Journal of Cancer Survivorship

, Volume 5, Issue 2, pp 142–151 | Cite as

Towards a personalised approach to aftercare: a review of cancer follow-up in the UK

  • Nicola J. DaviesEmail author
  • Lynn Batehup



Due to growth in cancer survivorship and subsequent resource limitations, the current UK position of follow-up services is unsustainable. With people living longer after a cancer diagnosis, supported self-management for ongoing treatment-related chronic conditions is a fundamental component of aftercare services. Alternative models to traditional hospital aftercare require consideration in terms of clinical effectiveness and cost-effectiveness.


‘Evidence to Inform the Cancer Reform Strategy: The Clinical Effectiveness of Follow-Up Services after Treatment for Cancer’ (Centre for Reviews and Dissemination 2007) has been updated using a number of quality-controlled databases. Correspondence with experts was also sought to identify current initiatives.


The review highlights a shift towards patient empowerment via individualised and group education programmes aimed at increasing survivor’s ability to better manage their condition and the effects of treatment, allowing for self-referral or rapid access to health services when needed. The role of specialist nurses as key facilitators of supportive aftercare is emphasised, as is a move towards technology-based aftercare in the form of telephone or web-based services.


The challenge will be replacing traditional clinic follow-up with alternative methods in a cost-effective way that is either as equally effective, or more so. To establish this, more rigorous trials are needed, with larger sample sizes and longer follow-up assessments.

Implications for cancer survivors

Increasing patient confidence to initiate follow-up specific to their needs is likely to increase the workload of primary care providers, who will need training for this.


Aftercare Cancer Neoplasm Review Survivors 


  1. 1.
    Cardy P. Worried Sick: the emotional impact of cancer. 2006, Macmillan Cancer Support.Google Scholar
  2. 2.
    Macmillian Cancer Support. Two Million Reasons: The Cancer Survivorship Agenda. 2008.Google Scholar
  3. 3.
    Allberry J. Cancer Reform Strategy: Maintaining Momentum, Building for the Future – First Annual Report. Department of Health, December 2008.Google Scholar
  4. 4.
    Lorig K, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, et al. (1999) Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999;37(1):5–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Centre for Reviews and Dissemination (CRD) Evidence to inform the Cancer Reform Strategy: The clinical effectiveness and cost-effectiveness of follow-up services after treatment for cancer. 2007, Centre for Reviews and Dissemination.Google Scholar
  6. 6.
    Collins RF, Bekker H, Dodwell DJ. Follow-up care of patients treated for breast cancer: a structured review. Cancer Treat Rev. 2004;30:19–35.PubMedCrossRefGoogle Scholar
  7. 7.
    National Institute of Clinical Excellence (NICE) Guidance on cancer services – improving outcomes in breast cancer. 2002, NICE.Google Scholar
  8. 8.
    Grogan M, Rangan A, Gebski V, et al. The value of follow-up of patients with early breast cancer treated with conservative surgery and radiation therapy. Breast. 2002;11:163–69.PubMedCrossRefGoogle Scholar
  9. 9.
    Richard CS, McLeod R. Follow-up of patients after resection for colorectal cancer: a position paper of the Canadian Society of Surgical Oncology and the Canadian Society of Colon and Rectal Surgeons. Can J Surg. 1997;40:90–100.PubMedGoogle Scholar
  10. 10.
    Jeffery M, Hickey B, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. . Cochrane Database of Systematic Reviews. 2007(1).Google Scholar
  11. 11.
    Renehan AG, Egger M, Saunders MP, et al. Mechanisms of improved survival from intensive follow up in colorectal cancer: a hypothesis. Br J Cancer. 2005;92:430–33.PubMedGoogle Scholar
  12. 12.
    Rosen M, Chan L, Beart RW, et al. Follow-up of colorectal cancer: a meta-analysis. Dis Colon Rectum. 1998;41:1116–26.PubMedCrossRefGoogle Scholar
  13. 13.
    Younes RN, Gross J, Deheinzelin D. Follow-up in lung cancer: how often and for what purpose? Chest. 1999;115:1494–99.PubMedCrossRefGoogle Scholar
  14. 14.
    Montgomery DA, Krupa K, Cooke TG. Alternative methods of follow up in breast cancer: a systematic review of the literature. Br J Cancer. 2007;96:1625–32. doi: 10.1038/sj.bjc.6603771.PubMedCrossRefGoogle Scholar
  15. 15.
    Grunfeld E, Levine MN, Julian JA, Coyle D, Szechtman B, Mirsky D, et al. Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care. J Clin Oncol. 2006;24:848–54.PubMedCrossRefGoogle Scholar
  16. 16.
    Grunfeld E, Mant D, Yudkin P, Adewuyi-Dalton R, Cole D, Stewart J, et al. Routine follow up of breast cancer in primary care: randomised trial. BMJ. 1996;313:665–9.PubMedGoogle Scholar
  17. 17.
    Brown L, Payne S, Royle G. Patient initiated follow up of breast cancer. Psychooncology. 2002;11:346–55.PubMedCrossRefGoogle Scholar
  18. 18.
    Koinberg IL, Fridlund B, Engholm GB, Holmberg L. Nurse-led follow-up on demand or by a physician after breast cancer surgery: a randomised study. Eur J Oncol Nurs. 2004;8:109–17.PubMedCrossRefGoogle Scholar
  19. 19.
    Baildam AD, Keeling F, Thompson L, Bundred N, Hopwood P. Nurse-led surgical follow up clinics for women treated for breast cancer – a randomised controlled trial. Breast Cancer Res Treat. 2004;88:S136–7.Google Scholar
  20. 20.
    Gulliford T, Opomu M, Wilson E, Hanham I, Epstein R. Popularity of less frequent follow up for breast cancer in randomised study: initial findings from the hotline study. BMJ. 1997;314:174–7.PubMedGoogle Scholar
  21. 21.
    Kokko R, Hakama M, Holli K. Follow-up cost of breast cancer patients with localized disease after primary treatment: a randomised trial. Breast Cancer Res Treat. 2005;93:255–60.PubMedCrossRefGoogle Scholar
  22. 22.
    Oltra A, Santaballa A, Munárriz B, Pastor M, Montalar J. Cost-benefit analysis of a follow-up program in patients with breast cancer: a randomized prospective study. Breast J. 2007;13(6):571–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Macafee DA, Whynes D, Scholefield JH. Risk-stratified intensive follow up for treated colorectal cancer - realistic and cost saving? Colorectal Dis. 2008;10(3):222–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Snyder CF, Earle C, Herbert RJ, Neville BA, Blackford AL, Frick KD. Trends in follow-up and preventive care for colorectal cancer survivors. J Gen Intern Med. 2008;23(3):254–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Melloni B. Follow-up of patients with curative-intent surgical resection. in press., NSCLC.Google Scholar
  26. 26.
    Montgomery DA, Krupa K, Wilson C, Cooke TG. Automated telephone follow-up after breast cancer: an acceptability and feasibility pilot study. Br J Cancer. 2008;99(5):704–10.PubMedCrossRefGoogle Scholar
  27. 27.
    Moore S, Corner J, Haviland J, et al. Nurse-led follow-up and conventional medical follow-up in management of patients with lung cancer: randomised trial. BMJ. 2002;325:1145–47.PubMedCrossRefGoogle Scholar
  28. 28.
    Beaver K. Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial. BMJ. 2009;338(7690):337–40.Google Scholar
  29. 29.
    Sheppard C, Higgins B, Wise M, Yiangou C, Dubois D, Kilburn S. Breast cancer follow up: a randomised controlled trial comparing point of need access versus routine 6-monthly clinical review. Eur J Oncol Nurs. 2009;13(1):2–8. Epub 2008 Dec 31.PubMedCrossRefGoogle Scholar
  30. 30.
    Koinberg I, Engholm G-B, et al. A health economic evaluation of follow-up after breast cancer surgery: results of an rct study. Acta Oncol. 2009;48(1):99–104.PubMedCrossRefGoogle Scholar
  31. 31.
    Mandelblatt JS, Cullen J, Lawrence WF, Stanton AL, Yi B, Kwan L, et al. Economic evaluation alongside a clinical trial of psycho-educational interventions to improve adjustment to survivorship among patients with breast cancer. J Clin Oncol. 2008;1;26(10):1684–90.CrossRefGoogle Scholar
  32. 32.
    Pinto B. (unpublished) Physical activity promotion in cancer follow-up care.Google Scholar
  33. 33.
    Fletcher SG, Clark S, Overstreet DL, Steers WD. An improved approach to follow-up care for the urological patient: drop-in group medical appointments. J Urol. 2006;176(3):1122–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Maher J, Jackson L. Patient-triggered follow-up for breast cancer survivors. Ongoing study., Hillingdon Breast Unit Mount Vernon Cancer Centre.Google Scholar
  35. 35.
    Chapman D, Cox E, Britton PD, Wishart GC. Patient-led breast cancer follow up. Breast. 2009;18:100–2.PubMedCrossRefGoogle Scholar
  36. 36.
    Chatfield C, Simcock R. 2008 Follow-up in breast cancer; SCN Conference presentation,
  37. 37.
    Primrose J. A randomised controlled trial to assess the cost-effectiveness of intensive versus no scheduled follow-up in patients who have undergone resection for colorectal cancer with curative intent - main trial. (ongoing study: NCT00560365,
  38. 38.
    Basch E, Artz D, Dulko D, Scher K, Sabbatini P, Hensley M, et al. Patient online self-reporting of toxicity symptoms during chemotherapy. J Clin Oncol. 2005;23(15):3552–61.PubMedCrossRefGoogle Scholar
  39. 39.
    Wright P. A web-based two-way information platform for use in low risk cancer survivors post-treatment. ongoing study.: Psychosocial Oncology and Clinical Practice Research Group, St James’s Institute of Oncology, ongoing study.Google Scholar
  40. 40.
    Richardson A, John J, Kelly J, Armes J, Ream E (2009). Surviving Cancer, Living Life” Support Service: An Evaluation. King’s College London.Google Scholar
  41. 41.
    Dunn J, WM, Taggert F, Hulme C, Tritter J, Austoker J, et al.. Involving patients in clinical trial design: the experience of the UK iBreast early breast cancer follow-up trial in Poster presentation at the Annual Meeting of the Society for Clinical Trials. 2009.Google Scholar
  42. 42.
    Wille-Jørgensen P, Laurberg S, Påhlman L, Carriquiry L, Lundqvist N, Smedh K, et al. An interim analysis of recruitment to the COLOFOL trial. Colorectal Dis. 2009;11(7):756–8.Google Scholar
  43. 43.
    Sheppard C, Higgins B, Wise M, Yiangou C, Dubois D, Kilburn S (2009) Breast cancer follow up: a randomised controlled trial comparing point of need access versus routine 6-monthly clinical review. Eur J Oncol Nurs. 2009; Feb;13(1):2-8. Epub 2008 Dec 31. Chapman D, C.E., Britton PD, Wishart GC, Patient-led breast cancer follow up. The Breast 2009; 18:100–102.Google Scholar
  44. 44.
    Dent J, Allinson A. Self-referral for breast cancer follow-up. ongoing study: Calderdale and Huddersfield NHS Foundation Trust Hospital Trust.Google Scholar
  45. 45.
    Dunn J, WM, Taggert F, Hulme C, Tritter J, Austoker J, Mossman J, et al. Involving patients in clinical trial design: The experience of the UK iBreast early breast cancer follow-up trial in Poster presentation at the Annual Meeting of the Society for Clinical Trials. 2009.Google Scholar
  46. 46.
    Basch E, Iasonos A., Barz A, Culkin A, Kris MG, Artz D, et al. Long-term toxicity monitoring via electronic patient-reported outcomes in patients receiving chemotherapy. J Clin Oncol. 2007; 25(34):5374–80.Google Scholar
  47. 47.
    Pinto BM, Goldstein MG, Papandonatos GD. Promoting physical activity in follow-up care for breast cancer patients. Presented at the Society of Behavioral Medicine Annual Meeting. 2009; Apr 2009.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.National Cancer Survivorship Initiative, Self-Management WorkstreamMacmillan Cancer SupportLondonEngland
  2. 2.Macmillan Cancer SupportVauxhall, LondonUK

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