Viswanathan M, Halpern M, Swinson Evans T, Birken SA, Mayer DK, Basch E. Models of Cancer Survivorship Care. Technical Brief. No. 14. (Prepared by the RTI-UNC Evidence-based Practice Center under Contract No. 290-2012-00008-I.) AHRQ Publication No. 14-EHC011-EF. Rockville, MD: Agency for Healthcare Research and Quality; March 2014.
The number of cancer survivors in the United States is projected to grow to 18 million by 2020. In addition to the unique post-treatment needs faced by all cancer survivors, adult cancer survivors have an increased risk for comorbidities that result in significant care coordination challenges. Few publications have described the structure, process, or outcomes of adult survivorship care models for this growing population with complex needs. The purpose of this Technical Brief is to describe existing and proposed models of survivorship care for survivors with adult-onset cancer who have completed active treatment.
The Technical Brief integrates discussions with Key Informants and targeted searches of published and gray literature on questions of background, context, research gaps, and future research directions. We also conducted a comprehensive and systematic search of the evidence to answer questions on outcomes associated with models of survivorship care.
The literature review and Key Informant information consistently indicated considerable heterogeneity in models of survivorship care, components of models, survivor populations, and target outcomes. Models of survivorship care are highly individualized to the institution or setting where they are provided. Broad-based “usual care” for survivors does not exist. Although competing considerations and incentives may lead oncologists or oncology providers in many instances to continue seeing cancer survivors long after treatment ends, anticipated shortages in the oncology workforce may require other approaches such as the expanded use of nurse practitioners and physician assistants, shared care with primary care providers, and patient navigators. Concerns associated with these alternatives include payment considerations, adequacy of training, and the potential for fragmented care. Our systematic review of the literature for the Technical Brief identified nine empirical studies of survivorship care models, covering nurse-led models, physician-led models, models in which survivorship care plan development is a key component, and individual or group counseling models. Future research is needed to explore the optimal timing of survivorship models, tailoring of models based on patient characteristics and risk factors, and key outcomes.
The optimal nature, timing, intensity, format, and outcome of survivorship care models continue to be uncertain. The paucity of evidence limits our ability to make conclusions about the effectiveness of survivorship care models. Further research regarding survivorship care models, focusing on issues including settings, processes and continuity of care, payments, types of health care providers involved, collaborations and communications, outcomes, and differences associated with cancer type or patient sociodemographic characteristics, is needed before recommendations and conclusions regarding model development, implementation, and evaluation can be made.