Survivorship Issues for Patients With Lung Cancer

Christie L. Pratt Pozo, DHSc; Mary Ann A. Morgan, PhD; Jhanelle E. Gray, MD


Cancer Control. 2014;21(1):40-50. 

In This Article

Models and Survivorship Programs

In academic cancer centers, various models of survivorship care are being developed and evaluated for their survivorship care effectiveness. These include disease-specific models (eg, breast, colon), one-time consultative models that review all of the patient records and then provide them with a comprehensive treatment summary and care plan, long-term general survivorship care models that follow many cancer types, and integrated models where patients are followed by advanced practice professionals at the end of treatment or are on maintenance therapy.[33]

In the community, many oncology practices have developed survivorship clinics or expanded their services. In 22 states, the National Cancer Institute has provided funding to 30 community cancer centers through the NCCCP to enhance services at local community hospitals with shared resources, presentations, and the NCCCP Web site.[32,33]

Regardless of the type of survivorship model implemented, primary care must be integrated for the coordination of patient care. Some patients with low intensity and low risk for recurrence are referred back to their primary providers for ongoing followup. Other patients share care between oncologists and primary care providers.[34] The Survivorship Care Plan was recommended by the IOM to assist in this coordination of care. Although ASCO endorses the National Coalition for Cancer Survivorship definition of a survivor as any patient with a diagnosis of cancer, by focusing on high-quality cancer survivorship care, ASCO has limited its focus to individuals who have successively completed curative treatment or have transitioned to maintenance or prophylactic therapies.[23,33] Each site will need to define survivoras a key aspect of developing a survivorship program.

Patients with stage I lung cancer may be transferred back to their primary care physician after 5 years of annual history and physical examinations, laboratory studies, and chest radiography. However, compared with the general population, these patients continue to have a higher risk for second malignancies.[35] Given the complexity of treatment and frequent late stage at diagnosis, the shared care model is likely most appropriate for survivors of lung cancer. In this model, patient care is shared among specialist and generalist providers whose roles are clearly delineated and ongoing communication is established, with a periodic transfer of knowledge available from the oncology team to the primary care providers and pulmonologists. The care plan should include a summary of treatments given, potential long- and late-term effects, a formal follow-up plan of testing and visits, and healthy lifestyle recommendations such as smoking cessation, diet, and exercise. Different models exist to determine who will prepare such a document (eg, the oncology team prepares this plan in the diseasespecific model, while the long-term survivorship clinics may complete the plan in the consultative model). Although the individual who completes these will likely be determined from site to site, it is clear that physicians, advanced practice professionals, and nurses are likely to be involved.[32,33] Since reimbursement for preparing these documents is not yet available, when reviewing them with patients, counseling time should be documented for appropriate coding.