Immuno-Oncology Brings New Considerations for Survivorship Care

As the oncology community’s understanding and knowledge of cancer continues to deepen, so too does awareness of the diverse concerns and needs of the nation’s growing population of cancer survivors.

Fifteen years ago, with the release of the National Academy of Medicine’s consensus report, From Cancer Patient to Cancer Survivor: Lost in Transition, cancer care providers were challenged to respond to a call to action. The 2005 report highlighted gaps in helping the nation’s cancer survivors (10 million at the time) transition from active treatment to post-treatment survivorship. The report recommended that each cancer patient receive a “survivorship care plan.” 

In the intervening 15 years (2005 – 2020), the oncology community has worked with stakeholders to address the issues raised in the National Academy of Medicine’s report. The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) have developed and continue to review, expand, and update survivorship care guidelines. The American College of Surgeons Commission on Cancer (CoC) included a survivorship care plan standard in its 2012 and 2016 Cancer Program Standards for cancer program accreditation. To facilitate the development of survivorship care plans (SCPs), ASCO and other professional and patient advocacy organizations created SCP templates for cancer programs and practices to adopt.

These and other cancer survivorship resources continue to evolve as more information emerges on the long-term screening, surveillance, symptom management, and supportive care needs of cancer survivors. The number of people needing these services continues to rise. Between 2005 and 2019, the population of individuals with a history of cancer living in the U.S. grew from 10 million to 16.9 million. These years have also brought accelerating advances in cancer diagnosis, treatment, and therapeutics, with an increasing number of new approvals and indications for oral oncolytics, targeted therapies, and—most exciting—a new treatment paradigm: therapy with immune checkpoint inhibitors and the emergence of CAR-T therapy.

Although requirements for SCPs have thus far focused on patients treated with curative intent, for some patients cancer has become a chronic disease. Patients are now being treated with immunotherapies alone or in combination with other treatments, and many patients with advanced disease are living longer after their disease has stabilized. 

As the population of cancer survivors becomes increasingly diverse, many cancer programs are rethinking their approach to survivorship care services, the development of SCPs, and how the transition from cancer patient to cancer survivor is changing with the new needs of patients after treatment. In January, the Commission on Cancer's Optimal Resources for Cancer Care (2020 Standards) went into effect. Included is the new phased-in Standard 4.8 Survivorship Program, which provides more flexibility for cancer programs to identify how best to improve survivorship care for their patient populations. Standard 4.8 lists survivorship care plans among a variety of services survivorship program teams should consider.

As cancer programs plan how to phase in Standard 4.8, a publication from the ACCC Immuno-Oncology Institute, Survivorship Care Plans for Patients Receiving Immunotherapy: A New Frontier, can be a helpful resource. This publication explores the experiences of clinicians in identifying effective practices for providing survivorship care services to patients treated with immunotherapy, including SCP design and delivery. For example, Shaw Cancer Center in Edwards, Colorado, chose to restructure its approach to planning for survivorship care by streamlining its SCP and aiming for wider, more consistent delivery of these plans to patients. With more of its patients being treated with immunotherapy, Cleveland Clinic Akron General in Ohio recognized the opportunity to develop its own criteria for SCP eligibility and expand survivorship care for its own patients.

These and other examples in ACCC’s guide illustrate how cancer programs that care for patients receiving immunotherapy can use patient survivorship care plans to:

• Increase awareness of the potential for side effects
• Reinforce information in the patient wallet card
• Coach survivors on how to raise concerns about side effects and survivorship issues during provider visits
• Deliver content about healthy living for patients and caregivers

ACCC invites you to share its guide on creating survivorship care plans for IO patients with your own survivorship program team.