Survivorship Care Planning: Inform, Strengthen, and Ease the Transition for Survivors

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By: Taraneh Tofighi, ELLICSR summer student

In an effort to support patients in their transition from treatment to follow-up care, researchers at ELLICSR have been working with health care providers and patients at the Princess Margaret Cancer Centre to develop and roll-out Survivorship Care Plans (SCP). What is a SCP? The SCP is a consult to share information with patients about:

  • Their treatment and future follow-up care,
  • How to prepare for the transition from cancer treatment to follow up care.

To date, SCP's have been fully implemented in some disease sites:

  • Testicular
  • Endometrial
  • With ongoing plans to expand to the Colorectal, Kidney and Prostate Cancer sites.

The SCPs are given to patients after treatment is complete, during their regular follow-up appointment. This SCP consult is designed to bring patients and their health care team together, to talk about the treatment they've got, follow-up plans, effects of treatment, and the responsibilities of everyone involved in follow-up care. The SCP includes personalized information such as:

  • Diagnosis and treatment summary
  • Recommended follow-up visits and cancer screening tests
  • Ways to manage persistent effects and monitor for late effects
  • How to look for signs of recurrence
  • How to optimize health and wellness
  • Who to contact for questions and concerns

After a 30 minute care plan consult with a clinical nurse, patients receive an email with the personalized SCP attached and links to various patient education and community support resources. A copy of the SCP is also sent to the patient's family doctor, in order to ensure a smooth transition to follow-up care.

Learn more about the exciting research happening at ELLICSR.