Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Prostate. 2021 May;81(7):398-406. doi: 10.1002/pros.24116. Epub 2021 Mar 23.
Survivorship care plans contain important information for patients and primary care physicians regarding appropriate care for cancer survivors after treatment. We describe the completeness of prostate cancer survivorship care plans and evaluate the concordance of follow-up recommendations with guidelines.
We analyzed 119 prostate cancer survivorship care plans from one academic and one community cancer center, abstracting demographics, cancer/treatment details, and follow-up recommendations. Follow-up recommendations were compared with the American Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network (NCCN) guidelines.
Content in >90% of plans included cancer TNM stage; prostate-specific antigen (PSA) at diagnosis; radiation treatment details (98% of men received radiation); and PSA monitoring recommendations. Potential treatment-specific side effects were listed for 82% of men who had surgery, 86% who received androgen deprivation therapy (ADT), and 97% who underwent radiation. The presence of posttreatment symptoms was noted in 71% of plans. Regarding surveillance follow-up, all guidelines recommend an annual digital rectal exam (DRE). No plans specified DRE. However, all 71 plans at the community site recommended at least annual follow-up visits with urology, radiation oncology, and primary care. Only 2/48 plans at the academic site specified follow-up visits. All guidelines recommend PSA testing every 6-12 months for 5 years, then annually. For the first 5 years, 90% of plans were guideline-concordant, 8% suggested oversurveillance, and 2% were incomplete. In men receiving ADT, ACS and ASCO recommend bone density imaging and NCCN recommends testosterone levels. Of 77 men on ADT, 1% were recommended bone density imaging and 16% testosterone level testing.
While care plan content is more complete for demographic and treatment summary information, both sites had gaps in reporting posttreatment symptoms and ADT-related testing recommendations. These findings highlight the need to improve the quality of information in care plans, which are important in communicating appropriate follow-up recommendations to patients and primary care physicians.
生存护理计划为患者和初级保健医生提供了有关癌症幸存者治疗后适当护理的重要信息。我们描述了前列腺癌生存护理计划的完整性，并评估了随访建议与指南的一致性。
我们分析了来自一个学术和一个社区癌症中心的 119 份前列腺癌生存护理计划，提取人口统计学、癌症/治疗细节和随访建议。将随访建议与美国癌症协会 (ACS)、美国临床肿瘤学会 (ASCO) 和国家综合癌症网络 (NCCN) 指南进行比较。
计划中超过 90%的内容包括癌症 TNM 分期；诊断时的前列腺特异性抗原 (PSA)；放射治疗细节（98%的男性接受放射治疗）；以及 PSA 监测建议。对 82%接受手术、86%接受雄激素剥夺治疗 (ADT) 和 97%接受放射治疗的男性列出了潜在的治疗特异性副作用。71%的计划记录了治疗后的症状。关于监测随访，所有指南都建议每年进行一次数字直肠检查 (DRE)。没有计划规定 DRE。但是，社区站点的所有 71 个计划都建议至少每年进行一次泌尿科、放射肿瘤学和初级保健的随访。学术站点的 48 个计划中只有 2 个规定了随访。所有指南都建议 PSA 检测每 6-12 个月进行一次，持续 5 年，然后每年一次。在前 5 年，90%的计划与指南一致，8%的计划建议过度监测，2%的计划不完整。在接受 ADT 的男性中，ACS 和 ASCO 建议进行骨密度成像，NCCN 建议检测睾酮水平。在接受 ADT 的 77 名男性中，1%被建议进行骨密度成像，16%被建议进行睾酮水平检测。
虽然护理计划的内容在人口统计学和治疗总结信息方面更加完整，但两个站点在报告治疗后症状和 ADT 相关检测建议方面都存在差距。这些发现强调了需要提高护理计划中信息质量的必要性，这对于向患者和初级保健医生传达适当的随访建议非常重要。
