Risk-based health care, the cancer survivor, the oncologist, and the primary care physician

Abstract

Cancer survivors face substantial risks for morbidity, reduced quality of life, and premature mortality related to the cancer itself and/or the interventions undertaken to control cancer. Risk-based care that involves a personalized systematic plan of periodic screening, surveillance, and prevention relevant to the cancer experience is recommended to address the comprehensive health needs of the growing population of cancer survivors. Risk-based care and coordination between oncology and primary care providers have been identified as important metrics of quality cancer survivorship care. Various models of survivorship care, treatment summaries, and survivorship care plans have been promoted as methods to facilitate communication among providers across care transitions and improve survivor access to quality survivorship care. However, research supporting the feasibility of implementing these practices and their effectiveness in enhancing health outcomes is limited. This article reviews key concepts underpinning clinical and research initiatives endeavoring to improve access to quality care among long-term survivors and summarizes results of intervention studies implementing these elements in transitioning survivors from oncology to primary care providers for long-term follow-up care.

Figure 1

A risk-stratified shared care model for cancer survivors assigns follow-up services based on the risk of long-term and late effects, cancer recurrence and second primaries. Roles and responsibilities of the oncology and primary care provider are defined across the survivorship spectrum from diagnosis to long-term follow-up. Such an approach optimizes the provision of health care resources by identifying services and specialty provider by need. Modified and adapted, with permission, from Oeffinger KC and McCabe MS, J Clin Oncol, 2006.