Recommendations
Following deliberations and voting consensus of our interdisciplinary expert panel that included representation of jurisdictions across Canada and people with lived experience of cancer (patient partners) we have developed our recommendations for these four alternate models of survivorship care for follow-up of adult cancer survivors. The recommendations are based on evidence of effects on outcomes in comparison to oncologist specialist led-care models of care. The Brief Summary of Recommendations table provides a condensed version of the recommendations. Below you will find the full recommendation details and associated evidence-to-decision frameworks.
| Brief Summary of Recommendations | |
|---|---|
| Model of Care | Recommendation and Remarks |
| Shared-Care Model |
Recommendation: The panel recommends that shared care models of survivorship care are appropriate to be used for many adult cancer survivors who have completed cancer treatment.
(Strong recommendation, based on low certainty in the evidence) Remarks: Shared care must be recognized as a formalized arrangement with core elements in place to address essential components of quality survivorship care (surveillance, health promotion/prevention, psychosocial support, symptom management, etc.). Integration across care sectors is crucial for seamless survivor and provider experience. |
| Primary Care Physician Led-Care |
Recommendation: The panel recommends that primary care-led survivorship models of care are appropriate to be used for many adult cancer survivors who have completed cancer treatment.
(Strong recommendation, based on moderate certainty in the evidence) Remarks: Compared to oncologist-led care, primary care-led models showed trivial to small differences in health effects. They are favorable for many survivors, but oncologist-led models may be needed for patients with complex symptoms, high risk of recurrence, or specific preferences. |
| Nurse-Led Care Model |
Recommendation: The panel recommends that nurse-led survivorship models of care are appropriate to be used for many adult cancer survivors who have completed cancer treatment.
(Strong recommendation, based on moderate certainty in the evidence) Remarks: Similar to primary care-led models, nurse-led models showed small differences in outcomes compared to oncologist-led care. Suitable for many, but some patients may require specialist-led follow-up depending on their needs. |
| Patient-Initiated / Self-Management Models |
Recommendation: The panel suggests that patient-led survivorship models of care are appropriate for low-risk patients who have completed cancer treatment.
(Conditional recommendation, based on very low certainty in the evidence) Remarks: Rapid access back to oncologist-led care is critical to the success of this model. |
Shared Care Model of Survivorship Care
Statement of Recommendation
The panel recommends that shared care models of survivorship care are appropriate to be used for many adult cancer survivors who have completed cancer treatment. (Strong recommendation based on low certainty in the evidence).
Remarks: Shared care must be recognized as a formalized arrangement and core elements in place to address the essential components of quality survivorship care (surveillance, health promotion/prevention, psychosocial support, symptom management, etc.) and key features for these models of care for achievement of health outcomes and mechanisms for integration across these two care sectors are crucial to create a seamless experience for survivors and providers.
Shared care has been defined as a formalized arrangement in which primary care physicians (PCPs) and oncology specialists have specific identified roles in the delivery of survivorship care (66). However, we found in our review of the implementation literature shared care between primary care physicians and Advanced Practice Nurses and there may be opportunities for shared care between primary care physician and general practice oncologists, but these models were not identified in our review. Shared care between PCPs and oncology specialists are promoted as a model of care, whereby survivors can receive optimal cancer care combined with optimal generalist or primary care physician care that focuses on chronic disease and co-morbid disease management, health promotion and prevention, and psychosocial care (66); and includes the four essential components for survivorship care as identified in the IOM and quality survivorship care frameworks (38,39). As noted by Jefford and colleagues (2024), shared care may be applicable to large numbers of survivors especially those who are at high risk of recurrence/relapse (i.e. haematology populations) or have complex health challenges based on treatment exposures (e.g. high risk for new cancer, late effects) (66).
Primary Care-Led Model of Survivorship Care
Statement of Recommendation
The panel recommends that primary care-led survivorship models of care are appropriate to be used for many adult cancer survivors who have completed cancer treatment. (Strong recommendation based on moderate certainty in the evidence).
Remarks: When compared with oncologist specialist led survivorship models there were trivial to small differences in health effects with the primary care-led models, therefore favoring their use for many adult cancer survivors. However, depending on individual patient preferences, goals, level of risk of recurrence, and complexity of symptoms and treatment exposure risks an oncologist specialist-led model of follow-up care may be more appropriate for some patient populations.
Nurse-Led Model of Survivorship Care
Statement of Recommendation
The panel recommends that nurse-led survivorship models of care are appropriate to be used for many adult cancer survivors who have completed cancer treatment. (Strong recommendation based on moderate certainty in the evidence).
Remarks: When compared with oncologist specialist-led survivorship models there were trivial to small differences in health effects with the nurse-led models, therefore favoring their use for many adult cancer survivors. However, depending on individual patient preferences, goals, level of risk of recurrence, and complexity of symptoms and treatment exposure risks an oncologist specialist-led model of follow-up care may be more appropriate for some patient populations.
Patient-Led/Patient Initiated Follow-Up/Supported Self-Management Models of Survivorship Care
Statement of Recommendation
The panel suggests that patient-led survivorship models of care are appropriate to be used for low-risk patients who have completed cancer treatment. (Conditional recommendation, based on very low certainty of evidence).
Remarks: Rapid access to re-entry to oncologist specialist-led care is critical to the success of this model. It is also critical that careful selection of appropriate low risk patients is essential to effective operationalization of this model and who are prepared and have the capacity for cancer and health self-management.