: Care Plan In 2012 the Commission on Cancer introduced new Standards for Cancer Program Accredita:on. They created a new chapter of standards en:tled: CONTINUUM OF CARE SERVICES 1
Included in this sec:on were new requirements for: Pa:ent Naviga:on Process Psychosocial Distress Screening Care Plan 2
implement a process to disseminate a comprehensive care summary and followup plan to patients who are completing cancer treatment. The process is monitored, evaluated, and presented at least annually to the cancer committee and documented in minutes. 3
Programs were given 3 years to develop processes to sa>sfy these standards. The effec:ve date for implementa:on was January 2015. 4
In August 2013, the Commission on Cancer performed a needs assessment of its 1500 accredited cancer programs. 5
Storms on the horizon 6
Problems with preparedness: Programs Experience: plans in place 21% 7
Problems with preparedness: Programs Experience: plans in place 21% Completely Confident of compliance - 37% 8
Problems with preparedness: Programs Experience: plans in place 21% Completely Confident of compliance - 37% Addressing the Standard 40% 9
Problems with preparedness: Programs Experience: plans in place 21% Completely Confident of compliance - 37% Addressing the Standard 40% Had not addressed the Standard - 60% 10
Problems with preparedness: Need for Defini>ons 11
Problems with preparedness: Need for Defini>ons How to evaluate the process? 12
Problems with preparedness: Need for Defini>ons How to evaluate the process? What tools were available? 13
Problems with preparedness: Need for Defini>ons How to evaluate the process? What tools were available? What is required for successful implementa>on? 14
Problems with preparedness: Need for Defini>ons How to evaluate the process? What tools were available? What is required for successful implementa>on? Are there organiza>ons to turn to for help? 15
CoC Releases 3.3 Defini>ons! Revises Timeline for Implementa>on! 16
Defini:ons Who is a survivor? IOM: Anyone with cancer from diagnosis to death The defini>on of "survivor" in the Ins>tute of Medicine (IOM) Report, From Cancer Pa,ent to Cancer Survivor: Lost in Transi,on, states that "an individual is considered a cancer survivor from the,me of cancer diagnosis through the balance of his or her life, according to the Na,onal Coali,on for Cancer and the NCI Office of Cancer ". 17
Defini:ons Who is a survivor? IOM: Anyone with cancer from diagnosis to death CoC: Pa>ent treated with cura:ve intent* who has completed therapy** * Effec>vely all stage I- III cases for all disease sites ** Excluding long term hormonal therapy (breast, prostate) 18
Minimal Content for the Treatment Summary Based on a data set formulated by ASCO and expected to be released soon. 19
Minimal Content for the Treatment Summary 1) Surgery : yes/no if yes: a) procedure with loca>on in body b) date by year, month op>onal 20
Minimal Content for the Treatment Summary 2) Chemotherapy: yes/no if yes: a) name of systemic agents* b) end date by year, month op>onal *agents only, NOT regimen 21
Minimal Content for the Treatment Summary 3) Radia>on therapy : yes/no if yes: a) anatomic area treated b) date by year, month op>onal 22
Minimal Content for the Treatment Summary 4) Ongoing toxicity or side effects of all therapy PRESENT AT COMPLETION of therapy Informa>on on its likely course 23
Minimal Content for the Treatment Summary 5) For selected cancers, informa>on regarding: Predisposing condi>ons Gene>c/hereditary factors Results of gene>c tests if available 24
Follow Up Care Plan 1. Oncology Care Team Contact Numbers and Loca>on 25
Follow Up Care Plan 2. Ongoing Adjuvant Therapy Name of drug (s) Planned Dura>on of Therapy Expected Side Effects 26
Follow Up Care Plan 3. Schedule of Follow Up - Table Format Who? How Ojen? Where? 27
Follow Up Care Plan 4. Cancer Surveillance Tests- Table Format Who is responsible for ordering it? How Ojen it will be done? Where it will be done? 28
Follow Up Care Plan 5. Cancer Screening for early detec>on of new primaries** - Table Format Who is responsible for ordering it? How ojen it will be done? Where it will be done? ** Only if different from general popula>on 29
Follow Up Care Plan 6. Other periodic tes>ng: suggested phrase "con>nue all standard non- cancer related health care with your primary care provider, with the following excep>ons: [if there are any]" 30
Follow Up Care Plan 7. Possible Symptoms of Recurrence "Any new, unusual and/or persistent symptoms should be brought to the amen>on of your provider." 31
A list of likely or rare late term side effects that the survivor might experience based on his/ her diagnosis and treatment and the likely symptoms indica>ve of that side effect. 32
A list of items (e.g. emo>onal or mental health, paren>ng, work/employment, financial issues, and insurance) should be covered with standard language sta>ng that survivors have experienced issues in these areas and that the pa>ent should speak with his or her oncologist and/or PCP if having related concerns. 33
A general statement emphasizing the importance of healthy diet, exercise, smoking cessa>on and alcohol use reduc>on may be included. Statements may be tailored if par>cularly per>nent to the individual. 34
The cancer commimee will develop a policy of iden>fying a physician team member or advanced prac>ce partner who would be responsible for discussing the care plan with a pa>ent and track compliance annually. 35
Informa>on Sources American Society of Clinical Oncology Na>onal Coali>on for Cancer Livestrong Founda>on EHR providers 36
Timeline for Implementation January 1, 2015 10% January 1, 2016 25% January 1, 2017 50% January 1, 2018 75% January 1, 2019 100% At Survey 2015, 2016, or 2017, Programs at 100% receive Special Recognition 37
Washington State Legislative Issues An Update on Hazardous Drugs 38
The 2011 Legislature passed Engrossed Substitute Senate Bill (ESSB) 5594, requiring the Department of Labor & Industries (L&I) to set requirements to protect workers who handle chemotherapy and other hazardous drugs.
Initial Implementation Schedule Jan 1, 2014 Stage 1: Complete and implement a written hazardous drugs control program. July 1, 2014 Stage 2: Implement employee training. Jan 1, 2015 Stage 3: Install appropriate ventilated cabinets. 40
The rule applies to all employers in health care facilities that have employees with occupational exposure to hazardous drugs. For the purpose of this rule, health care facilities are defined as places where a health care provider provides health care to patients, including: Hospitals. Clinics. Nursing homes. Laboratories. Offices. Veterinary medicine clinics. Retail pharmacies. Home health care agencies. Research laboratories where a health care provider offers health care to patients. 41
Drugs Covered by USP 797 (now USP 800) include: Antineoplastics Hormones Antipsychotics Anti-epileptics 42
The inclusion of other classes of drugs has created a situation which has the potential to impact: 1) drug access for women for birth control and reproductive issues 2) labor and delivery 3) availability of mental health services 4) Patients with seizure disorders 43
February 10, 2014 Employer members of the Hazardous Drug Advisory Committee submitted a letter requesting a delay in implementation to allow for refining of the rules. 44
45
May 2014 Labor and Industries accepted the request to revisit the rules. The Advisory Committee cancelled further work on Best Practices Stakeholder meetings were planned One stakeholder meeting was held. 46
September 2014 Labor and Industries published new guidelines without further discussion with the Advisory Committee 47
After having granted the initial request to revise the rules, L & I may have violated the rules that govern Administrative Practices by reversing itself and then proceeding before Best Practices could be developed and by not allowing sufficient time for oncology practices to create their hazardous drug assessments and control manuals to satisfy the final rules. 48
What Happens Next? Discussions with all affected organizations Discussions with labor and Industries Meetings with Legislators 49