Presently, there is wide variation in the care and organization of services to address adult cancer survivor’s needs. Developing evidence-based guidelines for the organization and structure of cancer survivorship care, specifically models of care for post-treatment follow-up of adult cancer survivors (=> age 18) is essential to the coordination of care and services to meet the health and supportive care needs of this growing population while creating efficiencies in care delivery that take into consideration human and financial resources. Without such guidelines, health and supportive care services may vary widely, which could affect the delivery of quality of care and subsequently affect the survivors’ health, survival, well-being and overall quality of life.
Survivorship services should address the need for a coordinated and well-organized system and allow for the expressed allocation of responsibilities for different functions and processes of various entities or units, such as hospitals, cancer care programs and organizations, community-based organizations, health and supportive care teams, and survivors (37). Organizational considerations include staffing and staff mix, personnel training, and coordinated communication between health professionals and care sectors, financial and human resources, geographic considerations, social determinants of health, and equitable access.
Several promising models of care for the organization and structure of survivorship service delivery have emerged. However, there is uncertainty about the effectiveness of these models of care on disease and health outcomes and if they achieve similar or equivalent outcomes in comparison to traditional oncologist specialist led-survivorship care. Oncologist specialist-led survivorship care was identified as the most prominent model for survivorship care service delivery in Canada in 2018 in a report by the Canadian Partnership Against Cancer (46). Of concern, in this report a survey of over 13,000 Canadian survivors after treatment completion across a range of cancers noted significant unmet needs including unmanaged long-term health consequences, unrelieved physical and mental health symptoms (i.e. fatigue and pain), and poor quality of life. A recent systematic review suggested through a narrative synthesis of the evidence that other emerging models of care, for example nurse led-care or shared care may be as effective as oncologist specialist led-care and survivors report better quality of life and are more satisfied with these alternate models of care (47). However, cancer care organizations may still be concerned about the equivalence of these models on clinical outcomes such as time to detection of recurrence and quality of life outcomes. An updated review of the evidence and recommendations regarding these models of care is warranted to inform end-user decision-making, health care providers and survivors and could serve as a catalyst for change and uptake of alternate models of care.