Accepted Manuscript Cancer Survivorship Advocacy Pamela J. Haylock , PhD, RN, FAAN PII:

S0749-2081(14)00095-3

DOI:

10.1016/j.soncn.2014.11.009

Reference:

YSONU 50679

To appear in:

Seminars in Oncology Nursing

Please cite this article as: Haylock PJ, Cancer Survivorship Advocacy, Seminars in Oncology Nursing (2015), doi: 10.1016/j.soncn.2014.11.009. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Cancer Survivorship Advocacy

AC C

EP

TE D

M AN U

SC

RI PT

Pamela J. Haylock, PhD, RN, FAAN Oncology Care Consultant & Educator 18954 State Highway 16 North Medina, TX 78055 [email protected] 830-589-7380 & Adjunct Instructor Schreiner University Nursing Program Kerrville, TX

1

ACCEPTED MANUSCRIPT

Abstract: Objectives: To review the advocacy initiatives of major cancer-related organization and

RI PT

coalitions that are working to effect funding, planning, and implementation of care and services

SC

for cancer survivors.

M AN U

Data Sources: Web sites of cancer-related member organizations, advocacy associations, and published peer reviewed health policy literature.

Conclusion: Health care reform creates near endless opportunities for nurses to participate in

EP

survivors.

TE D

and contribute to the development of public policy to support meeting the needs of cancer

Implications for nursing practice: Emerging public policy initiatives, including legislation and

AC C

regulation created with professional nursing’s contributions are most likely to reflect the needs of cancer survivors.

Key Words: Survivorship advocacy, Survivorship Legislation, Survivorship Regulation

2

ACCEPTED MANUSCRIPT

Public policy is a system of regulatory decisions, legislative actions, funding priorities, and other

RI PT

courses of action.1 Everyone who is diagnosed with cancer, and health care professionals who provide care and services for people diagnosed with cancer, is impacted by public policy.1 This impact can include funding for all measures associated with cancer control: best practices and guidelines for prevention and early detection, research for new, effective, and less toxic

SC

therapies, public and private payer coverage for treatment, and financial and practical issues

M AN U

related to care.1 There is strong emphasis on public policy to improve survivors’ access to care, explore and implement evidence-based efforts to identify, prevent, or minimize short and longterm effects of the disease and its treatment, to eliminate disparities in cancer-related outcomes, and to improve coordination of care for survivors of cancer. Initiatives arising from advocacy, research, education and practice sectors underlie the most recent meaningful outcomes to occur

TE D

in the history of cancer survivorship. Throughout the three decades of the survivorship movement, policy change has been and continues to be essential to ensure that cancer survivors

EP

have access to high-quality, evidence-based cancer care.1,2,3 Advocacy among oncology nurses can be defined very simply as a voice for the vulnerable.4

AC C

Oncology nurses view advocacy efforts as existing on a continuum, ranging from one-on-one negotiations to arrive at effective symptom management strategies for individual patients, institution and delivery-system level efforts to advance evidence-based practices, to local, state, and national levels to effect change that promotes quality cancer care.4 The first organization in the world to focus solely on issues of cancer survivorship, the National Coalition for Cancer Survivorship (NCCS) was a catalyst for survivor advocacy, that also exists on a continuum,

3

ACCEPTED MANUSCRIPT

perhaps beginning at personal levels with self-advocacy, but broadening along the survivorship journey to include group, organization, and public advocacy efforts.3

RI PT

In its Position Statement on Access to Quality Cancer Care, the Oncology Nursing Society (ONS) affirms its philosophy that “access to quality cancer care is the right of all people.”5 This ONS Statement identifies basic characteristics of quality cancer care as “safety, efficacy,

timeliness, a patient-centered approach coordinated by a multidisciplinary team, and integration

SC

of evidence-based practice to continuously improve care.”5 The statement notes that without

M AN U

essential services (prevention, early detection, risk reduction, clinical trials, treatment, psychosocial care and survivorship) patients may experience diminished quality of life and/or sub-optimal outcomes.5 What the ONS calls the “substantive role of oncology nurses” in quality cancer care is affirmed and consistent with the Institute of Medicine’s Future of Nursing: Leading Change, Advancing Health.5,6 Major elements of the ONS Access to Quality Cancer

TE D

Care Position are identified in Table 1.

The NCCS recognizes quality cancer care as cancer patients having access to comprehensive and coordinated care that adheres to practice guidelines and evidence-based standards.1 Essential

Written care plan detailing patient-centered goals and intentions of therapy, all elements

AC C



EP

components of care include1:

of care

• • • •

Access to appropriate clinical trials Assessment and attention to psychosocial needs. Treatment summary Services to monitor health status, early recognition of complications and surveillance for recurrent and second cancers 4

ACCEPTED MANUSCRIPT



Coordinated care

Public Policy Priorities and Initiatives

RI PT

The Affordable Care Act implementation processes present nearly endless opportunities for nurses’ participation and contributions – development of regulatory language and legislation to further define health care delivery consistent with the intent of the ACA and nursing ethics.

SC

Coalitions

Cancer-related organizations and associations share a number of public policy priorities. In

M AN U

recognition of power in numbers, coalitions are formed that allow organizations to avoid duplication of efforts and combine resources to reach a shared goal. One such example is One Voice Against Cancer (OVAC), a coalition of 40 associations.7 Recognizing implications of the 14 million Americans living today with a history of cancer, the nearly 70% survival rate of the

TE D

1.6 million Americans diagnosed with cancer annually, the lack of optimal treatment for many forms of cancer and limited options for management of long-term and late effects, OVAC was formed to advocate for increases in cancer-related funding.7 The American Society for Clinical

EP

Oncology (ASCO), the American College of Surgeons Commission on Cancer (CoC),the American Society for Radiation Oncology (ASRO), the Intercultural Cancer Council Caucus

AC C

(ICCC), and the Oncology Nursing Society, are among coalition members to sign a call to support its Fiscal Year 2015 Appropriations Agenda.7 According to OVAC, cancer-related costs – direct treatment costs and lost productivity – exceed $256 billion just in the United States. In the late 1990s, the National Cancer Institute (NCI) budget accounted for 18.7% of the total National Institutes of Health (NIH) budget. Today, the NCI budget is 16.4% of the NIH budget - $1,680 million less than NCI would have received in FY. 2014 if its share of the NIH budget were maintained at 18.7%.7 OVAC calls for appropriations that support cancer research, 5

ACCEPTED MANUSCRIPT

cancer prevention and control activities, and improve efficiency and speed of Food and Drug Administration drug approval processes. OVAC supports efforts to shore up the oncology nursing workforce through allocations to the Health Resources and Services Administration

RI PT

(HRSA) for nurse training programs, additional nursing scholarships, and loan repayment application.8 National Coalition for Cancer Survivorship

SC

NCCS policy priorities focus on improving the quality and accessibility of cancer care. NCCS invests time, personnel and volunteer resources in public policy activities aimed at fostering a

M AN U

“cancer care system that is evidence-based, quality-driven, patient-focused, and affordable and accessible to all.”2 Since more than half of all cancer diagnoses occur among Medicare beneficiaries, strategies to improve payment for and delivery of cancer care is of particular interest.9 The Planning Actively for Cancer Treatment (PACT – H.R.2477) Act would ensure

TE D

that every Medicare-eligible cancer patient has access to cancer care planning and coordination to improve patient health and reduce inefficiencies in the system.10 Medicaid provisions: Although not currently an NCCS policy priority, changes in Medicaid

EP

provisions of the ACA are being implemented, and will likely become a matter of interest to the

AC C

organization.11 Opportunities exist for advocates, including oncology care professionals, to shape the debate about how cancer care is delivered to vulnerable patients. ASCO outlined guiding principles aimed at providing access to high-quality cancer care for all low-income individuals.11 The Oncology Nursing Society ONS advocates payment models that incorporate the work of oncology nurses and positively impact oncology practice. ONS considers its signature legislation to be the Improving Cancer

6

ACCEPTED MANUSCRIPT

Treatment Education Act of 2014 (H.R. 1661).12 This legislation requests one-hour Medicare reimbursement for symptom management education provided by an oncology nurse.12

RI PT

Another ONS public policy priority relates to national and global tobacco control efforts including a position that asks ONS and its members to support US ratification and

implementation of the World Health Organization’s Framework Convention on Tobacco.13 The

SC

ONS Position, Nursing Leadership in Global and Domestic Tobacco Control, identifies several initiatives in which nurses can assume roles that would ultimately decrease use of tobacco

M AN U

products in the United states and other nations.13

Organizational Survivorship Advocacy Efforts

Cancer-related professional associations and organizations were invited to provide overviews of their survivorship advocacy priorities and efforts. Organizations’ public policy staff members

TE D

were asked to respond to a standard set of queries relating to cancer survivorship. The responses summarized here offer insight to perceived needs in the provision of care and services available to cancer survivors, and provide direction for nurses wanting to contribute to promoting public

AC C

EP

policy that supports care and services for this population.

7

ACCEPTED MANUSCRIPT

National Coalition for Cancer Survivorship (NCCS) An advocacy organization

RI PT

www.canceradvocacy.org Prepared by: Ellen Stovall, Senior Health Policy Advisor

The National Coalition for Cancer Survivorship Mission: To advocate for quality care for

SC

people with all cancers

health policy and lawmakers.

M AN U

Constituency: Survivorship and Advocacy organizations and national leaders, organizations in

Top survivorship advocacy and/or public policy priorities

Quality cancer care – chiefly focused on delivery and payment reforms



Working with the Oncology Care Model implementation from CMS/CMMI to bring

TE D



patient-centered reforms to the delivery and payment of cancer care across all settings. NCCS’s current Survivorship advocacy actions and initiatives

EP

Bringing patient-centered care issues to the organizations and institutions What does NCCS hope is achieved once the Affordable Care Act is fully implemented?

AC C

Patient-centered quality cancer care across all settings where people access cancer care. What is the NCCS perception of the impact of ACA on survivorship research? We do not have a perception at this point. Federal funding levels are expected to remain flat, if not reduced.

What is the NCCS perception of the impact of ACA on survivorship services?

8

ACCEPTED MANUSCRIPT

We are more optimistic than at any other time, chiefly because of the actions of CMS and CMMI to put out an oncology care model on which we will be invited to comment. We expect both

AC C

EP

TE D

M AN U

SC

RI PT

delivery and payment reform to be impacted by these initiatives.

9

ACCEPTED MANUSCRIPT

Oncology Nursing Society Professional Association www.ons.org

RI PT

Prepared by: Alec Stone, Health Policy Director Mission: The mission of the Oncology Nursing Society (ONS) is to promote excellence in oncology nursing and quality cancer care.

SC

ONS members are a diverse group of professionals who represent a variety of professional roles, practice settings, and subspecialty practice areas. Registered nurses, including staff nurses,

M AN U

advanced practice nurses, case managers, educators, researchers, and consultants, and other healthcare professionals, benefit from membership. The society offers useful information and opportunities for nurses at all levels, in all practice settings, and in all subspecialties. The ONS constituency is its 40,000 members.

The ONS’s survivorship advocacy/public policy priorities

TE D

The ONS respectfully calls on the U.S. Congress and the Obama Administration to: Promote and improve cancer symptom management and palliative care;



Advance and ensure access to quality cancer prevention and care;



Bolster the nation’s nursing workforce to safeguard public health.

EP



AC C

The ONS current survivorship advocacy actions and/or initiatives The ONS efforts focus on strengthening the nursing workforce, education, and research to promote excellence in oncology nursing and quality cancer care. Priority issues include promoting understanding and appropriate application of palliative care, tobacco cessation, pain and symptom management and related education, and effective use of cancer screening techniques and programs.

10

ACCEPTED MANUSCRIPT

What does the ONS hope is achieved once the Affordable Care Act is fully implemented?

RI PT

The ONS works towards securing access to treatments and cures for those with cancer, and expansion of coverage that promotes improved access to cancer-related public health and prevention services.

SC

What is the ONS perception of the impact of the Affordable Care Act on survivorship research?

The ONS’ perceived impact of the ACA on survivorship research is that health care budgets will

M AN U

reflect an understanding that additional federal funding is imperative for the NIH (including the National Cancer Institute and the National Institute for Nursing Research) to support research for effective cancer control strategies, cancer cures and evidence-based oncology nursing interventions.

TE D

What is the ONS perception of the impact of the Affordable Care Act on survivorship services? The ONS certainly sees the need for CMS to be allowed more authority, funding and action in

AC C

disease.

EP

provide care and services for those diagnosed with cancer throughout the continuum of the

11

ACCEPTED MANUSCRIPT

American Cancer Society and American Cancer Society Cancer Action Network Volunteer Membership, Advocacy, and Voluntary Health Organization www.cancer.org

RI PT

Prepared by: Panel of ACS and ACSCAN Experts

The American Cancer Society (Society) is the largest voluntary health organization in the United

affiliate of the Society.

M AN U

American Cancer Society mission statement

SC

States. The American Cancer Society Cancer Action Network (ACS CAN) is the advocacy

The American Cancer Society is the nationwide, community-based, voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and

TE D

service.

American Cancer Society Cancer Action Network mission statement

EP

The American Cancer Society Cancer Action Network, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative

AC C

solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard.

The ACS constituency: Cancer patients, survivors and their loved ones

12

ACCEPTED MANUSCRIPT

The ACS and ACS CAN survivorship advocacy and/or public policy priorities

RI PT

The American Cancer Society Cancer Action Network (ACS CAN) works to ensure that cancer patients receive not only care focused on treating their disease, but that they also receive

palliative care to addresses side effects and symptoms of treatment, and coordination of their

SC

care. Palliative care is provided by a team of doctors, nurses, and other specialists who work with patients’ other health care professionals to provide an extra layer of support. Palliative care can

M AN U

help patients get well faster and easier by addressing symptoms like fatigue, nausea and emotional distress. Studies show that patient access to palliative care leads to better patient quality of life and increased patient and family satisfaction. ACS CAN believes that these services should be offered at the point of diagnosis to every cancer patient regardless of age or

TE D

stage of disease.

The ACS and ACS CAN survivorship advocacy actions and/or initiatives The American Cancer Society (Society)

EP

The Society is focused on expanding the survivorship evidence base which can be used to inform

AC C

public policy. To that end, the Society has conducted survivorship research that has been published in over 60 peer reviewed papers (1,2), and has also compiled special survivorship and pediatric supplements to the annual “Facts and Figures” series (3,4). The Society also operates the National Cancer Survivorship Resource Center through a grant from the Centers for Disease Control and Prevention (CDC), which provides survivors, practitioners and health systems with resources for improving survivorship experiences.

13

ACCEPTED MANUSCRIPT

(http://www.cancer.org/treatment/survivorshipduringandaftertreatment/nationalcancersurvivorshi presourcecenter/index) ACS CAN

RI PT

ACS CAN is engaged in a Quality of Life campaign (www.acscan.org/qualityoflife) focused on improving the lives of cancer patients by making treatment of pain and other symptoms, and coordination of care standard protocol during treatment for cancer. The goal is to improve

SC

quality of life for both the patient and the family and help patients get well faster and easier.

M AN U

ACS CAN is actively working on legislation that is pending in the United States Congress that would address patient barriers to palliative care in three key areas by: (1) ensuring sufficient numbers of specialists to teach doctors and nurses how to provide high quality palliative care; (2) investing in research on ways to improve patient quality of life through palliative care; and (3) by

TE D

delivering high-quality palliative care in hospitals, and later expanding that care to other community sites where cancer patients are treated.

implemented?

EP

What does ACS/ACS CAN hope is achieved once the Affordable Care Act is fully

AC C

First, we want to ensure that the new marketplace is actually working in a way that benefits children and adults living with cancer, survivors, and their families. That means making sure that market reforms like the prohibition on pre-existing condition exclusions, and the ban on rescissions, lifetime limits and annual caps are being properly implemented. We also want to make sure that the essential health benefits package guarantees access to the kinds of services that cancer survivors of any age need – including access to cancer medications. Second, we want to ensure that the new health care system is transparent – that cancer survivors are able to make 14

ACCEPTED MANUSCRIPT

apples to apples comparisons of plans and choose a health insurance plan that covers the drugs, services, and providers they need. We want to ensure that the new system improves the way care is delivered for cancer survivors, including seamless transitions of care, expanded use of

RI PT

care planning, greater involvement of patients in shared decision-making, better use of patient navigation services and palliative care, including symptom relief and psychosocial support. What is the ACS/ACS CAN perception of the impact of the Affordable Care Act on

SC

survivorship research?

M AN U

The primary focus of the ACA has been increasing coverage and improving healthcare delivery and public health, but research has also been impacted by the ACA’s emphasis on patient centeredness. Specifically, the ACA created the Patient Centered Outcomes Research Institute (PCORI), whose focus is to move beyond thinking narrowly in terms of how treatments affect

TE D

diseased tissue or organ systems, and move to a more broad examination of how treatments affect the whole patient and all of the various treatment goals that each individual may have. This will provide a patient voice in the design and conduct of research that will steer research

EP

toward patient needs and concerns like symptom management, quality of life, and long-term and late effects of treatment that are especially challenging with childhood cancer survivors. PCORI-

AC C

funded research should provide not only more evidence to help patients understand how various treatment decisions will affect their quality of life, but ideally it will also find ways to mitigate and eliminate those effects to the extent possible. What is the American Cancer Society/ACS Cancer Action Network perception of the impact of Affordable Care Act on survivorship services?

15

ACCEPTED MANUSCRIPT

The ACA has had a profound impact on survivorship by virtue of making affordable health care available to all cancer survivors regardless of age – and other Americans – and eliminating discriminatory insurance practices that prevented millions of people from getting and keeping

RI PT

health insurance. This is significant because research shows that having health insurance

coverage is directly linked to finding cancers at an earlier – and often more treatable – stage. The ACA’s creation of the Innovations Center will also directly impact survivorship services by

SC

testing new delivery systems like Accountable Care Organizations (ACOs), patient-centered

AC C

EP

TE D

M AN U

medical homes and other models that can improve care delivery for cancer survivors.

16

ACCEPTED MANUSCRIPT

The Leukemia & Lymphoma Society www.lls.org Voluntary Health Organization

RI PT

Prepared by: Sharon Ladin, Executive Director, Advocacy

Organizational Mission

The mission of The Leukemia & Lymphoma Society (LLS) is: Cure leukemia, lymphoma,

SC

Hodgkin's disease and myeloma, and improve the quality of life of patients and their families.

M AN U

LLS is the world's largest voluntary health agency dedicated to blood cancer. LLS funds lifesaving blood cancer research around the world and provides free information and support services.

The Leukemia and Lymphoma Society constituency

TE D

Blood cancer patients, survivors, family members and caregivers

The Leukemia and Lymphoma Society Survivorship advocacy and public policy priorities Cost sharing (i.e. oral drug parity and pharmaceutical specialty tier reform)



Network adequacy



Formulary transparency



Promoting development of companion diagnostics



Patient engagement in drug development



Expanded access to investigational drugs

AC C

EP



Leukemia and Lymphoma Society’s current survivorship advocacy actions and/or initiatives

17

ACCEPTED MANUSCRIPT

LLS recently hired an executive director and regionally located field staff dedicated to developing a coordinated, nation-wide, advocacy structure that empowers volunteers to advocate on federal, state and local issues. We are organizing local and state volunteer-led advocacy

RI PT

committees across the country to support our access-focused public policy efforts. Many

committee members are blood cancer patients and survivors. Patient and survivor advocates work with LLS advocacy, policy and government affairs staff to communicate with, and visit,

SC

key elected officials to share their personal stories and to advocate on behalf of the

M AN U

patient/survivor community.

What does the Leukemia and Lymphoma Society hope is achieved once the Affordable Care Act is fully implemented? Our hope is that this law leads to all blood cancer patients having sustainable access to affordable, appropriate, quality healthcare.

TE D

What is the Lymphoma and Leukemia Society’s perception of the impact of the Affordable Care Act on survivorship services?

The following protections provided by the ACA are a benefit to blood cancer patients: Total Out of Pocket Maximum of $6,350 in 2014 for an individual.



No lifetime limits on care



Non-discrimination standard

• • •

AC C



EP



Essential Health Benefits sets “floor for coverage” Coverage of clinical trial expenses Subsidies for individuals below 400% of FPL Implementation of ACA under current federal guidance raises several concerns for cancer patients’ access to life-saving therapies:

18

ACCEPTED MANUSCRIPT



Breadth of pharmaceutical and Network Coverage: Limited number of therapies on formulary and narrow networks of physicians and hospitals Cost-sharing: Exorbitant cost-sharing on services and specialty drug products violates the spirit of the anti-discrimination principles of the ACA.

Transparency: Patients must be able to determine which Plan best meets their individual

EP

TE D

M AN U

SC

needs, but not all the necessary information is available.

AC C



RI PT



19

ACCEPTED MANUSCRIPT

References Survivorship Advocacy 1. National Coalition for Cancer Survivorship. What is quality cancer care?

RI PT

http://www.canceradvocacy.org/cancer-policy/quality-cancer-care/. Accessed October 24, 2014.

2. National Coalition for Cancer Survivorship. Cancer Policy Priorities.

SC

http://www.canceradvocacy.org/cancer-policy/policy-priorities. Retrieved November 21,

M AN U

2014.

3. National Coalition for Cancer Survivorship. What is Advocacy? http://www.canceradvocacy.org/cancer-advocacy/what-is-advocacy. Retrieved November 21, 2014.

4. Haylock PJ. Giving voice to the vulnerable: Advocacy and oncology nursing. 2008.

TE D

2https://repositories.tdl.org/utmb-

ir/bitstream/handle/2152.3/280/DissertationHaylock.pdf?sequence=1. Accessed

EP

November 1, 2014.

5. Oncology Nursing Society. Position Statement on Access to Quality Cancer Care. 2014.

AC C

https://www.ons.org/advocacy-policy/positions/policy/access, Retrieved November 1, 2014.

6. Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.iom.edu/Reports/2010/The-Future-of-Nursing-LeadingChange-Advancing-Health.aspx November 1, 2014.

20

ACCEPTED MANUSCRIPT

7. One Voice Against Cancer. Fiscal Year 2015 Appropriations Requests. Retrieved from http://www.ovaconline.org/documents/OVACFY15Agenda_02202014.pdf, November 1, 2014.

RI PT

8. One Voice Against Cancer. FY 2015 Appropriations Requests Table. Retrieved from http://www.ovaconline.org/documents/FY15OVACTable_Senate_07242014.pdf November 1, 2014.

SC

9. National Coalition for Cancer Survivorship. Principles for Health Care Payment Reform to Improve Cancer Care Quality.http://www.canceradvocacy.org/cancer-

Retrieved November 21, 2014.

M AN U

policy/principles-for-health-care-payment-reform-to-improve-cancer-care-quality.

10. National Coalition for Cancer Survivorship. Take Action - The PACT Act. http://www.canceradvocacy.org/cancer-advocacy/pact-ac. Retrieved November 1, 2014.

TE D

11. Polite BN, Griggs JJ, Moy B, Lathan C, DuPont NC, Villani SL et al. American Society of Clinical Oncology Policy Statement on Medicaid Reform. J Clin Oncol. 2014. Published Ahead of Print on November 17, 2014 as 10.1200/JCO.2014.56.3452.

EP

Accessed November 18, 2014.

12. Oncology Nursing Society. ONS Advocacy and Policy. https://www.ons.org/advocacy-

AC C

policy

13. Oncology Nursing Society. Position Statement: Nursing Leadership in Global and Domestic Tobacco Control. Retrieved November 1, 2014. https://www.ons.org/advocacy-policy/positions/policy/tobacco

21

ACCEPTED MANUSCRIPT

Table 1: Elements of the ONS Position Statement: Access to Quality Cancer Care5



Provision of comprehensive health care coverage for cancer prevention, early detection, risk assessment and reduction services, appropriate use of genetic predisposition testing and counseling. The provision of healthcare coverage that is accessible and affordable and includes consumer choice and control.

RI PT



Access to evidence-based conventional and integrative therapies, including regimens incorporating off-label therapies approved by the U.S. Food and Drug Administration, symptom management and palliative care, psychosocial care, long-term survivorship, and rehabilitation services.



Access to affordable full range of proven-effective tobacco cessation strategies and therapies.



Services provided by professional oncology nurses, including advanced practice nurses who are competent in the essentials of oncology nursing and the administration of oncologic therapies, are accessible and eligible for reimbursement.



Health disparities and access to care and treatment challenges are addressed for at-risk and underserved populations and appropriate referrals are made to community resources

AC C

EP

TE D

M AN U

SC



22

Cancer survivorship advocacy.

To review the advocacy initiatives of major cancer-related organizations and coalitions that are working to effect funding, planning, and implementati...
378KB Sizes 2 Downloads 13 Views