Implementing Personalized Pathways for Cancer Follow-up Care in the United States
A new approach to cancer follow-up care is required to meet the needs of the growing population of cancer survivors in the United States, while also addressing provider shortages and rising costs, according to a new multiagency report. The report—published by Alfano et al in CA: A Cancer Journal for Clinicians—outlines national strategies to develop and implement care that addresses these issues by treating patients in personalized pathways based on the type and level of resources needed for their long-term care.
Follow-up Care Needs
The number of cancer survivors in the United States is rising, from 15.5 million currently to an estimated 20 million by 2026. Cancer survivors need appropriate follow-up care, including the management of chronic and late effects of cancer and comorbid conditions; screening and treatment for potential recurrence and subsequent cancers; attention to psychosocial, economic, and family concerns; and encouragement of lifestyle behaviors to improve health. Current follow-up care models fail to meet survivors’ needs. Many survivors report ongoing physical, functional, psychosocial, and emotional problems that limit participation in work and community roles, reduce quality of life, and decrease survival.
In an approach in England and Northern Ireland, now being adapted for other countries, patients are triaged to one of three follow-up care pathways based on the severity of ongoing symptoms and other health-care needs. All patients continue to see their primary care physician for non–cancer-related care and are supported in self-managing their health to the fullest extent possible. This approach has been shown to meet survivors’ needs, while reducing health-care costs and allowing clinicians to spend more time helping survivors with greater needs.
U.S. Summit
In January 2018, the American Cancer Society and ASCO convened a summit to identify the steps necessary to move this work from concept to implementation in the United States. Experts in oncology, nursing, primary care, academic research, health-care delivery, government, research, and other areas heard from UK Survivorship Initiative leaders, who presented lessons learned and outcomes from the England and Northern Ireland experience.
The summit identified four key strategies going forward for the United States: (1) developing a candidate model (or models) of care delivery; (2) building the case for implementation by conducting studies modeling the effects of personalized pathways of follow-up care on patient outcomes, workforce, and health-care resources, as well as utilization and costs; (3) creating consensus-based guidelines to guide the delivery of personalized care pathways; and (4) identifying and filling research gaps to develop and implement needed care changes.
“U.S. cancer care delivery systems are already struggling to treat the growing number of oncology patients. Continuing to see most follow-up patients in oncology clinics will both fail to meet survivors’ needs and make timely scheduling of new patients worse,” said Catherine M. Alfano, PhD, lead author of the report. “U.S. health-care systems should consider how implementing a personalized care pathway approach like the model used in England and Northern Ireland may help their system to ensure that affordable and high-quality cancer care is available to all in need.”
Disclosures: The study authors' full disclosures can be found at onlinelibrary.wiley.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
