goal of this proposal is to investigate the extent to which SCPs are implemented in clinical care and used among diverse and underserved populations of breast and colorectal cancer survivors in California. Leveraging population-based cancer registries, we therefore propose the Cancer Registry for Understanding and Improving Survivorship Experiences (CRUISE) project, which takes a comprehensive, multi-level approach to examine the implementation of, and patient experiences with, SCPs, with focus on underserved populations.
Our aims are as follows: 1) to examine the use and effectiveness of SCPs on patient-reported outcomes in breast and colorectal cancer survivors in the Greater San Francisco Bay Area; 2) to investigate the implementation and content of survivorship strategies and support including SCPs in use in California health systems serving diverse cancer patient populations; and 3) to convene a Delphi panel of stakeholders to develop best practices for delivering SCPs to meet the needs of diverse patient populations. The current proposal will advance our understanding of the implementation and effectiveness of SCPs from both the perspective of survivors and healthcare systems, focusing in particular on underserved patient populations.
The long-term goal of this research is to improve the use and effectiveness of survivorship care plans for diverse, underserved patient populations. This project leverages population-based cancer registries to take a comprehensive, multi-level approach to examining the implementation of and patient experiences with survivorship care plans in breast and colorectal cancer survivors. Promising solutions will be developed in the form of best practice strategies that will re-envision the nature and delivery of survivorship care plans.