American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Standard 2.20: Breast Cancer Survivorship Care

A comprehensive process to prepare and disseminate a breast cancer survivorship care plan, with accompanying treatment summary, to all eligible patients within six (6) months of completing active treatment and no later than one year (365 days) from date of diagnosis is developed and implemented.

Definition and Requirements

The Institute of Medicine (IOM) report From Cancer Patient to Cancer Survivor outlines the importance of providing cancer survivors with a comprehensive treatment summary and follow-up plan (in other words, a survivorship care plan) that addresses follow-up care to improve health and quality of life. This document serves as a communication and education tool that survivors can provide to all of their health care providers in various disciplines.

The Survivorship Care Plan (SCP) is the record of a patient’s breast cancer history, what transpired during active treatment, current continued long-term treatment (in other words, hormonal and targeted therapy), recommendations for follow-up care and surveillance testing/examination, referrals for support services the patient may need going forward, and other information pertinent to the survivor’s short- and long-term survivorship care. It is to stipulate specifically what surveillance is to be performed, at what frequency, by whom, and when.

The American Society of Clinical Oncology (ASCO) has defined the minimum data elements to be included in a treatment summary and SCP. The center is not required to use the ASCO template, however, the SCP template selected for use by the center must, at a minimum, include ASCO’s recommended minimum data elements to meet compliance for this standard. The minimum set of data elements and ASCO’s template are available on the ASCO website.

For the purposes of this standard, an eligible patient is defined as a patient who:

  • Was diagnosed with Stage 0 (ductal carcinoma in situ), I, II, or III breast cancer,
  • Was treated with curative intent for an initial breast cancer occurrence,
  • Is an analytic case, and
  • Has completed active therapy (chemotherapy and radiation), though may still be receiving hormonal or targeted therapy.

Ineligible Patients and Timeline Extension

  • Patients diagnosed with Stage IV breast cancer are not required to have a SCP, as they are assumed to be under continuous treatment. However, consideration should be given to providing these patients with ongoing treatment summaries for their use and to be shared with their primary care physician (PCP), including a listing of common potential late effects and their possible timing.
  • The one-year-from-diagnosis requirement to provide a SCP is extended to 18 months for patients receiving hormonal and targeted therapy.

Process Requirements

Breast centers must develop and implement processes to monitor the preparation and dissemination of a SCP for all eligible patients.

  • A SCP is manually or electronically prepared by the health care provider(s) who coordinate the oncology treatment for the patient with input from the patient’s other care providers. Providers who are part of the patient’s care team and appropriate under this standard to deliver the SCP:
    • Physicians
    • Registered nurses
    • Advanced practitioner nurses
    • Nurse practitioners
    • Physician assistants
    • Credentialed clinical navigators (does not include lay navigators)
    If two different facilities are providing treatment, both facilities should work together to collaborate on providing a completed SCP. The facility providing follow-up and monitoring of the patient (medical oncology) should provide the SCP. In all cases, facilities should work together to provide the information necessary for completion of a SCP containing all required elements.
  • The SCP is given to and discussed with the patient within six (6) months of completing active treatment and no longer than one year (365 days) from date of diagnosis. Survivors are to be provided with multiple copies of their SCP to allow them to share it with additional care providers and retain a master copy of this living document for their records. Providing the SCP without discussion with the patient does not meet the standard.
  • This SCP is given to all providers involved in the survivor’s care, including the PCP and/or gynecologist and other cancer-related and non-cancer-related practitioners. The SCP includes a list of providers with whom the SCP has been shared.

Implementation of the standard and required percentage of SCPs provided must follow the schedule as outlined:

  • End of 2016: Provide SCPs to ≥ 25 percent of eligible patients who have completed treatment
  • End of 2017 and on: Provide SCPs to ≥ 50 percent of eligible patients who have completed treatment

To calculate the percentage of eligible patients, it is recommended that you begin with your number of analytic cases as the denominator and then subtract ineligible patients.

Documentation

Complete all required standard fields in the Survey Application Record (SAR).

Provide the standard of practice (SOP)/policy and procedure for preparation and dissemination of a comprehensive breast cancer treatment summary and SCP. The documented process must include at minimum:

  • Defined patient eligibility
  • Identify appropriate mechanism(s) for generating the SCP
  • Identify appropriate individual(s) for delivering the SCP
  • The method and timing of delivery of the SCP
  • Tracking and reporting the number of SCP’s provided to eligible patients

Provide a sample treatment summary and SCP.

Document the annual audit by the Breast Program Leadership Committee (BPLC) in the meeting minutes.

Evaluation

The surveyor will review the number of SCPs provided during the medical records review portion of the site visit. The surveyor will also review and discuss the SCP and the implemented survivorship care process, as well as confirm the annual audit by the BPLC.

Rating Compliance

Compliance

  1. A comprehensive process to prepare and disseminate a breast cancer survivorship care plan, with accompanying treatment summary, to all eligible patients within six (6) months of completing active treatment and no later than one year (365 days) from date of diagnosis is developed and implemented.
  2. Compliance is reviewed annually by the BPLC and documented in the meeting minutes.

Noncompliance

The center does not fulfill one or more of the compliance criteria.

Resources

Patient Eligibility: The decision matrix below displays eligibility by treatment scenario and is intended to be a companion tool for use with National Accreditation Program for Breast Centers (NAPBC) Standard 2.20. The scenarios listed are not intended to be an exhaustive or definitive list.

Patients Diagnosed

First Course of Treatment—Curative Intent

with
DCIS / Stage 0
Stage I–III

Surgery

Chemo

Radiation

SCP

Your Center

Your Center

Elsewhere

Elsewhere

Yes

Your Center

Your Center

None

None

Yes

Your Center

Elsewhere

Your Center

Your Center

Yes

Your Center

Elsewhere

Your Center

None

Yes

Your Center

Elsewhere

Your Center

Elsewhere

Yes

Your Center

Elsewhere

None

Your Center

Yes

Your Center

Elsewhere

Elsewhere

Your Center

Yes

Your Center

Elsewhere

None

None

No

Elsewhere

Your Center

Your Center

Your Center

Yes

Elsewhere

Your Center

Elsewhere

Your Center

Yes

Elsewhere

Your Center

Your Center

Elsewhere

Yes

Elsewhere

Elsewhere

Your Center

Your Center

Yes

Stage IV

 

 

 

No

Recurrence

 

 

 

No

LCIS

 

 

 

No

American Cancer Society SCP

American Society of Clinical Oncology Cancer Treatment and SCP