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.
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