Abstract
There is a recognized need and demand for comprehensive cancer survivorship care postactive treatment. 1 –3 After prolonged clinic and hospital visits and life-altering treatments, patients may feel “untethered” from providers and seek guidance to maintain or optimize their health. 4 –6 Survivorship care guidelines recommend follow-up care focusing on surveillance, health behaviors, and lingering effects of treatment. 7 –10 However, many institutions struggle to provide cost-effective comprehensive programming to meet this need. 2,3
The University of California-San Francisco's (UCSF) Psycho-Oncology service, in collaboration with supportive and integrative services across the cancer center, launched a novel group program in 2017 to meet this unmet need. Survivorship Wellness uses an interdisciplinary team approach to address physical, psychologic, and spiritual needs postactive treatment. This program aims to increase patient support through a vibrant community at a critical transition in care, simplify access to existing supportive care resources, assess patient-reported outcomes, and develop sustainable recruitment and clinical service reimbursement.
Survivorship Wellness consists of 8 weekly 90-min sessions of between 8 and 15 participants offering instruction and personalized goal setting for patients, with any cancer diagnosis, who have concluded active treatment. The evidence-based core curriculum, as outlined in Table 1, harnesses the expertise of existing cancer center supportive care resources to address many unmet psychologic, emotional, physical, sexual, social, and spiritual needs common to cancer survivors. 11 –15 Monthly sessions expand on the core curriculum, focusing on specialized topics, including integrative oncology, mindfulness, and late effects of treatment.
Core Components and Content of Survivorship Wellness Sessions
Each session is moderated by a clinical psychologist with expertise in health behavior change and goal setting to empower patients with self-management strategies. Interdisciplinary comoderators include dieticians, chaplains, exercise specialists, health coaches, and palliative care and integrative oncology providers. Candidates for this program are identified through provider referrals, patient self-referral, distress screening, and survivorship clinic enrollment. Sessions are reimbursable under insurance using health and behavior billing codes, and participation is documented in patients' medical record.
Since the launch of Survivorship Wellness, 10 cycles of the 8-session curriculum have been delivered. This quality improvement pilot program has enrolled 85 participants to date, 63 of whom have completed at least half of the 8-session curriculum. Data collection is ongoing with regard to participant attendance, satisfaction (as measured after each session), as well as quality of life and other patient-reported outcomes at preenrollment, and 9 and 15 weeks postprogram enrollment.
Current recruitment data, however, suggest that the program is connecting with only a subset of eligible patients. Discussions with referring providers, many of whom are keenly aware of the unique survivorship/postactive treatment needs of their patients, indicate that some considered the program only for select patients, or to be a peripheral program, rather than one systematically built into the care plan and available to all survivors.
Opportunities exist to improve utilization of these group services: first, investigate ways to systematically identify patients approaching end of active treatment and automate those referrals; second, encourage all providers to plan for survivorship care throughout active treatment; lastly, deploy supportive care screenings at end of active treatment to identify patients who may benefit from survivorship services. Ongoing efforts will utilize implementation science best practices to optimize program visibility and partnerships with referring providers.
Footnotes
Author Disclosure Statement
No competing financial interests exist.