Cancer care plans act as roadmaps that make sure to let know where the patients are going and how they will get in time. According to National Coalition for Cancer Survivorship (NCCS), cancer patients should have access to the following Cares.
- Care that adheres to practice guidelines and evidence-based standards of care;
- Comprehensive cancer care that assures proper treatment of the symptoms and side effects of cancer and cancer treatment;
- Coordinated care with strong communication among all the providers and the patient, supported by modern health information technology;
- A written care plan detailing all elements of cancer care;
- Care in a clinical trial, if it represents a potential treatment option;
- Honest discussion with their physicians regarding prognosis, the intent of therapy and the patient’s values and preferences regarding care;
- An assessment of their psychosocial needs and referrals to resources;
- Palliative care throughout the course of treatment, from diagnosis through end of life;
- End-of-life care, including but not limited to hospice care of adequate scope and duration;
- Their personal health information, including their electronic health records; and
- Robust health information systems that support and improve all other aspects of quality cancer care.
Upon discharge from cancer treatment, including treatment of recurrences, every patient should be given a record of all care received and important disease characteristics and a written follow-up care plan. This should include:
- Diagnostic tests performed and results.
- Tumor characteristics (e.g., site(s), stage and grade, hormonal status, marker information).
- Dates of treatment initiation and completion.
- Surgery, chemotherapy, radiotherapy, transplant, hormonal therapy, gene or other therapies provided, including agents used, treatment regimen, total dosage, identifying number and title of clinical trials (if any), indicators of treatment response, and toxicities experienced during treatment.
- Psychosocial, nutritional, and other supportive services provided.
- Full contact information on treating institutions and key individual providers.
- Identification of a key point of contact and coordinator of continuing care.
- The likely course of recovery from treatment toxicities, as well as need for ongoing health maintenance/adjuvant therapy
- A description of recommended cancer screening and other periodic testing and examinations, and the schedule on which they should be performed (and who should provide them).
- Information on possible late and long-term effects of treatment and symptoms of such effects.
- Information on possible signs of recurrence and second tumors.
- Information on the possible effects of cancer on marital/partner relationship, sexual functioning, work, and parenting, and the potential future need for psychosocial support.
- Information on the potential insurance, employment, and financial consequences of cancer and, as necessary, referral to counseling, legal aid, and financial assistance.
- Specific recommendations for healthy behaviors (e.g., diet, exercise, healthy weight, sunscreen use, virus protection, smoking cessation, osteoporosis prevention). When appropriate, recommendations that first degree relatives be informed about their increased risk and the need for cancer screening (e.g., breast cancer, colorectal cancer, prostate cancer).
- As appropriate, information on genetic counseling and testing to identify high risk individuals who could benefit from more comprehensive cancer surveillance, chemoprevention, or risk reducing surgery.
- As appropriate, information on known effective chemoprevention strategies for secondary prevention (e.g. Tamoxifen in women at high risk for breast cancer; aspirin for colorectal cancer prevention).
- Referrals to specific follow-up care providers, support groups, and/or the patient’s primary care provider.
- A listing of cancer-related resources and information (Internet-based sources and telephone listings for major cancer support organizations).