Journal of Cancer Survivorship

, Volume 6, Issue 4, pp 359–371 | Cite as

Models of care for post-treatment follow-up of adult cancer survivors: a systematic review and quality appraisal of the evidence

  • D. HowellEmail author
  • T. F. Hack
  • T. K. Oliver
  • T. Chulak
  • S. Mayo
  • M. Aubin
  • M. Chasen
  • C. C. Earle
  • A. J. Friedman
  • E. Green
  • G. W. Jones
  • J. M. Jones
  • M. Parkinson
  • N. Payeur
  • C. M. Sabiston
  • S. Sinclair



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.


Psychosocial 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.

Editorial independence

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.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • D. Howell
    • 20
    • 21
    • 22
    Email author
  • T. F. Hack
    • 2
    • 3
  • T. K. Oliver
    • 4
  • T. Chulak
    • 5
  • S. Mayo
    • 1
  • M. Aubin
    • 6
  • M. Chasen
    • 7
    • 8
  • C. C. Earle
    • 9
  • A. J. Friedman
    • 10
    • 11
  • E. Green
    • 11
  • G. W. Jones
    • 12
    • 13
  • J. M. Jones
    • 14
  • M. Parkinson
    • 15
  • N. Payeur
    • 16
  • C. M. Sabiston
    • 17
  • S. Sinclair
    • 18
    • 19
  1. 1.Faculty of NursingUniversity Health NetworkTorontoCanada
  2. 2.Faculty of NursingUniversity of ManitobaWinnipegCanada
  3. 3.Patient and Family Support ServicesCancer Care ManitobaWinnipegCanada
  4. 4.Department of OncologyMcMaster UniversityHamiltonCanada
  5. 5.Nutrition Sciences, ParticipACTIONTorontoCanada
  6. 6.Department of Family Medicine and Emergency MedicineUniversité LavalQuebecCanada
  7. 7.Palliative Care ProgramUniversity of OttawaOttawaCanada
  8. 8.Palliative Rehabilitation and SurvivorshipElisabeth Bruyere Research Institute and Ottawa Regional Cancer FoundationOttawaCanada
  9. 9.Health Services Research ProgramCancer Care Ontario and the Ontario Institute for Cancer ResearchTorontoCanada
  10. 10.Cancer Patient Education and SurvivorshipUniversity Health NetworkTorontoCanada
  11. 11.Cancer Care OntarioTorontoCanada
  12. 12.Peel Regional Oncology ProgrammeCredit Valley HospitalMississaugaCanada
  13. 13.Department of Radiation OncologyUniversity of TorontoTorontoCanada
  14. 14.Department of Psychiatry, Cancer Survivorship Program, University Health NetworkUniversity of TorontoTorontoCanada
  15. 15.Patient and Family Counselling ServicesBC Cancer AgencyVancouverCanada
  16. 16.Patient and Family Counselling ServicesBC Cancer AgencyVictoriaCanada
  17. 17.Department of Kinesiology and Physical EducationMcGill UniversityMontrealCanada
  18. 18.Manitoba Palliative Care Research UnitUniversity of ManitobaWinnipegCanada
  19. 19.Faculty of Medicine, Calgary, Alberta, and Spiritual Care Services, Alberta Health Services, Tom Baker Cancer CentreUniversity of CalgaryCalgaryCanada
  20. 20.Faculty of NursingUniversity Health Network (Princess Margaret Hospital)TorontoCanada
  21. 21.Psychosocial Oncology and Palliative CareOntario Cancer InstituteTorontoCanada
  22. 22.Lawrence Bloomberg Faculty of NursingUniversity of TorontoTorontoCanada

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