Models for delivery of follow-up care – what does the evidence tell us thus far?


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Jon Emery1,

1University of Melbourne, Melbourne, Australia

Abstract

  Improvements in cancer detection, treatment and an aging population mean that there are an increasing number of people living with and beyond cancer. Current hospital-centred models of cancer follow-up have tended to focus on detection of cancer recurrence which may result in significant unmet needs, particularly psychosocial needs. This presentation will first present the findings of a rapid review focused on the role of primary care in cancer follow-up. Several trials have assessed alternative models of cancer follow-up care involving primary care, with most assessing the period of survivorship relatively soon after treatment completion. Many of these studies have involved either a shared model of follow-up care between the oncology specialist and primary care provider or a direct transfer of follow-up care to the primary care provider, with the majority of studies focusing on detecting recurrence or managing adverse effects of chemotherapy.┬áSeveral randomised controlled trials have shown primary care-led follow-up care to be equivalent to hospital-led care in terms of patient wellbeing, recurrence rates and survival, and might be less costly. Successful primary care-led follow-up requires appropriate guidelines, clear communication and accessible specialist care if required. The second aspect of this presentation will report findings from the ProCare Trial, a multi-centre phase II RCT of shared care for prostate cancer conducted in Australia. The intervention is a shared care model of follow-up visits in the first 12 months after completing treatment for prostate cancer with the following specific components: a survivorship care plan, GP management guidelines, register and recall systems, screening for distress and unmet needs and patient information resources. Data will be presented on psychosocial outcomes, unmet needs and clinical process measures and key issues learnt about the feasibility of this novel model of shared care will be discussed.

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