Early Survivorship Care May Improve Patient Outcomes

Survivorship care plans can come in varying forms. While the jury is still out regarding the best way to deliver survivorship care, there are some key components that should be included, explained Dr. Michelle Melisko.

Dr. Melisko is an associate clinical professor in the department of medicine at the UCSF Helen Diller Family Comprehensive Cancer Center. She recently discussed cancer survivorship at the Educated Patient Women’s Cancer Summit.

“One thing I think is really interesting and challenging in the survivorship era is that we’re making so much progress in precision medicine of cancer treatment … but unfortunately still, even to this day – even though there is a big focus on survivorship – there’s still less money and effort directed toward how therapies result in differential toxicity,” Melisko said.

Hopefully one day there will be better predictive models of which patients will have severe side effects from treatment. But as for now, survivorship care that comes earlier rather than later may be key in improving outcomes.

Melisko said that a good cancer survivorship plan should include the following:

• Recommendations for appropriate treatment and screenings that can diagnose or prevent recurrence and/or secondary cancers
• Assessment of medical and psychosocial late effects
• Interventions that address and mitigate side effects from cancer treatment
• Coordination between primary care physicians, oncologists, specialists, and patients

Much of what Melisko discussed includes taking care of current and potential future side effects from cancer treatment. She said that research is now focusing on analyzing patients’ genetics to better predict who will develop these side effects – a discipline called pharmacogenetics.

“The future is incorporating pharmacogenetics into personalized medicine, so that we can actually separate out which patients will get no benefit but develop toxicity from therapy, and those who will benefit but might have some toxicity,” Melisko said.

Researchers are analyzing patient genetics as well as patient-reported outcomes to create more efficacious personalized cancer drugs.

At Melisko’s institution, she said that these patient-reported outcomes are taken “from the get-go,” as soon as a patient begins receiving cancer care at UCSF. On the intake form, there are questions about the patients’ medical and social histories, PROMIS scores (which measure patient function), and psychosocial history.

UCSF researchers analyzed 428 patients who completed this form between 2014 and 2015. They found that more than half of the patients met the criteria to be referred to supportive care, which could include social work, onco-fertility specialists, genetic counseling, psycho-oncology, and more.

“We believe that by identifying patient needs early, we consider survivorship to be from the time of diagnosis, and we’re hoping that we can actually improve patient-reported outcomes,” Melisko said.