Improved models of care for cancer survivors
Open accessAbstract
The number of survivors of cancer is increasing substantially. Current models of care are unsustainable and fail to address the many unmet needs of survivors of cancer. Numerous trials have investigated alternate models of care, including models led by primary-care providers, care shared between oncology specialists and primary-care providers, and care led by oncology nurses. These alternate models appear to be at least as effective as specialist-led care and are applicable to many survivors of cancer. Choosing the most appropriate care model for each patient depends on patient-level factors (such as risk of longer-term effects, late effects, individual desire, and capacity to self-manage), local services, and health-care policy. Wider implementation of alternative models requires appropriate support for non-oncologist care providers and endorsement of these models by cancer teams with their patients. The COVID-19 pandemic has driven some changes in practice that are more patient-centred and should continue. Improved models should shift from a predominant focus on detection of cancer recurrence and seek to improve the quality of life, functional outcomes, experience, and survival of survivors of cancer, reduce the risk of recurrence and new cancers, improve the management of comorbidities, and reduce costs to patients and payers. This Series paper focuses primarily on high-income countries, where most data have been derived. However, future research should consider the applicability of these models in a wider range of health-care settings and for a wider range of cancers.
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Implementation challenges for comprehensive survivorship care include lack of health care professional awareness and training, prioritization of survivorship, organizational barriers such as dedicated time slots, multidisciplinary assessment, referral networks, and reimbursement issues.
“This may be related to implementation challenges such as lack of health care professional awareness and training and prioritization of survivorship, organizational barriers including the need for dedicated time slots in clinics to allow for multidisciplinary assessment and management involving a range of subspecialty professionals and supportive care experts, articulation with appropriate referral”
From Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer (2023) · cites this paper as [18]
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Franzoi, M. A., Degousée, L., Martin, E., Semedo, P. M., Aupomerol, M., Soldato, D., Di Meglio, A., Chiodi, C., Barbier, A., Chaouachi, H., et al. (2023) · JCO Oncology Practice · doi:10.1200/op.23.00016 · Cited by 18 · see citing works
- Authors
- Jefford, M., Howell, D., Li, Q., Lisy, K., Maher, J., Alfano, C. M., Rynderman, M., & Emery, J.
- Affiliations
- The University of Melbourne (AU)
- Princess Margaret Cancer Centre (CA)
- Jiangnan University (CN)
- Northwell Health (US)
- Peter MacCallum Cancer Centre (AU)
- Corresponding author
- Jefford, Michael
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2022-04
- Volume
- 399
- Issue
- 10334
- Pages
- 1551-1560
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC9009839
- OpenAlex
- W4224065842
- Cited by
- 281
- References
- 84
- Citations by year
- 2026: 71 · 2025: 74 · 2024: 74 · 2023: 42 · 2022: 19
- FWCI
- 6.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- cancer survivors, models of care, primary care, oncology nurses, shared care, late effects of cancer, quality of life, comorbidity management, tumor recurrence, COVID-19 pandemic, patient-centered care, health care costs
- MeSH terms
- Cancer Survivors, COVID-19, Humans, Neoplasms, Quality of Life, Survivors, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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