Follow up is recommended for almost all patients after completion of treatment for cancer. Traditionally, follow up has been specialist-led (by an oncologist, haematologist or surgeon), hospital-based, and face-to-face. This model is becoming increasingly unsustainable given the large and growing number of survivors, and the limited health workforce. Traditional follow up has tended to have a limited focus, mostly on detection of possible cancer recurrence, rather than considering the breadth of issues and needs that survivors can experience.
Australian cancer survivorship research priorities, as well as numerous international groups, emphasise the need to develop and implement alternative models of post-treatment survivorship care. One proposed model is shared care, wherein care is shared between the patient’s hospital-based specialists and their general practitioner (GP). Such a model combines cancer-specific follow up, with optimal management of comorbid illness, and general preventive care. Cancer Australia recommends shared follow up care for survivors of several cancer types.
Two Australian randomised controlled trials, for survivors who had completed potentially curative treatment for either prostate or colorectal cancer, have shown quite similar findings. Compared to patients who had usual hospital based follow up, those exposed to shared care had similar quality of life outcomes and no apparent difference in cancer recurrence. Compared to hospital providers, GPs were more adherent to recommended follow up testing. Patients exposed to shared care strongly prefer this model of care and shared care is cheaper than hospital-based follow up. Few GPs declined participation in shared care in either of these studies. Several other studies of shared care are continuing in Australia.
Qualitative research with patients, GPs and oncologists, and a systematic review of barriers, and facilitators to shared care provide recommendations for practice and policy to support broader implementation of shared cancer care. Shared follow up care is an appropriate model of care for many cancer survivors.