TABLE I.

Core competencies^a

Topic	Competencies
Survivorship ▪ Demonstrate how to obtain a cancer and cancer treatment history and how to interpret the health implications of that history. ▪ Differentiate the common uses of the terms personal cure, disease-free survival, overall survival, survivorship, and cancer survivor, and how they affect clinical approaches and policymaking. ▪ Identify incidence and prevalence of cancer survivorship overall and differences by age and sex.
Surveillance ▪ Understand the risk of new primary cancers and local or metastatic recurrences, and the temporal pattern of recurrences of specific primary cancers. ▪ Be aware of available surveillance methods (for example, history and physical examination; imaging studies; bloodwork, including tumour markers) and if applicable, the sensitivity and specificity in detecting recurrences and their cost-effectiveness. ▪ Be familiar with data about the effect of surveillance and early detection of recurrences on overall survival. ▪ Recognize treatment options and their effectiveness in the event of a new primary cancer and local or metastatic recurrences.
Long-term and late effects ▪ Be aware of potential consequences of cancer treatment in various age groups, to include the effects on cardiopulmonary, skeletal, gastrointestinal, respiratory, and endocrine systems, and sexual function and fertility. ▪ Appropriately assess cancer survivors for late and long-term effects of treatment, to include surgery, radiation, chemotherapy, hormonal treatments, immunotherapy, and targeted therapies. ▪ Assess the interplay between late and long-term effects and other comorbid medical conditions. ▪ Be aware of best practices in symptom management and rehabilitation.
Health promotion and disease prevention ▪ Demonstrate knowledge that cancer survivors are at increased risk for comorbid health conditions. ▪ Be able to screen, counsel, and provide referrals to programs for smoking cessation, weight management, physical activity, sexual rehabilitation, and other lifestyle habits. ▪ Encourage cancer survivors to establish a relationship with a primary care provider to receive age- and risk-based screening and non-cancer disease management.
Psychosocial care ▪ Be aware of the psychological, social, economic, and spiritual impacts of cancer and its treatments in various age groups. ▪ Be able to identify problems in psychosocial well-being in the post-treatment period. ▪ Be able to evaluate the contributions of disease and treatment features to problems in psychosocial well-being. ▪ Be aware of best practices in the psychosocial care of cancer survivors, and be able to make appropriate referrals.
Childhood and adolescent-and-young-adult (AYA) cancer survivors ▪ Recognize that childhood and AYA cancer survivors are a growing population with significant rates of premature mortality, chronic morbidities, and second malignant neoplasms. ▪ Be aware of the recommendations from the U.S. Institute of Medicine about risk-based follow-up care for all survivors of childhood and AYA cancer. ▪ Be familiar with the long-term surveillance guidelines based on exposures from the U.S. Children’s Oncology Group. ▪ Be able to provide childhood and AYA cancer survivors with appropriate risk-based care. ▪ Recognize that requests for, and use and discussion of, cancer survivorship care plans with survivors can facilitate the delivery of evidence-based or best-practice follow-up care.
Older adult cancer survivors ▪ Understand the demographics of cancer survivorship and aging, with the recognition that most cancer survivors are older adults. ▪ Recognize the anticipated workforce shortage to care for the growing number of older cancer survivors, and the need for geriatric competence embedded in all disciplines of health care. ▪ Understand that care of the older cancer survivor is driven by a patient-centred approach guided by the patient’s functional rather than chronologic age and taking into account their values and preferences. ▪ Consider that the increasing association of aging with poverty and social isolation requires unique approaches in terms of assistance, transportation, navigation, and other means to deliver proper cancer and survivorship care.
Caregivers of cancer survivors ▪ Recognize that most survivors receive important care and support from informal caregivers. Those individuals, commonly family members, are often key to the optimal health and well-being of the survivor. ▪ Be aware that informal cancer caregivers are at risk for depression and caregiving burden. Furthermore, because most cancer survivors are older adults, their caregivers could also be older and have their own health problems. ▪ Recognize the importance of acknowledging the role of and providing support to caregivers through appropriate mental health referrals and use of programs to help them to manage caregiver burden as needed.
Communication and coordination of care ▪ Understand and recognize various care models for delivery and coordination of post-treatment care of survivors. ▪ Be able to provide a facilitated transition from oncology to primary care, coordinated shared care, and advance care planning that includes a patient-centred discussion and written documentation. ▪ Communicate with other health care professionals to facilitate coordination of care among providers.