2.  Define Survivorship  Demonstrate understanding of the history of cancer survivorship  State the requirements of the Commission on Cancer of the American College of Surgeons Standard of Survivorship

3. According to the National Cancer Institute, a Survivor is:  One who remains alive and continues to function during and after overcoming a serious hardship or life- threatening disease. In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.

4.  Include family and friends  Begins when treatment ends  Do not include patients with metastaic disease  Is considered living with, through and beyond a cancer diagnosis

5.  1985-Fitzhugh Mullen  Seasons of Survivorship ◦ Acute Survivorship ◦ Extended Survivorship ◦ Permanent Survivorship

6.  1986-The NCCS was founded to advocate for cancer survivors

7. 1996-The Office for Cancer Survivorship of the National Cancer Institute was established to focus on research into issues facing individuals with cancer.

8. 2005-The Institute of Medicine published their report on cancer survivorship

9. Psychological Distress Sexual Dysfunction Infertility Impaired organ function Cosmetic changes Limitations in mobility, communication and cognition

10.  Recognizing Survivorship as a distinct phase of cancer care  Ensuring delivery of appropriate survivorship care  Expanding research efforts in survivorship  Eliminating discrimination and adverse effects on employment  Ensuring access to good health insurance

11.  In 2008, Dr. Kenneth Miller revisited Dr. Mullen’s Seasons of Survival.  With earlier diagnoses and more effective treatment, more people are living through and beyond cancer and many are now living with cancer as a chronic disease.

12.  Acute Survivorship: ◦ Time of Diagnosis ◦ Time of treatment

13.  Transitional Survivorship-Immediately after treatment ends

14.  Extended Survivorship-Those who have completed treatment, are living with cancer as a chronic disease or are in remission because of ongoing treatment

15.  Permanent Survivorship- ◦ Cancer free and asymptomatic ◦ Cancer free with long term/late problems ◦ Develop secondary cancers unrelated to early treatment ◦ Have secondary cancers related to treatment

17.  Written in 2012 to be implemented in 2015, this standard requires: ◦ A Survivorship Care plan prepared by the principal provider ◦ Given to the patient on completion of treatment ◦ Contains a record of the care receivedwith a follow up plan

18.  In September of 2014, the CoC released clarifications to the standard that was to be implemented in January of 2015  A survey had been done to all member organizations and only 37% of responders were “completely confident” that their program would be able to implement the standard by January  63% of organizations felt this was the most difficult new standard to implement

19.  The standard is only for patients receiving curative treatment  The survivorship requirement is now being rolled out gradually over five years  Cancer programs have more flexibility in choosing who will create the plan and who should distribute the plan to patients  Minimum information to be included in the plans was clarified

20.  Treatment summary ◦ Contact information of treating institutions and providers ◦ Specific diagnosis, including histological type ◦ Surgery ◦ Chemotherapy ◦ Radiation ◦ Ongoing toxicity or side effects of treatment ◦ Genetic or hereditary risk factors/Genetic Testing Results

21.  Follow up care plan: ◦ Oncology team member contacts ◦ Schedule of related clinical visits ◦ Cancer Surveillance tests for recurrence ◦ Cancer screening tests for early detection and who will be responsible for ordering ◦ Need for Ongoing adjuvant therapy  Name of Therapy  Planned Duration  Expected Side effects

22.  Academic Center  Community Hospital  Primary Care Medical Group  County Hospital

23.  What’s Next? Life After Cancer Treatment  Journey Forward  ASCO Cancer Treatment Summary  Prescription for Living  LIVESTRONG Care Plan

24.  Is a distinct phase of cancer treatment  Was first recognized by the IOM in 2005  Effects almost 14 million cancer survivors today  Is being phased in as a CoC standard beginning in 2015