Is it time to revisit the role of survivorship care plans?

Abstract

657 Background: Cancer survivorship care plans (SCPs) outline prior cancer treatments and a comprehensive plan to address potential long-term effects in cancer survivors. Despite the implementation of SCPs into general practice, there are differences in guidelines around the use of SCPs, and controversy exists on whether SCPs meaningfully improve overall outcomes, particularly mortality. Methods: Patients >18 years with a primary cancer diagnosis, diagnosed between 2018-2023 at a single health system and treated with curative intent were included. SCP receipt was identified through electronic health record (EHR) data. Descriptive statistics and chi-square tests characterized SCP receipt by sociodemographic and clinical factors. Multivariable logistic regression identified independent predictors of SCP receipt. Overall survival was examined using the Kaplan-Meier estimator and multivariable Cox models, adjusting for age, sex, race, rurality, area deprivation index (ADI), cancer type, and stage. Inverse Probability of Treatment Weighting (IPTW) was used to address possible selection bias. Results: Of 34,188 adult cancer patients, 5,670 (16%) received a SCP. The rate of receiving SCP varied substantially by cancer type: breast cancer patients had the highest rate (36%), while hematologic malignancies, thyroid, and liver had the lowest rates (all < 5%). Older age was significantly associated with lower odds of SCP receipt (75+ [vs. 50-64 years]: OR 0.52, 95% CI 0.48–0.57,). Stage IV disease was associated with lower odds of receipt (OR 0.42, 95% CI 0.36–0.50) compared to stages I–II. Higher ADI was also associated with lower SCP receipt (OR 0.89, 95% CI 0.81–0.98). SCP receipt increased from 2018 through 2022 before declining in 2023. In adjusted Cox models, SCP receipt was associated with a 52% lower hazard of death (HR 0.48, 95% CI 0.49–0.53) compared to those who did not receive an SCP. This association was observed across cancer types and was sustained in stage-stratified analyses as well as in the IPTW model, indicating that unobserved confounding was unlikely. Conclusions: SCP receipt remains low overall and is inequitably distributed, with older patients, and those from higher-deprivation areas least likely to receive this evidence-based care. SCP receipt, however, is strongly associated with improved survival, underscoring its potential clinical value. Future work should examine whether SCPs drive improved outcomes through enhanced preventative care utilization.