Follow-up care for cancer survivors: the views of clinicians

Abstract

Background: Evidence for the efficacy of late effects surveillance in adult cancer survivors is lacking and there is little agreement among clinicians on appropriate follow-up care.

Methods: We report the views of both cancer experts and general practitioners (GPs) on long-term follow-up provision for cancer survivors, focussing on the 18-45 years age group. A total of 421 cancer experts (36% haematologists, 33% oncologists, 18% surgeons, 10% nurses, 2% other) and 54 GPs responded to a structured online survey. Reasons for follow-up care (clinical or supportive); advantages and disadvantages of follow-up in primary care; current practice; and resources required for a quality follow-up service were assessed.

Results: Clinicians valued clinical reasons for follow-up more highly than supportive reasons (P<0.001). Learning more about late effects and checking for cancer recurrence were rated as the most important reasons for follow-up by cancer experts and GPs. A total of 85% of cancer specialists hold follow-up consultations alongside patients on active treatment. Cancer experts agreed that primary care follow-up would increase their availability for acute oncological care, but reduce information on late effects. The most important resource to provide a quality follow-up service was specialist nursing support (91%).

Conclusions: Follow-up guidelines that include late effects surveillance are needed. Where and who should deliver this care requires further debate.

Figure 1

Scatter plots of scores for clinical and supportive reasons for follow-up by professional group. Scores were rated on a five-point (1–5) scale with a high score indicating more agreement. Mean scores were compared between professional groups by a one-way ANOVA (analysis of variance). If the overall one-way ANOVA was significant at the 0.05 level, then a series of pairwise multiple comparisons were made to determine which mean differences using a post hoc (Tukey's) test allowed for multiple comparisons. Significant differences between the mean scores by professional groups are indicated using the following notation: H=haematologist, O=oncologist, S=surgeon, N=nurse, G=GP. For example, for clinical care scores, the N above the haematologist scatter plot implies significant differences between the mean haematologist and nurse scores, but none of the other professional groups.

Figure 2

Advantages and disadvantages of follow-up in primary care according to cancer experts.