Risk-Stratified Pathways for Cancer Survivorship Care: Insights from a Deliberative Multi-Stakeholder Consultation

Abstract

Risk-stratified pathways of survivorship care seek to optimize coordination between cancer specialists and primary care physicians based on the whole person needs of the individual. While the principle is supported by leading cancer institutions, translating knowledge to practice confronts a lack of clarity about the meaning of risk stratification, uncertainties around the expectations the model holds for different actors, and health system structures that impede communication and coordination across the care continuum. These barriers must be better understood and addressed to pave the way for future implementation. Recognizing that an innovation is more likely to be adopted when user experience is incorporated into the planning process, a deliberative consultation was held as a preliminary step to developing a pilot project of risk-stratified pathways for patients transitioning from specialized oncology teams to primary care providers. This article presents findings from the deliberative consultation that sought to understand the perspectives of cancer specialists, primary care physicians, oncology nurses, allied professionals, cancer survivors and researchers regarding the following questions: what does a risk stratified model of cancer survivorship care mean to care providers and users? What are the prerequisites for translating risk stratification into practice? What challenges are involved in establishing these prerequisites? The multi-stakeholder consultation provides empirical data to guide actions that support the development of risk-stratified pathways to coordinate survivorship care.

Needs and preferences of breast cancer survivors regarding outcome-based shared decision-making about personalised post-treatment surveillance

“…Finally, results may not be completely generalisable to other countries because surveillance may be organised differently due to cultural or budgetary incentives. However, other countries are also looking to optimize aftercare and surveillance, and the results of this study can contribute to this process [23][24][25]. Strengths of this study are the fact that data saturation was achieved and the heterogenous group of participants in terms of age, region in the Netherlands, and time since diagnosis and treatment.…”

Predictors and impact of survivorship care plans and survivorship care visits

“…There are ongoing studies assessing how risk-stratified survivorship care can be delivered to cancer patients. Patients with low risk of recurrence or low likelihood of treatment side effects may benefit from self-management, whereas those with medium risk of recurrence could benefit from a SCP alone with regular follow-up primarily with their primary care team [ 13 ]. For those patients with a high risk of recurrence, significant medical or psychosocial co-morbidities, or late or significant treatment adverse effects, a SCV including follow-up with specialized clinical nurses, scheduled screening for recurrence, and referrals to rehabilitation, psychological, or nutritional support services as needed would be more beneficial than a SCP alone [ 13 ].…”

“…Patients with low risk of recurrence or low likelihood of treatment side effects may benefit from self-management, whereas those with medium risk of recurrence could benefit from a SCP alone with regular follow-up primarily with their primary care team [ 13 ]. For those patients with a high risk of recurrence, significant medical or psychosocial co-morbidities, or late or significant treatment adverse effects, a SCV including follow-up with specialized clinical nurses, scheduled screening for recurrence, and referrals to rehabilitation, psychological, or nutritional support services as needed would be more beneficial than a SCP alone [ 13 ]. However, barriers such as limited upfront risk-stratifying methods and limited coordination among care providers have prevented risk-stratified survivorship care from being widely adopted to standard practice [ 14 ].…”

Identifying the Needs of Primary Care Providers Caring for Breast and Colon Cancer Survivors in the Safety-Net: a Qualitative Study

“…As safety-net health care organizations struggle with a shortage of PCPs and specialists [35], one of the solutions proposed by participants is similar to risk-based surveillance [36,37] which takes into account the stage of cancer, treatment received, the estimated risk of recurrence, and patient preferences to determine the optimal cancer survivorship care follow-up. Risk-based cancer survivorship care has been implemented in the UK based on cancer survivors' needs [37]. For example, cancer survivors with early-stage cancer treated with surgery alone can be cared for by PCPs using a cancer care surveillance checklist.…”

“…Intermediate-risk cancer survivors with moderate risk of recurrence and after a period of shared care are transitioned to PCPs. Furthermore, highrisk cancer survivors who are considered to be high risk of recurrence and have significant oncologic care needs may benefit from indefinite co-management with oncologists and PCPs [37].…”