Realignment of models of care is identified as a health system priority to meet the supportive care and surveillance needs of a burgeoning survivor population. Further research is needed to evaluate the efficacy of models of care in a broader population of cancer survivors with differing needs and risks. While the evidence is limited, there is research that may be used to guide the configuration of health care services and planning.

designed for survivors of cancer. Articles were excluded from the systematic review if they focused only on pediatric cancer survivor populations or on populations that transitioned from pediatric cancer to adult services; if they addressed only pharmacologic interventions or diagnostic testing and follow-up of cancer survivors; if they were systematic reviews with inadequately described methods; if they were qualitative or descriptive studies; and if they were opinion papers, letters, or editorials. Data Extraction and SynthesisEvidence was selected and reviewed by three members of the Cancer Journey Survivorship Expert Panel (SM, TC, TKO). The resulting summary of the evidence was guided further and reviewed by the members of Cancer Journey Survivorship Expert Panel. Fourteen practice guidelines, eight systematic reviews, and sixty-thee randomized controlled trials form the evidence base for this guidance document. These publications demonstrate that survivors benefit from coordinated post-treatment care, including interventions to address specific psychosocial, supportive care, and rehabilitative concerns. ConclusionsOngoing high-quality research is essential to optimize services for cancer survivors. Interventions that promote healthy lifestyle behaviours or that address psychosocial concerns and distress appear to improve physical functioning, psychosocial well-being, and quality of life for survivors. ABSTRACT ObjectiveOur goal was to develop evidence-based recommendations for the organization and structure of cancer survivorship services, and best-care practices to optimize the health and well-being of post-primary treatment survivors. This review sought to determine the optimal organization and care delivery structure for cancer survivorship services, and the specific clinical practices and interventions that would improve or maximize the psychosocial health and overall wellbeing of adult cancer survivors. Data SourcesWe conducted a systematic search of the

Cognitive screening tests are frequently used in brain tumor clinics. The Mini Mental State Examination (MMSE) is the most commonly used, and the Montreal Cognitive Assessment (MoCA) is an alternative. This study compares the diagnostic accuracy of both screening tests. Fifty-eight patients with brain tumors were prospectively accrued and administered the MMSE and MoCA, 67% of who completed a comprehensive neuropsychological evaluation as a gold standard comparison. Quality of life and community integration were measured with the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Community Integration Questionnaire (CIQ), respectively. At the pre-defined cut-off scores, the MoCA had superior sensitivity (61.9% vs. 19.0%, P < 0.005) and the MMSE had superior specificity (94.4% vs. 55.6%, P < 0.017). The areas under the ROC curve for the MMSE (0.615, standard error = 0.091) and MoCA (0.606, standard error = 0.092) were poor, indicating that at no single cut-off score is either test both sensitive and specific. Neither the MMSE (ρ = 0.12; P < 0.444) nor MoCA (ρ = 0.24; P < 0.108) were significantly correlated with the FACT-Br. The MoCA was modestly correlated with the CIQ (ρ = 0.35; P < 0.017), but the MMSE was not (ρ = 0.14; P < 0.359). The MMSE has extremely poor sensitivity. Using this test in clinical practice, research, and clinical trials will result in failing to detect cognitive impairment in a substantial percentage of patients. The MoCA has superior sensitivity, and is better correlated with self reported measures of community integration, and therefore should be preferentially chosen in practice and clinical trials.

Our results indicate that the MoCA is a superior prognostic indicator than the MMSE. Furthermore, given its superior sensitivity and better correlation with quality of life, the MoCA should be preferentially chosen in clinical practice and trials.

Objective:Two prospective studies in patient with brain tumours were performed comparing the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The first assessed their feasibility and the second compared their diagnostic accuracy against a four-hour neuropsychological assessment (NPA). The introduction of the NPA decreased accrual and retention rates. We were therefore concerned regarding potential selection bias.Methods:Ninety-two patients were prospectively accrued and subsequently divided into three categories: a) no NPA required b) withdrew consent to NPA c) completed NPA. In order to quantify any potential bias introduced by the NPA, patient demographics and cognitive test scores were compared between the three groups.Results:There were significant differences in age (p<0.001), education (p=0.034), dexamethasone use (p=0.002), MMSE (p=0.005), and MoCA scores (p<0.001) across the different study groups. Furthermore, with increasing involvement of the NPA, patients' cognitive scores and educational status increased, while their age, dexamethasone use, and opioid use all decreased. Individuals who completed the NPA had higher MoCA scores than individuals who were not asked to complete the NPA (24.7 vs. 20.5; p < 0.001). In addition, this relationship held when restricting the analyses to individuals with brain metastases (p < 0.001).Conclusions:In this study, the lengthy NPA chosen introduced a statistically and clinically significant source of selection bias. These results highlight the importance of selecting brief and well tolerated assessments when possible. However, researchers are challenged by weighing the improved selection bias associated with brief assessments at the cost of reduced diagnostic accuracy.