To review models of care for adult cancer survivors and the challenges in program development. Review of the literature. As the number of cancer survivors continues to grow, so does the need to develop unique. ![]() Models of care for cancer survivorship. Breast Cancer. For cancer survivors with breast cancer, if no ongoing treatment issues are observed after the completion of primary therapy (though hormonal therapy may still be ongoing), their discharge from specialist- led care to community- based family physician- led care is a reasonable option. In cancer survivors with breast cancer, if no ongoing treatment issues are observed after the completion of primary therapy (though hormonal therapy may still be ongoing), their discharge from specialist- led care to nurse- led care within an institutional setting is a reasonable option. Colorectal Cancer. In cancer survivors with colorectal cancer who have completed all treatment, discharge from specialist- led care to community- based family physician care is a reasonable option. In patients with colorectal cancer who have completed all treatment, the transition to nurse- led care within an institution may be a reasonable option, based on a similar disease follow- up care trajectory to breast cancer. ![]() Survivorship care occurs immediately after primary cancer treatment. The Victorian Cancer Survivorship Program is being rolled out across Victoria in 2015. 1: Models for Multidisciplinary Cancer Survivorship Care; 2: Cancer Survivorship Management for Primary Care Physicians; 3: Cancer-related Fatigue; 4: Fertility: Understanding the Options after Cancer Treatment; 5: Coping. The Institute of Medicine report on cancer survivorship, From Cancer Patient to Cancer Survivor: Lost in. Although several excellent articles outline the major types of survivorship care program models. The Models of Care for Cancer Survivorship Working Group reviewed the results of the survey. Lesley Souter, PhD, Research Coordinator, Cancer Care Ontario's Program in Evidence-based Care; Eva Grunfeld, MD, DPhil, FCFP. Models of Care for Adult Cancer Survivors Linda A. Director, Lance Armstrong Foundation Living Well After Cancer Program Abramson Cancer Center, University of Pennsylvania Philadelphia, PA. The Evaluating Cancer Survivorship Care Models project is an innovative 3-year study that is collecting data to help understand how to. This section provides information about funding models for alcohol. The Home and Community Care program provides. The Victorian Government undertakes a range of projects in relation to cancer treatment and cancer care. To provide a clinical update of models of care for adult cancer survivors and the challenges in program development.Review of the literature.In the 4 years sinc. Cancer Survivorship is more than surviving cancer. It starts from the time of diagnosis, continues after treatment and includes individuals who experience cancer as well as family, friends and caregivers. However, there is insufficient data to inform whether nurse- coordinated care is equivalent to specialist- led. Prostate Cancer. In patients with prostate cancer who have completed primary treatment (radiation or surgery, but with hormonal therapy possibly still ongoing), the transition to nursing- led care within an institution is a reasonable option. Insufficient data exist to inform whether a discharge to primary care is equivalent, but, based on the disease trajectory, the expert opinion is that this is a reasonable option. Other Cancer Types. In patients with melanoma and esophageal cancer, follow- up outside specialist care appears to be acceptable to patients, but without clinical outcomes data, no model of care recommendations can be made. No recommendation can be made about models of care of other disease types based on the currently available published literature. Nursing Models within Community Setting. Nursing models of care within a community care setting appear to be of interest but have not been explicitly evaluated to date. Shared Care Models. No recommendation about the role of shared- care models can be made at this time based on the currently published literature. None provided. Cancer. Management. Family Practice. Internal Medicine. Oncology. Radiation Oncology. Surgery. Advanced Practice Nurses. Hospitals. Nurses. Physician Assistants. Physicians. To evaluate the models described in the literature for the follow- up care of adults with cancer who have completed treatment and are clinically disease free To evaluate if certain models are favoured for survivors of specific cancer types in terms of the following. Clinical outcomes (e. Survivor quality of life outcomes (e. Adults without evidence of disease after primary, curative treatment for any stage of cancer. Discharge of cancer survivors from specialist- led to community- based family physician care Transition of cancer survivors to nurse- led care within an institutional setting Clinical Outcomes. Disease- free survival Mortality (cancer- related and all cause) Morbidity (late effects) Time to recurrence Quality of Life (Qo. L) Outcomes. Quality of life Patient satisfaction Hand- searches of Published Literature (Primary Sources)Hand- searches of Published Literature (Secondary Sources)Searches of Electronic Databases. Searches of Unpublished Data. Objective 1: Framework Development. The working group reviewed selected articles on the delivery and organization of survivorship care from a targeted scan of documents from leading researchers, specific journals (e. Journal of Cancer Survivorship) and from the following Web sites of organizations concerned with survivorship care: The working group came to a consensus on several landmark papers that outlined models of care relevant to current professional knowledge within the Ontario context. These core models were used to develop the framework by which the studies defined in Objective 2 could be described and organized. Objective 2: Literature Review. Search Strategies. Electronic. OVID was used to systematically search the MEDLINE (R) and EMBASE databases for articles assessing the impact of model(s) of care for post- treatment cancer survivors, published between 2. Key terms were purposely broad and included: cancer, survivor, follow- up care and after care, with a subsequent randomized controlled trial (RCT) and systematic review filter. The literature search strategy is reproduced in Appendix 2 in the original guideline document. Other Sources. Reference lists of primary articles were scanned for potentially useful studies, and selected journals were hand- searched (e. Journal of Cancer Survivorship). Websites relevant to care for cancer survivors were searched for evidence- based practice and/or institutional guidelines (e. BC Cancer Agency: Cancer Management Guidelines) and recommendations (see Appendix 3 in the original guideline document). The main searches were supplemented by material identified by individual members of the working group. This strategy ensured that pioneering studies published before 2. Study Selection Criteria. Eligible sources of information had to include the following: Peer- reviewed published full reports with information on follow- up care models for adult cancer survivors or examining elements of such models. Follow- up had to be beyond 1. The coordinating provider(s) had to be identified and the model(s) clearly defined and, at minimum, include some aspect of medical care and/or surveillance (rather than merely support). If a trial was not explicit in terms of the model(s) being researched, the evidence was still initially considered if the data and results were relevant to the research objectives. Reports published in English. Randomized controlled trials (RTCs), expecting a comparison between a model or elements of a model with another approach. If a trial was not explicit in terms of the model(s) being researched but there were sufficient descriptions to ascertain model or defining feature of survivorship care, the evidence was still considered if the data and results were relevant to the research questions. Systematic reviews identified by the systematic search. Additional sources provided by the working group (such as pioneering studies) if they were relevant to the topic. The most common reasons for excluding articles were when the articles were not oncology- related, pertained to the active treatment phase, or did not include the target population (e. Literature Selection. Citations and brief records identified by the search strategy were downloaded electronically into a bibliographic management package (End. Note X5). A research coordinator (SKO) studied the titles from all the searches to identify which abstracts should be obtained. The list of titles was reviewed by a working group member (MB). Following this, two reviewers (JS and SKO) independently reviewed all the eligible abstracts to assess whether the full- text article should be retrieved. Assessments were based on the selection criteria noted. All abstracts categorised as . Two reviewers (JS and SKO) independently reviewed the full texts for eligibility. The reasons for excluding studies at this full- text stage included the following: a lack of information about who was providing the overall care, treatment included in the follow- up period being studied, a focus on an adjunctive lifestyle program, and an incomplete final data collection. Two members of the working group reviewed the studies to be included and finalized the list of articles and sources included in the evidentiary base. The studies that met the criteria were retained, and data extraction and analysis followed. Objective 1: Core Survivorship Models of Care. Five published articles from the literature were selected as a foundation on which to organize models of survivorship care. In addition and although it was in the palliative arena, a report by Cancer Care Ontario (CCO) that described recommendations on the organization and delivery of palliative care in Ontario, was included. Objective 2: Systematic Literature Search. The systematic literature search yielded a total of 2. RCTs) that addressed different providers or aspects of follow- up care and four systematic reviews that looked at different providers or methods of follow- up care. Expert Consensus (Committee)Not applicable. Systematic Review with Evidence Tables. Critical Appraisal and Data Extraction. Data were extracted by one reviewer, using a predefined form, and audited by a second reviewer independently (see Appendix 4 in the original guideline document). Study quality was independently assessed by two reviewers. For randomized controlled trials (RCTs), no specific instrument was used, but pre- determined criteria included: method of randomization clearly described; whether blinding was employed; power calculations stated; sample size adequate in relation to outcome(s); length of follow- up stated; details of statistical analyses, withdrawal and other losses to follow- up described; and sources of funding declared. The working group members recognised that, due to the nature of the studies being examined, blinding of the model of care was not always possible, and therefore, lack of blinding was not considered a significant weakness in the study design. The methodological quality ratings of the included RCTs are presented in Appendix 5 in the original guideline document. A formal assessment of systematic review quality was not conducted; however, checks were made to ensure the systematic reviews were explicit in how studies were selected (clear inclusion and exclusion criteria) and assessed and clear about attempts to minimize biases and how studies were integrated to form the conclusions. Synthesizing the Evidence. Due to the anticipated large variation in the outcomes measured and/or how they were reported, pooling the data was not planned but would be considered if the data were to allow.
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