Transcript Community-Based Patient Navigation & The KU Wichita Center

The KU Wichita Center for Breast
Cancer Survivorship
Judy Johnston, MS, RD/LD
Research Instructor
Department of Preventive Medicine and
Public Health, KUSM-W
Program Director, KU Wichita Center for
Breast Cancer Survivorship
Utilizing the CDC definition of
“Cancer Survivor”
• Those diagnosed with cancer
and
• Those affected by the diagnosis:
– family members
– friends
– caregivers
Cancer Survivorship: Survive Cancer and Live. Centers for Disease Control and
Prevention, Department of Health and Human Services. Division of Cancer
Prevention and Control . APR04
Addressing Multiple Categories
of Survivorship Challenges
•
•
•
•
•
Physical
Emotional
Social
Spiritual
Financial
Hudson et al. Identifying Key Questions to Advance Research and Practice in
Cancer Survivorship Follow-Up Care: A Report From the ASPO Survivorship
Interest Group Cancer Epidemiology July 2009
Models of Survivorship Care
Currently Being Tested
• Community-based shared care model
– The PCP refers the patient to the oncologist for cancer therapy and
periodic follow-up consultation
– PCP provides ongoing maintenance of co-morbid diseases and healthmaintenance care
– Cancer survivorship care plan is provided to the PCP by the oncologist
• Disease-specific cancer survivorship programs at academic
institutions
• Comprehensive survivorship programs at academic institution
– consultative option
– advanced practitioner clinician-led survivor clinic
– specialized multidisciplinary survivorship program
Oeffinger KC, McCabe MS. Models for delivering survivorship care. J Clin Oncol
2006;24:5117–24.
KU-Wichita Center for Breast
Cancer Survivorship
Cypress Medical Park, Wichita
•
•
•
•
•
•
•
Comprehensive survivorship program
Tailored care plans
Research-supported health promoting behavioral options
Patient navigation
Rural access
Education & Research
Community partnerships
Funded in part through generous grants from
Susan G. Komen for the Cure Mid-Kansas Affiliate
Coordination of Survivorship Care
• Communication among all members of the care team
–
–
–
–
–
–
Survivor
Oncologist
Breast Surgeon
Radiation oncologist
Primary Care Physician
Survivorship Center Staff
• Non-duplication of services
• Connecting survivors to existing community support
services
Activated Patients
• Tailored care plans
– ASCO Survivorship Forms
– Additional assessment and follow-up of potential late side effects of
treatment
• Patient communication
Hewitt ME, Greenfield S, Stovall E; National Cancer Policy Board (U.S.).
Committee on Cancer Survivorship: Improving Care and Quality of Life. From
cancer patient to cancer survivor: lost in transition. Washington (DC): National
Academies Press; 2006.
Major Research Questions about
Survivorship
• What are the most common late effects?
• Who is at risk for late effects?
• Can treatment-related injury to normal tissue be
prevented/reversed?
• What % of survivors will have recurrent or second
malignancies?
• Who should be following these survivors to detect disease
recurrence?
• What constitutes ‘optimal surveillance” and what is the
cost of such follow-up care?
• Do medical, psychosocial or behavioral interventions
reduce morbidity in these populations?