A Care Plan for All Phases of Cancer Treatment

“Like any complex project, managing a treatment plan for an individual with cancer requires taking the right steps at the right time.” -Julia Trosman

Treatment Plans for Individuals: Taking the Right Steps at the Right Time

Like any complex project, managing a treatment plan for an individual with cancer requires taking the right steps at the right time.  These days crucial information often comes from genetic testing. Take breast cancer as an example. If a person has a mutation in a particular gene, it significantly increases her chances of getting cancer in the other breast.  If the genetic analysis is available prior to her surgery, she may decide to have both breasts removed in order to minimize her chance of getting a second cancer. But if the genetic analysis is not available, she and her health care team will have to make an uninformed decision prior to her surgery.

Julia Trosman

Christine Weldon

Julia Trosman, PhD, MBA and Christine Weldon, MBA identified this problem in a study they performed at Northwestern University.  They also saw that the challenge of providing the right sequence of care was not limited to genetic testing. In addition to needing the right information at the right time, there is also a need to provide the right care at the right time.  For example, a patient may need to have dental work performed before radiation treatment to the head or neck can be started. Patients may choose to freeze sperm or eggs in order to preserve their ability to have children before they receive specific medications.

Enter the 4R Model

So Trosman and Weldon developed and piloted the 4R model: Right Information/Right Care/Right Patient/Right Time to help manage the sequencing of care, facilitate teamwork and empower patients to engage in their care.  When the plan is presented clearly, the patient and his or her family have a customized schedule of things to do. This is comparable to making a list of chores that need to be completed before a trip: the plan is both a schedule and a “to do” list.

For Julia Trosman and Christine Weldon, cancer is a personal story as it is for many others.  “Both of our families have a history of cancer,” Julia says. “We aim to not only improve care coordination and delivery for all patients with cancer, but also make the patient / family more informed, self-sufficient and equipped to control and manage the process of going through care. This doesn’t mean that care teams will abdicate their responsibilities, but this does mean that patients will feel more confident and in control of what care they receive and when.”

Stanford researchers have joined centers across the US to study the 4R model in breast cancer.  So far, patient responses show that they are in favor of the model. One patient noted, “This plan helped me understand all the things that I was facing.  It made me feel that I was in control. I feel I can do anything if I know what is going to happen.” A cancer survivor added “I am still relying on that chart to keep my appointments on schedule.  I was totally prepared by this plan.”

The 4R Plan Helps with Survivorship Care

One of the anticipated benefits of using the 4R model is that cancer survivors will be more involved in understanding, planning and implementing their survivorship care.  Since 2005, when the Institute of Medicine published a report recommending that all cancer survivors receive a Survivorship Care Plan, efforts have been made to give cancer survivors a summary of their cancer treatment and recommendations for follow-up care and prevention.  For some people, this has been a helpful document but more work is needed to make this a useful document for all cancer survivors.

Perhaps using the 4R model throughout cancer treatment will prepare survivors to understand their care plan once active treatment has finished and enable  them to take charge of scheduling visits and tests and making lifestyle changes that will help stay healthy.

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“This plan helped me understand all the things that I was facing. It made me feel that I was in control. I feel I can do anything if I know what is going to happen.” - Cancer Survivor