The development and implementation of the After Cancer Treatment Transition (ACTT) Program for survivors of cancer

Shari Moura, Patricia Nguyen, Aronela Benea, Carol Townsley

Abstract


Background: The After Cancer Treatment Transition (ACTT) program at Women’s College Hospital (Toronto) is a transitional follow-up program for patients, their families, and healthcare providers to address the broad range of post-cancer treatment and survivorship needs. This publication describes the systematic development and implementation of the ACTT program, with a focus on the advanced practice nursing (APN) role. 

Program Development: ACTT development required the collaboration of an APN, a general practitioner in oncology (GPO), and an inter-professional team. ACTT developers proposed a clinic structure in an ambulatory setting, linking healthcare professionals to provide post-treatment follow-up and ongoing survivorship care. Post-treatment guidelines were developed based on expert oncologist consensus, cancer site group input, and evidence-informed guidelines or best practice recommendations. 

Program Implementation: Initial challenges and concerns were rooted in the requirements that post-cancer treatment care was maintained and survivor needs were addressed. Cancer site groups and the inter-professional teams provided continuous feedback on processes and protocols. ACTT established a standard approach to transition  patients safely and effectively out of tertiary care and, ultimately, to primary care. 

Current ACTT Program: ACTT delivers comprehensive post-
treatment and survivorship care through close collaboration between the GPO and APN. Both roles specialize in managing late or persistent effects, cancer surveillance and prevention, and addressing psychosocial needs prior to discharge to primary care. The survivorship care plan provided by ACTT is an informative tool for both patient and primary care provider to continue post-treatment follow-ups. 

Future Directions: Next steps for ACTT include expanding to other cancer specialties, exploring new ways to deliver care, optimizing the transition of care, and conducting comprehensive evaluations of patient reported outcomes.


Full Text:

PDF

References


Advanced Practice Nursing Framework Revision Advisory Committee. (2019). Advanced Practice Nursing: A pan-Canadian framework. Canadian Nurses Association. https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/apn-a-pan-canadian-framework.pdf

Baravelli, C., Krishnasamy, M., Pezaro, C., Schofield, P., Lotfi-Jam, K., Rogers, M., Milne, D., Aranda, S., King, D., Shaw, B., Grogan, S., & Jefford, M. (2009). The views of bowel cancer survivors and health care professionals regarding survivorship care plans and post treatment follow-up. Journal of Cancer Survivorship: Research and Practice, 3, 99-108. https://doi.org/10.1007/s11764-009-0086-1

Blouin, L. (2012). Defining the role of GPOs. Oncology Exchange, 11, 8–9.

Bredin, M., Corner, J., Krishnasamy, M., Plant, H., Bailey, C., & A’Hern, R. (1999). Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer. BMJ (Clinical research ed.), 318(7188), 901–904. https://doi.org/10.1136/bmj.318.7188.901

Brooten, D., Naylor, M. D., York, R., Brown, L. P., Munro, B. H., Hollingsworth, A. O., Cohen, S. M., Finkler, S., Deatrick, J., & Youngblut, J. M. (2002). Lessons learned from testing the quality cost model of Advanced Practice Nursing (APN) transitional care. Journal of nursing scholarship: an official publication of Sigma Theta Tau International Honor Society of Nursing, 34(4), 369–375. https://doi.org/10.1111/j.1547-5069.2002.00369.x

Brown, S. A., & Grimes, D. E. (1995). A meta-analysis of nurse practitioners and nurse midwives in primary care. Nursing research, 44(6), 332–339.

Bryant-Lukosius, D. & DiCenso, A. (2004). A framework for the introduction and evaluation of advanced practice nursing roles. Journal of Advanced Nursing, 48, 530–540. https://doi.org/10.1111/j.1365-2648.2004.03235.x

Canadian Cancer Statistics Advisory Committee. (2017). Canadian Cancer Statistics 2017. Canadian Cancer Society. https://www.cancer.ca/Canadian-CancerStatistics-2017-EN.pdf

Canadian Cancer Statistics Advisory Committee. (2019). Canadian Cancer Statistics 2019. Canadian Cancer Society. https://www.cancer.ca/Canadian-Cancer-Statistics-2019-EN

Cook, O., McIntyre, M., & Recoche, K. (2015). Exploration of the role of specialist nurses in the care of women with gynaecological cancer: A systematic review. Journal of Clinical Nursing, 24(5-6), 683–695. https://doi.org/10.1111/jocn.12675

Cook, O., McIntyre, M., Recoche, K., & Lee, S. (2019). “Our nurse is the glue for our team†– Multidisciplinary team members’ experiences and perceptions of the gynaecological oncology specialist nurse role. European Journal of Oncology Nursing: The official journal of European Oncology Nursing Society, 41, 7–15. https://doi.org/10.1016/j.ejon.2019.05.004

Corner, J., Plant, H., A’Hern, R., & Bailey, C. (1996). Non-pharmacological intervention for breathlessness in lung cancer. Palliative Medicine, 10(4), 299–305. https://doi.org/10.1177/026921639601000405

Dempsey, L., Orr, S., Lane, S., & Scott, A. (2016). The clinical nurse specialist’s role in head and neck cancer care: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology and Otology, 130(S2), S212–S215. https://doi.org/10.1017/S0022215116000657

Dietrich, L., Smith, A. L., Watral, A., Borgert, A. J., Al-Hamadani, M., Van Oosbree, M., & Meyer, C. M. (2016). Effectiveness of a survivorship program: An assessment of patients with breast cancer in a community setting. Journal of Oncology Practice, 12(6), e688–e696. https://doi.org/10.1200/JOP.2015.010413

Downs-Holmes, C., Dracon, A., Svarovsky, T., & Sustin, M. (2014). Development of a survivorship program. Clinical Journal of Oncology Nursing, 18(Suppl), 53–56. https://doi.org/10.1188/14.CJON.S2.53-56

Ganz, P. A., Desmond, K. A., Leedham, B., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2002). Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. Journal of the National Cancer Institute, 94(1), 39–49. https://doi.org/10.1093/jnci/94.1.39

Glaser, K. M., McDaniel, D. C., Hess, S. M., Flores, T. F., Rokitka, D. A., & Reid, M. E. (2019). Implementing an integrative survivorship program at a comprehensive cancer center: A multimodal approach to life after cancer. Journal of Alternative and Complementary Medicine (New York, N.Y.), 25(S1), S106–S111. https://doi.org/10.1089/acm.2018.0383

Goldenberg, B. A., Carpenter-Kellett, T., Gingerich, J. R., Nugent, Z., & Sisler, J. J. (2020). Moving forward after cancer: Successful implementation of a colorectal cancer patient-centered transitions program. Journal of Cancer Survivorship: Research and Practice, 14(1), 4–8. https://doi.org/10.1007/s11764-019-00819-0

Grunfeld, E., Mant, D., Yudkin, P., Adewuyi-Dalton, R., Cole, D., Stewart, J., Fitzpatrick, R., & Vessey, M. (1996). Routine follow-up of breast cancer in primary care: Randomized trial. British Medical Journal, 313, 665–669. https://doi.org/10.1136/bmj.313.7058.665

Grunfeld, E., Fitzpatrick, R., Mant, D., Yudkin, P., Adewuyi-Dalton, R., Stewart, J., Cole, D., & Vessey, M. (1999). Comparison of breast cancer patient satisfaction with follow-up in primary care versus specialist care: Results from a randomized controlled trial. The British journal of general practice: the journal of the Royal College of General Practitioners, 49(446), 705–710.

Grunfeld, E. (2006). Looking beyond survival: How are we looking at survivorship? Journal of Clinical Oncology, 24, 5166-5169. https://doi.org/10.1200/jco.2006.06.5953

Grunfeld, E., Levine, M. N., Julian, J. A., Coyle, D., Szechtman, B., Mirsky, D., Verma, S., Dent, S., Sawka, C., Pritchard, K. I., Ginsburg, D., Wood, M., & Whelan, T. (2006). Randomized control trial of long-term follow-up for early stage breast cancer: a comparison of family physician versus specialist care. Journal of Clinical Oncology, 24, 848–855. https://doi.org/10.1200/jco.2005.03.2235

Grunfeld, E., Hodgson, D. C., Del Giudice, M. E., & Moineddin, R. (2010). Population-based longitudinal study of follow-up care for breast cancer survivors. Journal of Oncology Practice, 6(4), 174–181. https://doi.org/10.1200/JOP.200009

Halpern, M. T., & Argenbright, K. E. (2017). Evaluation of effectiveness of survivorship programmes: how to measure success? The Lancet. Oncology, 18(1), e51–e59. https://doi.org/10.1016/S1470-2045(16)30563-0

Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ (Clinical research ed.), 324(7341), 819–823. https://doi.org/10.1136/bmj.324.7341.819

Howell, D., Currie, S., Mayo, S., Jones, G., Boyle, M., Hack, T., Green, E., Hoffman, L., Simpson, J., Collacutt, V., McLeod, D. & Digout, C. (2009). A Pan-Canadian Clinical Practice Guideline: Assessment of psychosocial health care needs of the adult cancer patient. Canadian Association of Psychosocial Oncology. https://www.capo.ca/guidelines

Howell, D., Hack, T. F., Oliver, T. K., Chulak, T., Mayo, S., Aubin, M., Chasen, M., Earle, C. C., Friedman, A. J., Green, E., Jones, G. W., Jones, J. M., Parkinson, M., Payeur, N., Sabiston, C. M., Sinclair, S., & Tompson, M. (2011). Pan-Canadian guidance on organization and structure of survivorship services and psychosocial-supportive care best practices for adult cancer survivors. Canadian Association of Psychosocial Oncology. https://www.capo.ca/guidelines

Institute of Medicine & National Research Council. (2006). From cancer patient to cancer survivor: Lost in transition. The National Academies Press. https://doi.org/10.17226/11468.

Janmohamed, N., Segal, P., Corrado, A. M., Lofters, A., Nguyen, P., Townsley, C., & Zahedi, A. (2021). Endocrinologist-perceived factors affecting the transition of thyroid cancer patients from specialist to primary care postcancer treatment in Ontario, Canada. Thyroid: Official Journal of the American Thyroid Association. Advance online publication. https://doi.org/10.1089/thy.2020.0413

Kantsiper, M., McDonald, E. L., Geller, G., Shockney, L., Snyder, C., & Wolff, A. C. (2009). Transitioning to breast cancer survivorship: Perspectives of patients, cancer specialists, and primary care providers. Journal of General Internal Medicine, 24, S459–S466. https://doi.org/10.1007/s11606-009-1000-2

Kerr, H., Donovan, M., & McSorley, O. (2021). Evaluation of the role of the clinical Nurse Specialist in cancer care: An integrative literature review. European journal of cancer care, e13415. Advance online publication. https://doi.org/10.1111/ecc.13415

Kilpatrick, K., DiCenso, A., Bryant-Lukosius, D., Ritchie, J. A., Martin-Misener, R., & Carter, N. (2014). Clinical nurse specialists in Canada: Why are some not working in the role? Nursing leadership (Toronto, Ont.), 27(1), 62–75. https://doi.org/10.12927/cjnl.2014.23738

Madarnas, Y., Joy, A. A., Verma, S., Sehdev, S., Lam, W., & Sideris, L. (2011). Models of care for early stage breast cancer in Canada. Current Oncology, 18, S10–S19. https://doi.org/10.3747/co.v18i0.898

McCorkle, R., Strumpf, N. E., Nuamah, I. F., Adler, D. C., Cooley, M. E., Jepson, C., Lusk, E. J., & Torosian, M. (2000). A specialized home care intervention improves survival among older post-surgical cancer patients. Journal of the American Geriatrics Society, 48(12), 1707–1713. https://doi.org/10.1111/j.1532-5415.2000.tb03886.x

Mitchell, L., Stuart-McEwan, T., Panet, H., & Gupta, A. (2017). Adolescents and young adults: Addressing needs and optimizing care with a clinical nurse specialist. Clinical Journal of Oncology Nursing, 21(1), 123–126. https://doi.org/10.1188/17.CJON.123-126

Moore, S., Corner, J., Haviland, J., Wells, M., Salmon, E., Normand, C., Brada, M., O’Brien, M., & Smith, I. (2002). Nurse led follow up and conventional medical follow up in management of patients with lung cancer: Randomised trial. BMJ (Clinical research ed.), 325(7373), 1145. https://doi.org/10.1136/bmj.325.7373.1145

Moore, J., & McQuestion, M. (2012). The clinical nurse specialist in chronic diseases. Clinical Nurse Specialist (CNS), 26(3), 149–163. https://doi.org/10.1097/NUR.0b013e3182503fa7

Nekhlyudov, L. (2014). Integrating primary care in cancer survivorship programs: Models of care for a growing patient population. The Oncologist, 19(6), 579–582. https://doi.org/10.1634/theoncologist.2013-0384

Oncology Nursing Program. (2018a). Clarifying the role of clinical nurse specialist and nurse practitioners in delivery of cancer care in Ontario. Cancer Care Ontario. https://www.cancercareontario.ca/en/content/clarifying-roles-clinical-nurse-specialists-and-nurse-practitioners-delivery-cancer-care-ontario

Oncology Nursing Program. (2018b). Expert recommendation report on clinical nurse specialist and nurse practitioner roles in the delivery of adult cancer services in Ontario. Cancer Care Ontario. https://www.cancercareontario.ca/en/content/expert-recommendation-report-clinical-nurse-specialist-and-nurse-practitioner-roles-delivery-adult-cancer-services-ontario

Pascoe, S. W., Neal, R. D., Allgar, V. L., Selby, P. J., & Wright, E. P. (2004.) Psychosocial care for cancer patients in primary care? Recognition of opportunities for cancer care. Family Practice, 21, 437–442. https://doi.org/10.1093/fampra/cmh415

Pollard, C. A., Garcea, G., Pattenden, C. J., Curran, R., Neal, C. P., Berry, D. P., & Dennison, A. R. (2010). Justifying the expense of the cancer Clinical Nurse Specialist. European journal of cancer care, 19(1), 72–79. https://doi.org/10.1111/j.1365-2354.2008.01000.x

Rowland, J. H. (2008). Cancer survivorship: rethinking the cancer control continuum. Seminars in Oncology Nursing, 24, 145–152. https://doi.org/10.1016/j.soncn.2008.05.002

Shulman, L. N., Jacobs, L. A., Greenfield, S., Jones, B., McCabe, M. S., Syrjala, K., Diller, L., Shapiro, C. L., Marcus, A. C., Campbell, M., Santacroce, S., Kagawa-Singer, M., & Ganz, P. A. (2009). Cancer care and cancer survivorship care in the United States: Will we be able to care for these patients in the future? Journal of Oncology Practice, 5, 119–123. https://doi.org/10.1200/jop.0932001

Sisler, J., Brown, J., & Stewart, M. (2004). Family physicians’ roles in cancer care. Survey of patients on a provincial cancer registry. Canadian Family Physician, 50, 889–96.

Sisler, J. J., DeCarolis, M., Robinson, D., & Sivananthan, G. (2013). Family physicians who have focused practices in oncology: Results of a national survey. Canadian Family Physician/Medecin de famille canadien, 59(6), e290–e297.

Sisler, J., Chaput, G., Sussman, J., & Ozokwelu, E. (2016). Follow-up after treatment for breast cancer: Practical guide to survivorship care for family physicians. Canadian Family Physician/Medecin de famille canadien, 62(10), 805–811.

Sun, V., Olausson, J. M., Fujinami, R., Chong, C., Dunham, R., Tittlefitz, T., Greer, K., & Grant, M. (2015). The role of the advanced practice nurse in survivorship care panning. Journal of the Advanced Practitioner in Oncology, 6(1), 64–70. https://doi.org/10.6004/jadpro.2015.6.1.7

Sussman, J., Beglaryan, H., & Payne, A. (2019). Follow-up model of care for cancer survivors: Recommendations for the delivery of follow-up care for cancer survivors in Ontario. Cancer Care Ontario. https://www.cancercareontario.ca/en/content/follow-model-care-cancer-survivors-recommendations-delivery-follow-care-cancer-survivors-ontario

Thom, B., Boekhout, A. H., Corcoran, S., Adsuar, R., Oeffinger, K. C., & McCabe, M. S. (2019). Advanced practice providers and survivorship care: They can deliver. Journal of Oncology Practice, 15(3), e230–e237. https://doi.org/10.1200/JOP.18.00359

Virani, T., & Associates for Canadian Nurses Association. (2012). Strengthening the role of the clinical nurse specialist in Canada. 2012 Pan-Canadian Roundtable Discussion. Canadian Nurses Association. https://www.cna-aiic.ca/-/media/cna/page-content/pdf-fr/strengthening_the_cns_role_background_paper_e.pdf?

la=en&hash=F2D0FBBCA236CE4F620348B4FED5FE5615A5B373

Virgo, K. S., Lerro, C. C., Klabunde, C. N., Earle, C., & Ganz, P. A. (2013). Barriers to breast and colorectal cancer survivorship care: Perceptions of primary care physicians and medical oncologists in the United States. Journal of Clinical Oncology, 31, 2322–2336. https://doi.org/10.1200/jco.2012.45.6954

Watson, N. R. (2010). Evaluating the pilot ACTT clinic [Unpublished manuscript]. Department of Medicine: Women’s College Hospital.

Weiss, C. H. (1972). Evaluation research: Methods of assessing program effectiveness. Prentice-Hall.

Wholey, J. S. (1979). Evaluation: promise and performance. Washington, DC: Urban Institute.

Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-oncology, 10(1), 19–28. https://doi.org/10.1002/1099-1611(200101/02)10:1<19:aid-pon501>3.0.co;2-6


Refbacks

  • There are currently no refbacks.


Bookmark and Share