Survivorship Care Plans in Gynae-oncology an interactive discussion

Transcription

1 Survivorship Care Plans in Gynae-oncology an interactive discussion Nicole Kinnane Project Manager Australian Cancer Survivorship Centre Nurse Co-ordinator Gynae-oncology Peter Mac

2 Survivorship Care Plans (SCPs) in Revise gynaecology cancer incidence and health issues pre and post treatment Provide an overview of the SCP literature Open discussion regarding implementation of SCP in practice Patient preferences recent survey ( if we have time ) Resources available Gynae-oncology

3 Gynaecological Cancers Gynaecologic cancer survivors experience a broad array of health issues before, during and after treatment, while multi-modality therapy has improved survival and outcomes..(survival is) associated with higher odds of experiencing several different health issues Westin et al 2016 Survivors of gynaecologic malignancies: impact of treatment on health and well being. Journal of Cancer Survivorship 10:

4 Gynaecological Cancer in Australia 18% female cancers worldwide Estimated to be the 3rd most commonly diagnosed cancer among females in 2016 It is estimated that the risk of being diagnosed with gynaecological cancer by 85th birthday will be 1 in 22. In in Australia, females diagnosed with gynaecological cancer had a 68% chance of surviving for 5 years Most associated with good survival rates AHIW 2014 Gynaecological cancer in Australia

5 Age specific incidence Most > 55yrs More than likely more than on other chronic disease

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7 Salani 2013 Survivorship planning in gynaecologic cancer patients Literature review articles Highlights: SCPs following primary treatment may improve coordination of care Common late and long term effects Survivorship period a teachable moment to improve lifestyle behaviours and promote Salani R (2013) Survivorship planning in gynaecologic cancer patients. Gynaecologic Oncology 130:

8 Range of problems during and after treatment Westin et al 2016 (n=1029)

9 Treatment modality impacts Compared to surgery alone: Surgery, chemotherapy & radiotherapy Chemotherapy and radiation Surgery and chemotherapy fatigue sexual dysfunction, neurologic symptoms, bowel complaints, osteoporosis lymphoedema fatigue memory difficulties urinary problems (urinary leakage with cough, sneeze, feelings of urgency, frequent UTIs ) bowel complaints osteoporosis depression Memory difficulties Sleep disturbance( inability to fall asleep or stay asleep during the night ) anxiety This study sexual dysfunction was an issues for all patients regardless of radiation Westin et al 2016

10 5 highest unmet needs Beesley et al 2008 n=820 Fear of recurrence (17%) Concerns about those close to them (15%) Uncertainty (future) (14%) Lack of energy (14%) Unable to do things they used to (14%) Urbaniec et al 2011 n=45 Reported clinical anxiety(28.9%) Mild severe depression(20.0%) Probable post traumatic stress disorder(15.6%) NOTE: Fear of recurrence (26.7%); Worry about communication between health care professionals (26.7%) loss of assumptive world [nothing bad will happen to me] (26.7%)

11 Evaluated health behaviours of gynaecological cancer survivors 61-68% insufficiently active 19-44% obese 31-41% < 2 serves fruit 82-89% < 5 serves vegetables Endometrial cancer patients obese Cervix cancer patients smoking more prevalent

12 Survivorship Care Preparing cancer survivors for life after cancer should be an integral part of providing care. With increasing numbers of survivors and improved understanding of the range of challenges experienced post-treatment, new approaches are required. Current models of care are ill-equipped to cater for these demands. What is urgently needed is bestevidence guidance on medical follow-up and holistic interventions to support improved quality of life. Howell P, Kinnane N, Whitfield K 2015, Supporting cancer survivors in Victoria: Learning from the Victorian Cancer Survivorship Program pilot projects

13 SURVIVOSHIP CARE PLANS Where do they fit? Why use them?

14 What is the evidence? Kinnane et al 2015 Survivorship care plans: literature review. Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne

15 Evidence

16 Known challenges / enablers Challenges Time requires to complete Lack of personnel to complete Lack of resources Gaps in evidence No identified personal responsible (preparation, delivery, update) Remuneration Key Enablers Organisation commitment Clinical leadership Workforce education IT solutions Adequate resourcing to support implementation

17 SCP just a piece of paper? SCPs are a component of survivorship care not just a piece of paper Not designed to replace post treatment consultations Recommend development and delivery of SCP within a model of care

18 Addressing Gynaecology Survivorship - Multi-purpose communication tool Empower survivors in their post treatment care Details: Diagnosis Treatment summary Late and long term effects Signs of recurrence Recommended follow-up plan Strategies to remain well SCPs

19 Consider the audience and the Designed to meet needs of survivors/ health care professionals/ family/carers Plain language Differing literacy skills More detailed information needed by HCPs Avoid a one size fits all approach needs assessments intended outcome

20 Needs assessment tools DT and problem check list / CASUN Required more than one time point Timely referrals, appropriate use of resources Assist in promoting selfmanagement

21 Framework Needs Assessment Low Risk Endometrial Cancer Presentation 58 year old woman Post menopausal bleeding Diagnosis D&C Hysteroscopy Endometrial cancer MRI RISK STRAIFITY Proceeds to surgery (TAHBSO), sentinal lymph node RISK STRATIFY MDM presentation FIGO Stage 1 a Endometrial cancer Completion of primary treatment (?Care plan ) NEEDS ASSESSMENT AT REGULAR INTERVALS DURING FOLLOW-UP and SCP review RISK STRATIFY Post op review - routine surveillance (WCMICS Guidelines) (? Care plan )

22 Resources Survivorship Care Plans: Literature Review Survivorship Care Plans: Tool Kit

23 Resources

24 Resources

25 Conclusions: Survivorship Care Plans (SCPs) in Gynae-oncology Gynaecology cancer patients incidence is increasing and so are survivor numbers Health issues pre and post treatment impact quality of life SCPs can be used to promote wellness and positive lifestyle behaviours Consider implementation of SCPs as standard care in practice Resources are available

26 SCP Background IOM report 2005 Various professional groups / organisations promoted SCPs in clinical practice Livestrong Essential Element of survivorship Care 2011 American Society of clinical oncology (ASCO) 2013 promotes use of treatment summaries and care plans Clinical Oncology Society of Australia (COSA) Draft Position statement Critical Components of Survivorship (2015) promote survivorship care plan provision Not standard of clinical practice in Australia

27 Preferences of survivors local context Recent survey at Peter Mac Survey developed to ascertain preferences of survivors Targeted people up to 12 months post treatment Across 10 tumour streams (Breast, gynaecology, urology, bone and soft tissue, haematology, Upper GI, Lower GI, Melanoma, Head & Neck, Lung)

28 Information preferences at end of treatment 98% wanted to receive SCP Most frequently chosen topics n=219 74% List of symptoms to watch out for and report 70%A summery of treatment received 70% Plan for when I should have follow up 69%Things I can do to look after myself Least preference 10% quitting smoking 11% Fertility information 23% Sexual health information

29 *Breast Gynaecology Haem Head and Neck *Lower GI Upper GI Melanoma Sarcoma *Urology Preferences different across cancer groups Cohorts List of top 5 information requests as chosen by survivor groups Summary of treatment received A list of symptoms to watch out for and report Information about side effects of treatment A plan of when I should have follow up appointments Strategies for reducing worry about cancer coming back Name and contact details of who I should call if I have concerns A list of tests I am going to have and when Things I can do to look after myself Screening for other common cancers Special instructions to follow after treatment Pain and symptom management Diet information Exercise information Support group information Coping after treatment is over *Some topics had equal waiting within cohorts (equally chosen) so more than five indicated for some groups