Models of care for post-treatment follow-up of adult cancer survivors: a systematic review and quality appraisal of the evidence
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The impact of cancer and cancer treatment on the long-term health and quality of life of survivors is substantial, leading to questions about the most appropriate configuration of services and models of care for follow-up of post-primary treatment survivors.
A systematic review and quality appraisal of the health literature for structure of services and models of follow-up care for post-treatment survivors was identified through a search of guideline sources and empirical databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Library, CINAHL, and EBSCO from 1999 through December 2009.
Ten practice guidelines and nine randomized controlled trials comprised the evidence base for models of care for adult cancer survivors. Although the evidence base was rated as low quality, nurse-led and primary care physician models of follow-up care were equivalent for detecting recurrence. Consensus also suggests that cancer survivors may benefit from coordinated transition planning that includes the provision of survivorship care plans as part of standard care.
Realignment of models of care is identified as a health system priority to meet the supportive care and surveillance needs of a burgeoning survivor population. Further research is needed to evaluate the efficacy of models of care in a broader population of cancer survivors with differing needs and risks. While the evidence is limited, there is research that may be used to guide the configuration of health care services and planning.
KeywordsPsychosocial and supportive care Cancer survivorship Organization of care Delivery structure Care plan Systematic review
The survivorship expert panel would like to thank Ms. Sandra Costa for her assistance in the preparation of the manuscript. We thank Fay Bennie for her administrative support and Margaret Thompson who provided her insights as a cancer survivor and advocate, and expert in adult education. The systematic review evidence informed development of a guideline made possible through a grant from Health Canada, through the Canadian Partnership Against Cancer.
Conflict of interest
Each author completed conflict of interest forms, and forms were centrally collected and filed. None of the authors declared any real or perceived potential conflicts of interest associated with this systematic review of the evidence.
The authors are editorially independent of any funding sources. The views and interests of the funding sources have not influenced the conclusions derived in this document.
- 1.Hewitt M, Greenfield S, Stovall E, editors. From cancer patient to cancer survivor: lost in transition. Washington: National Academies Press; 2006.Google Scholar
- 17.Meneses KD, McNees MP. Upper extremity lymphedema after treatment for breast cancer: a review of the literature. Ostomy Wound Manag. 2007;53(5):16–29.Google Scholar
- 32.Ganz P. The ‘three Ps’ of cancer survivorship care. BMC Med. 2011;9(14):1–2.Google Scholar
- 33.Landler W. Survivorship care: essential components and models of delivery. Oncology (Williston Park). 2009;23(4 Suppl Nurse Ed):46–53.Google Scholar
- 34.Australian Institute of Health and Welfare and Australasian Association of Cancer Registries. Cancer in Australia 2001. Canberra: AIHW; 2004.Google Scholar
- 35.Davies NJ, Batehup L. Cancer follow-up: towards a personalized approach to aftercare services. A review of current practice and selected initiatives. National Cancer Survivorship Initiative Supported Self-Management Workstream. Macmillan Cancer Support, November 2009, National Health Service, Department of Health.Google Scholar
- 39.National Comprehensive Cancer Network. Clinical practice guidelines in oncology: colon cancer. Philadelphia: National Comprehensive Cancer Network; 2010. At: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed December 2009.Google Scholar
- 40.National Comprehensive Cancer Network. Clinical practice guidelines in oncology: rectal cancer. Philadelphia: National Comprehensive Cancer Network; 2010. At: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed December 2009.Google Scholar
- 42.Association of Community Cancer Centers. Cancer program guidelines. Rockville: Association of Community Cancer Centers; 2009. At: http://www.accc-cancer.org/publications/publications-cpguidelines.asp. Accessed December 2009.Google Scholar
- 43.Institute of Medicine. Cancer care for the whole patient: meeting psychosocial health needs. Washington: National Academies Press; 2008.Google Scholar
- 44.Oncoline. Prostate cancer: nationwide guideline, version 1. Netherlands: Dutch Association of Comprehensive Cancer Centres; 2007. At: http://www.oncoline.nl/index.php?pagina=/richtlijn/item/pagina.php&richtlijn_id=575. Accessed May 2010.Google Scholar
- 46.Urological Tumours National Working Group. Renal cell carcinoma: nationwide guideline, version 1.1. Netherlands: Dutch Association of Comprehensive Cancer Centres; 2006.Google Scholar
- 47.Grunfeld E, Dhesy-Thind S, Levine M, for the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: 9. follow-up after treatment for breast cancer (2005 update). CMAJ. 2005;172(10):1319.PubMedCrossRefGoogle Scholar
- 56.Brozek JL, Akl EA, Alonso-Coello P, Lang D, Jaeschke R, Williams JW, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy. 2009;64(5):669–77.PubMedCrossRefGoogle Scholar
- 57.Gates P, Krishnasamy M. Nurse-led survivorship care. Cancer Forum. 2009;33(3):1–4.Google Scholar
- 58.Chomik Consulting and Research Ltd. Supporting the role of primary care in cancer follow-up. Prepared for the Canadian Association of Provincial Cancer Agencies; 2010.Google Scholar