Simplifying Survivorship Care Planning

A Randomized Controlled Trial Comparing 3 Care Plan Delivery Approaches

Claire Snyder, PhD; Youngjee Choi, MD; Amanda L. Blackford, ScM; Jennifer DeSanto, RN, MS; Nancy Mayonado, MS; Susan Rall, Med; Sharon White, BA; Janice Bowie, PhD, MPH; David E. Cowall, MD; Fabian Johnston, MD, MHS; Robert L. Joyner Jr, PhD, RRT; Joan Mischtschuk, RN, MS; Kimberly S. Peairs, MD; Elissa Thorner, MHS; Phuoc T. Tran, MD, PhD; Antonio C. Wolff, MD; Katherine C. Smith, PhD


J Natl Cancer Inst. 2022;114(1):139-148. 

In This Article

Abstract and Introduction


Background: Survivorship care plans seek to improve the transition to survivorship, but the required resources present implementation barriers. This randomized controlled trial aimed to identify the simplest, most effective approach for survivorship care planning.

Methods: Stage 1–3 breast, colorectal, and prostate cancer patients aged 21 years or older completing treatment were recruited from an urban-academic and rural-community cancer center. Participants were randomly assigned, stratified by recruitment site and cancer type 1:1:1 to a mailed plan, plan delivered during a 1-time transition visit, or plan delivered during a transition visit plus 6-month follow-up visit. Health service use data were collected from participants and medical records for 18 months. The primary outcome, receipt of all plan-recommended care, was compared across intervention arms using logistic regression adjusting for cancer type and recruitment site, with P less than .05 considered statistically significant.

Results: Of 378 participants randomly assigned, 159 (42.1%) were breast, 142 (37.6%) prostate, and 77 (20.4%) colorectal cancer survivors; 207 (54.8%) from the academic site and 171 (45.2%) from the community site; 316 were analyzable for the primary outcome. There was no difference across arms in the proportion of participants receiving all plan-recommended care: 45.2% mail, 50.5% 1-visit, 42.7% 2-visit (2-sided P = .60). Adherence by cancer type for mail, 1-visit, and 2-visit, respectively, was 52.2%, 53.3%, and 40.0% for breast cancer; 48.6%, 64.1%, and 57.1% for prostate cancer; and 23.8%, 19.0%, and 26.1% for colorectal cancer. There were no statistically significant interactions by recruitment site or cancer type.

Conclusions: This study did not find differences in receipt of recommended follow-up care by plan delivery approach. Feasibility and other factors may determine the best approach for survivorship care planning.


When the Institute of Medicine recommended survivorship care plans (SCPs) in its 2006 report, 1 goal was ensuring that cancer survivors knew what follow-up care they needed when.[1] However, many randomized controlled trials (RCTs) evaluating SCPs conducted to date have focused on patient-reported outcomes (PROs) and, generally, have not found benefits of SCPs.[2–7] Fewer RCTs have evaluated health service use,[3,8] and many RCTs have included single, primarily female cancers.[2,3,7,8] Further, in the 15 years since the report's publication, numerous studies have documented the resource burdens of completing SCPs.[9–14]

The "Simplifying Survivorship Care Planning" RCT's objective was to evaluate 3 SCP delivery approaches to identify the simplest, most effective approach, with receipt of SCP-recommended care as the effectiveness measure. Secondary outcomes, reported elsewhere, included feasibility of the intervention arms,[15] content of the SCP recommendations and their concordance with guidelines,[16–18] PROs (Smith et al., unpublished data), and overuse of tests or procedures not recommended for routine care (eg, laboratory tests in breast cancer survivors) (Sheng et al., unpublished data). Here, we report the primary outcome results.