Skip to main content
SpringerLink
Log in

Follow-Up after Cancer Treatment—Evidence Gaps and Trends in Survivorship Care

  • Chapter
  • First Online:
Survivorship Care for Cancer Patients

  • 554 Accesses

Abstract

Thanks to advances in cancer detection and treatment, more and more people are surviving cancer. Many cancer survivors in developed countries have traditionally been channeled into follow-up regimes that can last for many years, where they attend regular specialist-led appointments aimed at detection of recurrence (or new cancer) and prompt initiation of treatment to improve survival. However, as the number of cancer survivors continues to increase, healthcare systems worldwide are beginning to experience the strain of providing follow-up care that is both effective and economically viable. Furthermore, the traditional focus of cancer follow-up on early recurrence detection is no longer sufficient, as survivors report unmet needs stemming from the long-term physical and psychosocial sequelae of having cancer. This has led to the need to rethink follow-up care after cancer treatment. In this chapter, we will review the available evidence for alternative follow-up models (e.g., general practitioner or nurse-led follow-up) and highlight recent developments in survivorship care, such as the shift towards more patient-centered care through the use of survivorship care plans (SCP), patient-reported outcomes (PRO) in clinical practice, and the implementation of risk-stratified care. These shifts have led to many cancer survivors receiving more responsibility and training in self-management after treatment. However, the evidence gaps indicate that we still need more knowledge on how to improve and measure the physical and psychological well-being of cancer survivors, in order to provide better support.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. International Agency for Research on Cancer. Latest global cancer data: cancer burden rises to 19.3 million new cases and 10.0 million cancer deaths in 2020. World Health Organization. 2020.

    Google Scholar 

  2. Cancer Research UK. Cancer survival statistics. 2019. https://www.cancerresearchuk.org/health-professional/cancer-statistics/survival. Accessed 12 January 2020.

    Google Scholar 

  3. Danckert B, Ferlay J, Engholm G, Hansen H, Johannesen T, Khan S, et al. NORDCAN: cancer incidence, mortality, prevalence and survival in the Nordic countries. Association of the Nordic Cancer Registries. Danish Cancer Society; 2019. http://www-dep.iarc.fr/NORDCAN/english/frame.asp. Accessed 20 January 2020.

    Google Scholar 

  4. Mayer D, Knafl G, Fitzpatrick B, Nevidjon BM. The survivorship tsunami: sustainability of current models of follow-up care. J Clin Oncol. 2018;36(7_suppl):48. https://doi.org/10.1200/JCO.2018.36.7_suppl.48.

    Article  Google Scholar 

  5. MacBride SK, Whyte F. Survivorship and the cancer follow-up clinic. Eur J Cancer Care. 1998;7(1):47–55. https://doi.org/10.1046/j.1365-2354.1998.00065.x.

    Article  CAS  Google Scholar 

  6. Mukherjee S. The emperor of all maladies: a biography of cancer. London: Harper Collins; 2011.

    Google Scholar 

  7. Collins RF, Bekker HL, Dodwell DJ. Follow-up care of patients treated for breast cancer: a structured review. Cancer Treat Rev. 2004;30(1):19–35. https://doi.org/10.1016/S0305-7372(03)00141-5.

    Article  PubMed  Google Scholar 

  8. Colleoni M, Sun Z, Price KN, Karlsson P, Forbes JF, Thürlimann B, et al. Annual hazard rates of recurrence for breast cancer during 24 years of follow-up: results from the international breast cancer study group trials I to V. J Clin Oncol. 2016;34(9):927–35. https://doi.org/10.1200/JCO.2015.62.3504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Høeg BL, Bidstrup PE, Karlsen RV, Friberg AS, Albieri V, Dalton SO, et al. Follow-up strategies following completion of primary cancer treatment in adult cancer survivors. Cochrane Database Syst Rev. 2019;11:CD012425.pub2. https://doi.org/10.1002/14651858.CD012425.pub2.

    Article  Google Scholar 

  10. Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2019;9 https://doi.org/10.1002/14651858.CD002200.pub4.

  11. Lewis RA, Neal RD, Hendry M, France B, Williams NH, Russell D, et al. Patients' and healthcare professionals' views of cancer follow-up: systematic review. Br J Gen Pract. 2009;59(564):e248–59. https://doi.org/10.3399/bjgp09X453576.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sperduti I, Vici P, Tinari N, Gamucci T, De Tursi M, Cortese G, et al. Breast cancer follow-up strategies in randomized phase III adjuvant clinical trials: a systematic review. J Exp Clin Cancer Res. 2013;32(1):89. https://doi.org/10.1186/1756-9966-32-89.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lewis RA, Neal RD, Williams NH, France B, Hendry M, Russell D, et al. Follow-up of cancer in primary care versus secondary care: systematic review. Br J Gen Pract. 2009;59(564):e234. https://doi.org/10.3399/bjgp09X453567.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Davies NJ, Batehup L. Towards a personalised approach to aftercare: a review of cancer follow-up in the UK. J Cancer Surviv. 2011;5(2):142–51. https://doi.org/10.1007/s11764-010-0165-3.

    Article  PubMed  Google Scholar 

  15. Phillips JL, Currow DC. Cancer as a chronic disease. Collegian. 2010;17(2):47–50. https://doi.org/10.1016/j.colegn.2010.04.007.

    Article  PubMed  Google Scholar 

  16. Cardoso F, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rubio IT, et al. Early breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019;30(8):1194–220. https://doi.org/10.1093/annonc/mdz173.

    Article  CAS  PubMed  Google Scholar 

  17. Argilés G, Tabernero J, Labianca R, Hochhauser D, Salazar R, Iveson T, et al. Localised colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(10):1291–305. https://doi.org/10.1016/j.annonc.2020.06.022.

    Article  PubMed  Google Scholar 

  18. GIVIO Investigators. Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial. The GIVIO investigators. JAMA. 1994;271(20):1587–92. https://doi.org/10.1001/jama.1994.03510440047031.

    Article  Google Scholar 

  19. Rosselli Del Turco M, Palli D, Cariddi A, Ciatto S, Pacini P, Distante V. Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National Research Council Project on Breast Cancer follow-up. JAMA. 1994;271(20):1593–7. Pubmed 7848404.

    Article  CAS  Google Scholar 

  20. 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(7058):665–9. Pubmed 8811760.

    Article  CAS  Google Scholar 

  21. Vos JAM, Wieldraaijer T, van Weert HCPM, van Asselt KM. Survivorship care for cancer patients in primary versus secondary care: a systematic review. J Cancer Surviv. 2021;15(1):66–76. https://doi.org/10.1007/s11764-020-00911-w.

    Article  CAS  PubMed  Google Scholar 

  22. Beaver K, Tysver-Robinson D, Campbell M, Twomey M, Williamson S, Hindley A, et al. Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial. BMJ. 2009;338:a3147. Pubmed 19147478.

    Article  Google Scholar 

  23. Beaver K, Williamson S, Martin-Hirsch P, Keating P, Tomlinson A, Sutton C, et al. ENDCAT: endometrial cancer telephone follow-up trial. Psychooncology. 2013;22:19.

    Google Scholar 

  24. Beaver K, Williamson S, Sutton C, Hollingworth W, Gardner A, Allton B, et al. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial. BJOG. 2017;124(1):150–60. https://doi.org/10.1111/1471-0528.14000.

    Article  CAS  PubMed  Google Scholar 

  25. Kimman ML, Dirksen CD, Voogd AC, Falger P, Gijsen BC, Thuring M, et al. Nurse-led telephone follow-up and an educational group programme after breast cancer treatment: results of a 2 × 2 randomised controlled trial. Eur J Cancer (Oxford, England: 1990). 2011;47(7):1027–36. Pubmed 21237636.

    Google Scholar 

  26. Morrison V, Spencer LH, Totton N, Pye K, Yeo ST, Butterworth C, et al. Trial of optimal personalised care after treatment-gynaecological cancer (TOPCAT-G): a randomized feasibility trial. Int J Gynecol Cancer. 2018;28(2):401–11. https://doi.org/10.1097/igc.0000000000001179.

    Article  PubMed  Google Scholar 

  27. Verschuur EM, Steyerberg EW, Tilanus HW, Polinder S, Essink-Bot ML, Tran KT, et al. Nurse-led follow-up of patients after oesophageal or gastric cardia cancer surgery: a randomised trial. Br J Cancer. 2009;100(1):70–6. Pubmed 19066612.

    Article  CAS  Google Scholar 

  28. Monterosso L, Platt V, Bulsara M, Berg M. Systematic review and meta-analysis of patient reported outcomes for nurse-led models of survivorship care for adult cancer patients. Cancer Treat Rev. 2019;73:62–72. https://doi.org/10.1016/j.ctrv.2018.12.007.

    Article  PubMed  Google Scholar 

  29. Moschetti I, Cinquini M, Lambertini M, Levaggi A, Liberati A. Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev. 2016;5:CD001768. https://doi.org/10.1002/14651858.CD001768.pub3.

    Article  Google Scholar 

  30. Lafranconi A, Pylkkänen L, Deandrea S, Bramesfeld A, Lerda D, Neamțiu L, et al. Intensive follow-up for women with breast cancer: review of clinical, economic and patient’s preference domains through evidence to decision framework. Health Qual Life Outcomes. 2017;15(1):206. https://doi.org/10.1186/s12955-017-0779-5.

  31. Baca B, Beart RW Jr, Etzioni DA. Surveillance after colorectal cancer resection: a systematic review. Dis Colon Rectum. 2011;54(8):1036–48. https://doi.org/10.1007/DCR.0b013e31820db364.

    Article  PubMed  Google Scholar 

  32. Zhao Y, Yi C, Zhang Y, Fang F, Faramand A. Intensive follow-up strategies after radical surgery for nonmetastatic colorectal cancer: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2019;14(7):e0220533. https://doi.org/10.1371/journal.pone.0220533.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Tjandra JJ, Chan MK. Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum. 2007;50(11):1783–99. https://doi.org/10.1007/s10350-007-9030-5.

    Article  PubMed  Google Scholar 

  34. Renehan AG, Egger M, Saunders MP, O'Dwyer ST. Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ. 2002;324(7341):813. https://doi.org/10.1136/bmj.324.7341.813.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Pita-Fernandez S, Alhayek-Ai M, Gonzalez-Martin C, Lopez-Calvino B, Seoane-Pillado T, Pertega-Diaz S. Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a systematic review and meta-analysis. Ann Oncol. 2015;26(4):644–56. https://doi.org/10.1093/annonc/mdu543.

    Article  CAS  PubMed  Google Scholar 

  36. Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, et al. American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. CA Cancer J Clin. 2016;66(1):43–73. https://doi.org/10.3322/caac.21319.

    Article  PubMed  Google Scholar 

  37. Zamagni C, Gion M, Mariani L, Stieber P, Rubino D, Fanti S, et al. CEA, CA15.3 and 18-FDG PET in the follow-up of early breast cancer (BC) patients (pts): a prospective, multicentric, randomized trial—KRONOS patient-oriented new surveillance study Italy. J Clin Oncol. 2017;35(15 suppl):TPS11627. https://doi.org/10.1200/JCO.2017.35.15_suppl.TPS11627.

    Article  Google Scholar 

  38. ClinicalTrials.gov. Follow-up of early breast cancer by dynamic evaluation of CEA and CA 15.3 followed by 18FDG-PET. 2014. https://ClinicalTrials.gov/show/NCT02261389.

  39. Tzelepis F, Sanson-Fisher RW, Zucca AC, Fradgley EA. Measuring the quality of patient-centered care: why patient-reported measures are critical to reliable assessment. Patient Prefer Adherence. 2015;9:831–5. https://doi.org/10.2147/PPA.S81975.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in transition. Washington, DC: The National Academies Press; 2006.

    Google Scholar 

  41. Salz T, Oeffinger KC, McCabe MS, Layne TM, Bach PB. Survivorship care plans in research and practice. CA Cancer J Clin. 2012;62(2):101–17. https://doi.org/10.3322/caac.20142.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Grunfeld E, Julian JA, Pond G, Maunsell E, Coyle D, Folkes A, et al. Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. J Clin Oncol. 2011;29(36):4755–62. Pubmed 22042959.

    Article  Google Scholar 

  43. Jefford M, Gough K, Drosdowsky A, Russell L, Aranda S, Butow P, et al. A randomized controlled trial of a nurse-led supportive care package (SurvivorCare) for survivors of colorectal cancer. Oncologist. 2016;21(8):1014–23. https://doi.org/10.1634/theoncologist.2015-0533.

    Article  PubMed  PubMed Central  Google Scholar 

  44. van de Poll-Franse LV, Nicolaije KAH, Ezendam NPM. The impact of cancer survivorship care plans on patient and health care provider outcomes: a current perspective. Acta Oncol. 2017;56(2):134–8. https://doi.org/10.1080/0284186X.2016.1266080.

    Article  PubMed  Google Scholar 

  45. Hill RE, Wakefield CE, Cohn RJ, Fardell JE, Brierley M-EE, Kothe E, et al. Survivorship care plans in cancer: a meta-analysis and systematic review of care plan outcomes. Oncologist. 2020;25:e351–e72. https://doi.org/10.1634/theoncologist.2019-0184.

    Article  PubMed  Google Scholar 

  46. Mayer DK, Birken SA, Check DK, Chen RC. Summing it up: an integrative review of studies of cancer survivorship care plans (2006-2013). Cancer. 2015;121(7):978–96. https://doi.org/10.1002/cncr.28884.

    Article  PubMed  Google Scholar 

  47. Birken SA, Urquhart R, Munoz-Plaza C, Zizzi AR, Haines E, Stover A, et al. Survivorship care plans: are randomized controlled trials assessing outcomes that are relevant to stakeholders? J Cancer Surviv. 2018;12(4):495–508. https://doi.org/10.1007/s11764-018-0688-6.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Mayer DK, Birken SA, Chen RC. Avoiding implementation errors in cancer survivorship care plan effectiveness studies. J Clin Oncol. 2015;33(31):3528–30. https://doi.org/10.1200/jco.2015.62.6937.

    Article  PubMed  Google Scholar 

  49. de Rooij BH, Ezendam NPM, Vos MC, Pijnenborg JMA, Boll D, Kruitwagen R, et al. Patients' information coping styles influence the benefit of a survivorship care plan in the ROGY care trial: new insights for tailored delivery. Cancer. 2019;125(5):788–97. https://doi.org/10.1002/cncr.31844.

    Article  PubMed  Google Scholar 

  50. Howell D, Molloy S, Wilkinson K, Green E, Orchard K, Wang K, et al. Patient-reported outcomes in routine cancer clinical practice: a scoping review of use, impact on health outcomes, and implementation factors. Ann Oncol. 2015;26(9):1846–58. https://doi.org/10.1093/annonc/mdv181.

    Article  CAS  PubMed  Google Scholar 

  51. McKenna S. The limitations of patient-reported outcome measurement in oncology. J Clin Pathways. 2016;2(7):37–46.

    Google Scholar 

  52. Basch E, Reeve BB, Mitchell SA, Clauser SB, Minasian LM, Dueck AC, et al. Development of the National Cancer Institute’s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Natl Cancer Inst. 2014;106(9) https://doi.org/10.1093/jnci/dju244.

  53. Atkinson TM, Ryan SJ, Bennett AV, Stover AM, Saracino RM, Rogak LJ, et al. The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): a systematic review. Support Care Cancer. 2016;24(8):3669–76. https://doi.org/10.1007/s00520-016-3297-9.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Chen J, Ou L, Hollis SJ. A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Serv Res. 2013;13:211. https://doi.org/10.1186/1472-6963-13-211.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Kotronoulas G, Kearney N, Maguire R, Harrow A, Di Domenico D, Croy S, et al. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol. 2014;32(14):1480–501. https://doi.org/10.1200/JCO.2013.53.5948.

    Article  PubMed  Google Scholar 

  56. Basch EM, Deal AM, Dueck AC, Bennett AV, Atkinson TM, Scher HI, et al. Overall survival results of a randomized trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. J Clin Oncol. 2017;318(2):197–8. https://doi.org/10.1200/JCO.2017.35.18_suppl.LBA2.

    Article  Google Scholar 

  57. Denis F, Lethrosne C, Pourel N, Molinier O, Pointreau Y, Domont J, et al. Randomized trial comparing a web-mediated follow-up with routine surveillance in lung cancer patients. J Natl Cancer Inst. 2017;109:9. https://doi.org/10.1093/jnci/djx029.

    Article  Google Scholar 

  58. Saltbæk L, Karlsen RV, Bidstrup PE, Høeg BL, Zoffmann V, Horsbøl TA, et al. MyHealth: specialist nurse-led follow-up in breast cancer. A randomized controlled trial—development and feasibility. Acta Oncol. 2019;58:619–26. https://doi.org/10.1080/0284186X.2018.1563717.

    Article  PubMed  Google Scholar 

  59. Mayer DK, Alfano CM. Personalized risk-stratified cancer follow-up care: its potential for healthier survivors, happier clinicians, and lower costs. J Natl Cancer Inst. 2019;111(5):442–8. https://doi.org/10.1093/jnci/djy232.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Sundhedsstyrelsen [Danish Health Authority]. Pakkeforløb for brystkræft [Treatment framework for breast cancer]. Copenhagen: Sundhedsstyrelsen; 2018.

    Google Scholar 

  61. Secco GB, Fardelli R, Gianquinto D, Bonfante P, Baldi E, Ravera G, et al. Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. Eur J Surg Oncol. 2002;28(4):418–23. Pubmed 12099653.

    Article  Google Scholar 

  62. Høeg BL, Frederiksen MH, Andersen EAW, Saltbæk L, Friberg AS, Karlsen RV, et al. Is the health literacy of informal caregivers associated with the psychological outcomes of breast cancer survivors? J Cancer Surviv. 2020; https://doi.org/10.1007/s11764-020-00964-x.

Download references

Author information

Authors and Affiliations

  1. Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark

    Beverley Lim Høeg & Pernille Envold Bidstrup

  2. Department of Psychology, University of Copenhagen, Copenhagen, Denmark

    Pernille Envold Bidstrup

  3. Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark

    Susanne Oksbjerg Dalton

  4. Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark

    Susanne Oksbjerg Dalton & Lena Saltbæk

Authors
  1. Beverley Lim Høeg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pernille Envold Bidstrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susanne Oksbjerg Dalton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lena Saltbæk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Beverley Lim Høeg .

Editor information

Editors and Affiliations

  1. Medical Oncology, Centre Hospitalier Emile Mayrisch, Esch, Luxembourg

    Stefan Rauh

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Høeg, B.L., Bidstrup, P.E., Dalton, S.O., Saltbæk, L. (2021). Follow-Up after Cancer Treatment—Evidence Gaps and Trends in Survivorship Care. In: Rauh, S. (eds) Survivorship Care for Cancer Patients. Springer, Cham. https://doi.org/10.1007/978-3-030-78648-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-78648-9_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-78647-2

  • Online ISBN: 978-3-030-78648-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation