Impact of Survivorship Care Plans and Planning on Breast, Colon, and Prostate Cancer Survivors in a Community Oncology Practice

  • Alexandra Hua
  • Mary E. Sesto
  • Xiao Zhang
  • Timothy R. Wassenaar
  • Amye J. TevaarwerkEmail author


With a growing number of cancer survivors, survivorship care plans (SCPs) are recommended to communicate information about late effects of treatment and follow-up care. Community oncology practices follow 85% of adult cancer survivors but report more difficulty in providing SCPs compared to academic centers. Our objective was to evaluate the impact of delivering SCPs in a community oncology practice by examining awareness of SCP receipt as well as how provision affects survivors’ perception of care quality and of their condition. Survivors who accepted a SCP as standard of care were recruited from a community oncology practice in the Midwest and completed surveys prior to SCP provision (baseline) and 4 weeks later (follow-up). Within-survivor changes in knowledge of SCP receipt, satisfaction and perceived care coordination were assessed. Thirty cancer survivors (breast, colon, and prostate) completed the baseline survey, while 24 completed the follow-up survey (80% response rate). Participants reported receiving SCPs and treatment summaries more frequently at follow-up after receiving a SCP. At follow-up, there was a significant increase in survivor activation and involvement in care along with satisfaction of knowledge of care. Communication about and during SCP provision may need to be clearer: 34% of survivors could not correctly identify SCP receipt in this study. This may place these survivors at a disadvantage, if this leads to less awareness of important information regarding follow-up surveillance and management. Of those aware of SCP receipt, SCP provision had positive impacts in this small, short-term study.


Survivorship care plans Survivor satisfaction Care coordination Community oncology 



The authors would like to thank the following: participating patients, providers, members of the UW Breast DOT (Renae Quale), and the Wisconsin Survivorship research Program (WiSP).


This work was supported by the NCI Cancer Center Support Grant P30 CA014520 and by grant UL1TR000427 to UW ICTR from NIH/NCATS. AJT received support from the Clinical and Translational Science Award (CTSA) program through the NIH National Center for Advancing Translational Sciences (NCATS), grants UL1TR000427 and KL2TR000428. The Summer Research Program was funded by institutional foundation award from the Herman and Gwen Shapiro Foundation. This work is supported in part by NIH/NCI P30CA014520, the University of Wisconsin Carbone Cancer Center Support Grant.

Compliance with Ethical Standards

This study was approved by the institutional review boards at the both the academic medical center and the community oncology practice (PHC).

Conflict of Interest

Hua, Alexandra—none

Sesto, Mary E—none

Tevaarwerk, Amye J—Epic Systems (family member)

Wassenaar, Timothy—none

Zhang, Xiao—none

Supplementary material

13187_2018_1457_MOESM1_ESM.pdf (525 kb)
Supplemental Material 1 Survivor surveys (PDF 524 kb)
13187_2018_1457_MOESM2_ESM.docx (76 kb)
Supplemental Table 1 PICS results (DOCX 75 kb)


  1. 1.
    Institute, National Cancer (2017) Cancer statistics. Accessed 2018Google Scholar
  2. 2.
    Medicine, Institute of, and National Research Council (2006) From cancer patient to cancer survivor: lost in transition. The National Academies Press, Washington, DCGoogle Scholar
  3. 3.
    Tremblay D, Latreille J, Bilodeau K, Samson A, Roy L, L’Italien MF, Mimeault C (2016) Improving the transition from oncology to primary care teams: a case for shared leadership. J Oncol Pract 12(11):1012–1019. CrossRefPubMedGoogle Scholar
  4. 4.
    Hill-Kayser CE, Vachani C, Hampshire MK, Jacobs LA, Metz JM (2009) An internet tool for creation of cancer survivorship care plans for survivors and health care providers: design, implementation, use and user satisfaction. J Med Internet Res 11(3):e39. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Weaver KE, Aziz NM, Arora NK, Forsythe LP, Hamilton AS, Oakley-Girvan I, Keel G, Bellizzi KM, Rowland JH (2014) Follow-up care experiences and perceived quality of care among long-term survivors of breast, prostate, colorectal, and gynecologic cancers. J Oncol Pract 10(4):e231–e239. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Earle CC, Burstein HJ, Winer EP, Weeks JC (2003) Quality of non–breast cancer health maintenance among elderly breast cancer survivors. J Clin Oncol 21(8):1447–1451. CrossRefPubMedGoogle Scholar
  7. 7.
    Tomasone JR, Brouwers MC, Vukmirovic M, Grunfeld E, O'Brien MA, Urquhart R, Walker M, Webster F, Fitch M (2016) Interventions to improve care coordination between primary healthcare and oncology care providers: a systematic review. ESMO Open 1(5):e000077. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Society, American Cancer. 2018. Survivorship care plans. Accessed 2018.Google Scholar
  9. 9.
    Birken SA, Mayer DK, Weiner BJ (2013) Survivorship care plans: prevalence and barriers to use. J Cancer Educ 28(2):290–296CrossRefGoogle Scholar
  10. 10.
    Brothers BM, Easley A, Salani R, Andersen BL (2013) Do survivorship care plans impact patients' evaluations of care? A randomized evaluation with gynecologic oncology patients. Gynecol Oncol 129(3):554–558. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    de Rooij BH, Ezendam NPM, Nicolaije KAH, Caroline Vos M, Pijnenborg JMA, Boll D, Boss EA, Hermans RHM, Engelhart KCM, Haartsen JE, Pijlman BM, van Loon-Baelemans IEAM, Mertens HJMM, Nolting WE, van Beek JJ, Roukema JA, Kruitwagen RFPM, van de Poll-Franse LV (2017) Effects of survivorship care plans on patient reported outcomes in ovarian cancer during 2-year follow-up - the ROGY care trial. Gynecol Oncol 145(2):319–328. CrossRefPubMedGoogle Scholar
  12. 12.
    Tevaarwerk AJ, Wisinski KB, Buhr KA, Njiaju UO, Tun M, Donohue S, Sekhon N, Yen T, Wiegmann DA, Sesto ME (2014) Leveraging electronic health record systems to create and provide electronic cancer survivorship care plans: a pilot study. J Oncol Pract 10(3):e150–e159CrossRefGoogle Scholar
  13. 13.
    Jacobsen PB, Derosa AP, Henderson TO, Mayer D, Moskowitz CS, Paskett ED, Rowland JH (2018) Impact of cancer survivorship care plans (SCPs) on health outcomes and health care delivery: a systematic review. J Clin Oncol 36(7_suppl):2–2. CrossRefGoogle Scholar
  14. 14.
    Forsythe LP, Parry C, Alfano CM, Kent EE, Leach CR, Haggstrom DA, Ganz PA, Aziz N, Rowland JH (2013) Use of survivorship care plans in the United States: associations with survivorship care. J Natl Cancer Inst 105(20):1579–1587. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Dietrich L, Smith AL, Watral A, Borgert AJ, Al-Hamadani M, Van Oosbree M, Meyer CM (2016) Effectiveness of a survivorship program: an assessment of patients with breast cancer in a community setting. J Oncol Pract 12(6):e688–e696. CrossRefPubMedGoogle Scholar
  16. 16.
    Parry C, Beckjord E, Moser RP, Vieux SN, Padgett LS, Hesse BW (2015) It takes a (virtual) village: crowdsourcing measurement consensus to advance survivorship care planning. Transl Behav Med 5(1):53–59CrossRefGoogle Scholar
  17. 17.
    Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM (2005) Development and validation of the patient assessment of chronic illness care (PACIC). Med Care 43(5):436–444CrossRefGoogle Scholar
  18. 18.
    Mayer DK, Deal AM, Crane JM, Chen RC, Asher GN, Hanson LC, Wheeler SB et al (2016) Using survivorship care plans to enhance communication and cancer care coordination: results of a pilot study. Oncol Nurs Forum 43(5):636–645. CrossRefPubMedGoogle Scholar
  19. 19.
    Cleary PD, Edgman-Levitan S (1997) Health care quality. Incorporating consumer perspectives. JAMA 278(19):1608–1612CrossRefGoogle Scholar
  20. 20.
    Maly RC, Liang L-J, Liu Y, Griggs JJ, Ganz PA (2017) Randomized controlled trial of survivorship care plans among low-income, predominantly Latina breast cancer survivors. J Clin Oncol 35(16):1814–1821. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Rocque GB, Wisinski KB, Buhr KA, Froeschner JL, Jones N, Donohue S, Wiegmann D, Sesto ME, Tevaarwerk AJ (2014) Development and evaluation of a survey to assess survivor knowledge change after survivorship care plans: WiSDOM-B (Wisconsin Survey of cancer DiagnOsis and Management in Breast cancer). J Cancer Educ 29(2):270–277. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Wagner EH, Ludman EJ, Bowles EJA, Penfold R, Reid RJ, Rutter CM, Chubak J, McCorkle R (2014) Nurse navigators in early cancer care: a randomized, controlled trial. J Clin Oncol 32(1):12–18. CrossRefPubMedGoogle Scholar
  23. 23.
    Hershman DL, Greenlee H, Awad D, Kalinsky K, Maurer M, Kranwinkel G, Brafman L, Jayasena R, Tsai WY, Neugut AI, Crew KD (2013) Randomized controlled trial of a clinic-based survivorship intervention following adjuvant therapy in breast cancer survivors. Breast Cancer Res Treat 138(3):795–806. CrossRefPubMedGoogle Scholar
  24. 24.
    Sabatino SA, Thompson TD, Smith JL, Rowland JH, Forsythe LP, Pollack L, Hawkins NA (2013) Receipt of cancer treatment summaries and follow-up instructions among adult cancer survivors: results from a national survey. J Cancer Surviv 7(1):32–43. CrossRefPubMedGoogle Scholar
  25. 25.
    Ayanian JZ, Zaslavsky AM, Guadagnoli E, Fuchs CS, Yost KJ, Creech CM, Cress RD, O'Connor LC, West DW, Wright WE (2005) Patients’ perceptions of quality of care for colorectal cancer by race, ethnicity, and language. J Clin Oncol 23(27):6576–6586. CrossRefPubMedGoogle Scholar

Copyright information

© American Association for Cancer Education 2019

Authors and Affiliations

  1. 1.University of WisconsinSchool of Medicine & Public HealthMadisonUSA
  2. 2.Carbone Cancer CenterMadisonUSA
  3. 3.ProHealth CareWaukeshaUSA

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