People who have completed treatment for head and neck cancer commonly experience severe long-term toxicities, late-occurring symptoms, and significant risks of second primary malignancy and comorbid illnesses. With multiple simultaneous health issues, health care providers often fail to comprehensively address the needs of these complex cancer survivors. A tool is needed to streamline and standardize comprehensive care for this cohort. We designed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR) to address health care challenges for this especially complex and vulnerable population. HN-STAR is an electronic platform that aims to simplify the provision of personalized care. It uses an algorithmic approach to synthesize patient-reported outcomes, clinical details, and evidence-based guidelines to standardize comprehensive care provided in routine clinical follow-up visits. It has four distinct components: a simplified treatment summary, an online survivor self-assessment, an interactive discussion guide presenting all relevant information to the provider during the clinic visit, and a survivorshp care plan generated at the end of each visit. By using a modifiable electronic platform, HN-STAR provides a method for tracking changes in symptoms, disseminating evidence on symptom management, and incorporating survivorship care plans into clinical practice. HN-STAR directly responds to the new Commission on Cancer accreditation standards, which require the dissemination a survivorship care plan (containing features included in HN-STAR's survivorship care plan) for all patients who have completed treatment for cancer. We propose to conduct a two-year pilot study to assess the feasibility and study design of a future multi-site, randomized clinical trial of HN-STAR. We will enroll 55 head and neck cancer survivors who are followed in one of two nurse practitioner-led survivorship clinics and implement HN-STAR for their routine survivorship visits. We will assess (1) usability and feasibility outcomes of HN-STAR from the perspective of key stakeholders and (2) the planned outcomes intended for the larger trial. We will collect usability and feasibility data from online surveys of survivors and teir providers. If the intervention trial is found to be feasible, an R01 application for support of a multi-institutional trial will be submitted to the National Cancer Institute. The long- term goal i to determine if such an intervention will lead to improved and simplified comprehensive survivorship care of complex cancer survivors.
Head and neck cancer survivors have a complex set of health needs that require ongoing care from oncology providers, primary care providers, and sometimes other specialists. In order to standardize, streamline, and simplify the care of these complex survivors, we designed an electronic system to collect information about survivors, guide discussions about care, and produce a personalized survivorship care plan to share with the survivor and their providers. Our proposal studies the usability and feasibility of this system from the perspective of experts and key stakeholders, so that we can study its effectiveness in a future multi-center trial.
| Salz, Talya; Baxi, Shrujal (2016) Moving survivorship care plans forward: focus on care coordination. Cancer Med 5:1717-22 |
| Salz, Talya; McCabe, Mary S; Oeffinger, Kevin C et al. (2016) A head and neck cancer intervention for use in survivorship clinics: a protocol for a feasibility study. Pilot Feasibility Stud 2:23 |
