TABLE 4.

Survivorship Care Plan Outcome-focused Studies (n=14)

Evidence level	Primary author, year	Data collection/methods	Sample and setting	Intervention	Results (data)	Conclusions
1	Grunfeld, 2011	RCT	408 women with early-stage breast cancer who completed primary treatment at least 3 months previously; mean age: 61.7; median time since diagnosis: 35.3 months.	Intervention group: Discharge visit plus SCP, reviewed during a 30-minute educational session with a nurse and delivered to PCP. Control group: Discharge visit only.	There were no differences between groups on cancer-related distress, satisfaction, or QOL. More survivors in the intervention than control group correctly identified their PCP as primarily responsible for follow-up (98.7% vs. 89.1%; difference, 9.6%; 95% CI, 3.9 to 15.9; p = .005)	The results do not support the hypothesis that SCPs are beneficial for improving patient-reported outcomes.
1	Hershman, 2013	RCT	126 BCS within 6 weeks of completing adjuvant therapy; mean age: 54; 48% Hispanic.	Intervention group: SCP delivered in 1-hour visit with a nurse practitioner and a nutritionist in English or Spanish. Control group received the NCI’s “Facing Forward” publication.	No significant differences were seen at 3 or 60 months between the two groups on the Impact of Cancer or treatment and survivor satisfaction scale. Health worry was lower in the intervention group (p = 0.02).	While the intervention did not lead to significant improvements in most patient-reported outcomes, it was associated with decreased health worry. Future interventions should determine the most efficient and effective method for delivering survivorship care plans.
1	Brothers, 2013	RCT	121 survivors of gynecological cancer across 3 providers, mean age: 60 (range: 24–89); 91% white; 6% African-American; 1% Asian; 2% other; 57% rural	Intervention group: Individualized SCP. Control group: no SCP/usual care.	The intervention group was more likely to report receiving educational materials (p=0.019); no differences were noted in satisfaction.	Gynecologic oncology patients providing ratings of health services and satisfaction with care provided equivalent evaluations, regardless if they had/had not received a SCP from the physician. Thus, the need remains for further evaluations of SCPs if they are to be vehicles for improving health service outcomes.
2	Sprague, 2013	Interview	48 BCS ages 35–75 and 10 CCS ages 41–70.	JourneyForward SCP	Most survivors felt SCP was useful, easy to understand and helpful in understanding diagnosis, treatment, follow-up care.	SCP helpful but still needing clarification about PCP and oncologists role in surveillance.
4	Casillas, 2011	Survey	376 survivors, mean age: 28 (range 18–39); 74% white; 54% female.	SCP	Being a minority and not receiving SCP were significantly associated with low confidence in managing survivorship care (p<0.05).	Findings suggest that provision of survivorship care plans for young adult cancer survivors can be used to improve confidence in managing survivorship care, particularly for ethnic minorities.
2	Jefford, 2011	Survey and interviews	Ten CCS survivors within a year of completing treatment	SurvivorCare intervention included booklet; DV; question prompt list; SCP; end-of-treatment nurse visit; and 3 follow-up phone calls	CCS felt that the intervention package was useful, relevant and convenient. SCP took 1–1.5 hours to complete.	SCP as a component of SurvivorCare was well received.
4	Rechis, 2013	Survey	2759 post-treatment survivors, mean age: 49 (TS group), 50 (no TS); female: 61% (TS group), 67% (no TS); white: 92% (TS group), 89% (no TS); mean time since diagnosis: 5.8 years (TS group), 6.9 (no TS). In both groups, the majority of participants were BCS.	TS	34% received TS. Those who didn’t receive TS experienced more emotional concerns (p<0.05). Those who received TS were more likely to be receiving care from an oncologist (p<0.01), report that their providers were meeting their needs during and after treatment (p<0.01); that they received information about possible late effects; and that the information met their needs (p<0.01).	Receipt of a TS was associated with a variety of positive outcomes; however, only approximately one third of survivors received one
4	Rosales, 2013	Survey	118 BCS in the St. Luke’s Mountain States Tumor Institute	SCP prepared in the electronic health record, reviewed during an appointment with a nurse practitioner and social worker, and mailed to the PCP.	Eighty-eight percent of survivors strongly agreed or agreed that they understood their SCP; 86% strongly agreed or agreed to feeling the survivorship visit met their survivorship needs. At 1 month, 80% of participants were still working on wellness goals. Survivor accounts analysis showed revenue covered costs.	Survivorship care at MSTI meets new standards, allows for patient engagement and satisfaction, and improves care coordination. Costs are covered by reimbursement.
4	Sabatino, 2013	National Health Interview Survey	1345 survivors, current age: 20–85+; 40% age <50 at diagnosis; 59% female, 83% white, 61% privately insured, 59% college educated, 20% BCS; 40% diagnosed ≤5 or >10 years prior; 63% had one treatment modality; 89% had no recent treatments; 91% did not participate in clinical trials; 75% were in good health or better.	TS and written instructions	32% reported receiving TS. Written instructions were associated with reporting recent provider recommendations for breast (p=0.03) and cervical cancer (p=0.007) surveillance. Written instructions were associated with recent mammography use (p=0.05).	Many recently diagnosed cancer survivors did not report receiving treatment summaries and written follow-up instructions. Opportunities exist to examine associations between use of these documents and recommended care and outcomes, and to facilitate their adoption.
4	Makari-Judson, 2013	Pre-post practice data audit	Wait times and surgical patient volume in a single medical center	Surgeons, medical oncologists and nurse practitioners in a breast cancer clinic agreed upon guidelines for follow up of BCS, developed a survivorship care program to follow active treatment, and gave survivors SCP following diagnosis beginning in 2009.	Wait times decreased from 43.5 before SCP use to 9 days after SCP use began; surgical patient volume increased from 573 to 650.	SCPs were useful in re-engineering follow-up habits of clinicians, adding value to each visit and gaining acceptance from established patients regarding recommended surveillance. SCPs contributed to reduced wait times and increase in volume of new patients seen by breast surgeons.
2	Nissen, 2013	Survey	203 BCS and 141 CCS, median time since diagnosis: 7.9 years (range, 3.2 – 13.1 years). BCS were younger and had been diagnosed less recently than CCS. Stage of disease and type of treatment differed for BCS and CCS.	TS	After receiving TS, Both BCS and CCS showed significant improvement in accuracy on stage of disease; BCS showed significant improvement in accuracy on morphology, estrogen receptor status, progesterone receptor status, receipt of hormone therapy, and receipt of doxorubicin (p<0.001).	Accuracy improved significantly, but survivor knowledge remained incomplete following TS receipt.
4	Blinder, 2013	Survey	174 BC patients in 20 diverse oncology practices, median age: 58; 84% white; most had stage I cancer (range 0-III).	Patients received treatment plans and summaries (TPSs) as part of the American Society of Clinical Oncology Breast Cancer Registry pilot program of 20 community oncology practices.	Of 157 patients who recalled receiving a TPS, 94% believed that the documents improved survivor-physician communication; 82% believed that they improved communication between physicians; 72% said the documents increased their peace of mind; 1% had less peace of mind. Ninety-seven percent still had their documents; of these, 97% said they were useful and 62% had given or planned to give the documents to another physician. All survivors recommended TPSs to continue to be provided.	Participants in this study expressed high satisfaction with TPSs. Additional research is needed to study the broad-scale implementation of the BCR and to evaluate the impact of routine use of TPSs on the quality of care delivered. Cancer 2013. © 2012 American Cancer Society.
4	Faul, 2012	Interviews	7 oncology providers; 7 CCS, all white, age range: 54–84	SCP	Survivors perceived reduced duplication of services and reduced worry associated with SCP. Providers noted billing/reimbursement issues and time to develop SCP as potential barriers.	Further investigation of SCPs is warranted regarding utility prior to widespread adoption in follow-up care.
4	Hill-Kayser, 2013	Survey	8690 cancer survivors used the SCP tool. Of these, 298 responded to a 1- month follow-up survey. Respondents 75% female, with a median age of 55. 93% were white, and 45% had breast cancer.	Internet-based SCP.	The majority of respondents (63%) thought that the SCP changed their health care participation, and 80% shared/planned to share it with their health care team. Of those survivors who had done so, 80% reported that it improved communication with their health care providers. Greater than one-half of survey users (54%) reported that they had made or planned to make a lifestyle change in response to the SCP, most commonly dietary modification and increased exercise.	Survivorship care plans are useful vehicles with which to promote lifestyle and behavioral changes, and to assist survivors with communication with health care providers. These findings support recommendations from the Institute of Medicine and the American College of Surgeons Commission on Cancer.