The utility of Survivorship Care Plans for rural cancer survivors

From the Chow Studies Group, Public Health Sciences Division

In 2005, the National Academy of Medicine published a report titled “From Cancer Patient to Cancer Survivor: Lost in Transition.” As the subtitle suggests, the report highlighted the importance of a coordinated transition from active treatment to post-treatment care in the maintenance of patients’ long-term health. One of the tools used in this transition is a Survivorship Care Plan. This document, which is given to patients at the end of their treatment,  summarizes the patient’s treatment and provides recommendations for follow-up care. Survivorship Care Plans may especially be of value to patients who are less likely to have access to coordinated follow-up care, including those who live in rural areas.

“Rural cancer survivors often have worse outcomes compared to other groups due to barriers in accessing appropriate health information,” said Dr. Catherine Duggan, the director of Collaborative Data Services at the Fred Hutch. “Despite recommendations by organizations such as the Institute of Medicine, few clinics have integrated Survivorship Care Plans —a written summary of patients’ diagnoses and treatment — into standard practice, which may be especially important among rural cancer survivors.” In a new study published in The Journal of Rural Health, Dr. Duggan and Dr. Eric Chow’s group in the Fred Hutch Public Health Sciences Division addressed the utility of Survivorship Care Plans for rural cancer survivors.

“In our study we recruited and randomized rural patients to receive either a Survivorship Care Plan or a Survivorship Care Plan and a personalized information session delivered by Cancer Information Services located at the Fred Hutch,” explained Dr. Duggan. 72 cancer survivors who utilize rural community-based clinics in Washington, Wyoming, Alaska, Montana, and Idaho participated in the study. They completed a questionnaire that included questions about their cancer diagnosis, treatment, quality of life, health-related self-efficacy, and health literacy. These answers were used to generate a Survivorship Care Plan for each participant. All participants received their Survivorship Care Plans, but half of the participants also received a 30-minute informational sessions on the phone delivered by lay health educators from Cancer Information Services at the Fred Hutch. The educators reviewed the Survivorship Care Plan with each participant, and discussed follow-up care plans and any topics of interest that participants flagged on their questionnaires.

A watercolor of a hospital building with a green field in the foreground and blue mountains in the background.
The majority of rural cancer survivors who participated in this study found Survivorship Care Plans useful, but did not benefit significantly from additional information sessions with lay health educators. Image generated with DALL-E 2 software.

“We found that the majority of survivors (62%) found the Survivorship Care Plan useful, but that the information session seemed to have limited additional benefit,” said Dr. Duggan. “One exception, however, may be for participants with inadequate or marginal health literacy. In exploratory analysis, we found that an increase in self-efficacy was significantly associated with the receipt of the intervention among participants with limited health literacy. Focusing on this group of survivors may be an effective and efficient way of improving outcomes for rural cancer survivors, while making best use of clinic resources.”

The results from this study raise additional questions that the team is eager to pursue. Dr. Duggan said, “We are currently, with NCI funding, exploring the effects of the Survivorship Care Plan delivery with and without an informational session with rural Latinx cancer survivors. We are conducting via  qualitive interviews with clinic administrators and oncologists, barriers and facilitators to increasing delivery of Survivorship Care Plans in clinics, and how to identify survivors who may receive most benefit from the intervention.”

Dr. Duggan noted the importance of collaborations in carrying out this type of research. “This research was funded through the Cancer Center Support Grants funding mechanism, targeting rural catchment areas,” said Dr. Duggan. “Several collaborations were key to enabling this research, including the [University of Washington’s] Institute of Translational Health Sciences WWAMI region Practice and Research Network (WPRN), which  is a primary care, practice-based research network across 34 organizations and over 90 clinics in the five-state WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho). It supports collaboration between primary care practices and academic researchers on research that improves the health and well-being of patients in their communities and enhances primary care clinical practice.”

This work was supported by the National Institutes of Health.

The Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium members Drs. Allison Cole, K. Scott Baker, Rachel Ceballos, and Eric Chow contributed to this work.

Duggan C, Cushing‐Haugen KL, Cole AM, Allen J, Gilles R, Hornecker JR, Gutierrez AI, Warner J, Baker KS, Ceballos RM, and Chow EJ. Feasibility of delivering survivorship care via lay health educators: A pilot randomized controlled trial among rural cancer survivors. The Journal of Rural Health. 2023; 1-10.