Cancer units can now self-assess their activities and services against new global standards and practice recommendations for the delivery of high quality survivorship care to people affected by advanced or metastatic cancer.

The Multinational Association for Supportive Care in Cancer (MASCC)-ASCO standards, published in JCO Oncology Practice [link here], include 45 practice recommendations across seven domains of care.

The recommendations follow a systematic review of the evidence and a Delphi process to achieve consensus across a 77-member expert panel including health professionals, hospital administrators, cancer survivors and caregivers, and policymakers from 33 countries.

Dr Nicolas Hart

Lead author Associate Professor Nicolas Hart, an NHMRC Emerging Leader Fellow in Cancer Survivorship and Program Director in Clinical Exercise Physiology at UTS, Sydney, told the limbic that the resource should be helpful to institutions in low, medium and high resource settings.

“One of our higher performing hospitals in Australia would go down that list and might find that they have those seven high level standards in place, but they might only be delivering two or three recommendations underneath each standard as opposed to all seven or eight for example,” he said.

“It’s really a signpost for them to do a self-evaluation and say what investment do we need to provide to clinicians so that we can support them to deliver this care.”

He said every healthcare system was at a different stage with respect to the provision of survivorship care.

“We’re very fortunate in Australia, but we are not there yet. You can imagine there are healthcare systems in other parts of the world, that if they were to go through this document and highlight what they are doing versus what they need to do in the future, it’s very different.”

An approach was to first identify the ‘low hanging fruit’ for improving care.

“What could they do better? What could they do tomorrow? Because in that list of recommendations, there are things that they should be able to enact with relatively low effort or energy, and then they can identify other things that they might need to prioritise for investment or structural change later.”

He said the standards would also be useful to individual clinicians and consumers.

“I think it’s a good resource for the person living with cancer to be able to self advocate for their care, because it actually tells them what is best practice. It allows for a cancer patient to say, hang on, I’m not getting this. I haven’t got a survivorship care plan.”

Associate Professor Hart said people with advanced or metastatic cancer have historically been de-prioritised by resource-limited healthcare systems.

“Survivorship care is often prioritised for early stage cancers once they’ve completed treatment but the issue is that people with advanced or metastatic cancer may never come off treatment.”

“With the advent of immunotherapy and other treatments, people are living 2, 3, 4 or 5 years and it’s not good enough to let them fall through the cracks at this point.”

“They do have complex healthcare needs. They do have a higher interaction with the healthcare system by way of needing more attention to address their complex needs. But that’s why a multidisciplinary care team and a well-coordinated, well-integrated care with referrals to allied health, involvement of the primary care physician,…[etc] is necessary.”

He said the area was fraught with different definitions of care and different cultural contexts around the globe.

“So we’ve wrestled with language a lot. As you can imagine, survivorship care is not a new field but it’s a term that’s evolved over time… People get confused by what is supportive care versus palliative care versus survivorship care versus this and that.

“And that’s why in the publication, we had a whole section devoted to harmonising definitions because there are different interpretations around the world. So this is just the start of the work, I’d say.”

He said the table of standards and practice recommendations would be translated from English into 13 other languages to facilitate implementation worldwide.

Other senior Australian authors on the journal article included medical oncologists Professor Bogda Koczwara and Professor Michael Jefford, palliative care physician Professor Meera Agar and cancer nurse researcher Professor Raymond Chan.

The MASCC-ASCO Standards were also published in Supportive Care in Cancer [link here].