title: Models of care for post-treatment follow-up of adult cancer survivors: a systematic review and quality appraisal of the evidence.
abstract: OBJECTIVE
  The impact of cancer and cancer treatment on the long-term health and quality of life of survivors is substantial, leading to questions about the most appropriate configuration of services and models of care for follow-up of post-primary treatment survivors.
  
  
  METHODS
  A systematic review and quality appraisal of the health literature for structure of services and models of follow-up care for post-treatment survivors was identified through a search of guideline sources and empirical databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Library, CINAHL, and EBSCO from 1999 through December 2009.
  
  
  RESULTS
  Ten practice guidelines and nine randomized controlled trials comprised the evidence base for models of care for adult cancer survivors. Although the evidence base was rated as low quality, nurse-led and primary care physician models of follow-up care were equivalent for detecting recurrence. Consensus also suggests that cancer survivors may benefit from coordinated transition planning that includes the provision of survivorship care plans as part of standard care.
  
  
  CONCLUSIONS
  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.
authors: Faculty of Nursing, University Health Network (Princess Margaret Hospital), 610 University Ave, Toronto, ON, Canada. doris.howell@uhn.on.ca
authors: D
authors: D
authors: Howell
authors: T F
authors: TF
authors: Hack
authors: T K
authors: TK
authors: Oliver
authors: T
authors: T
authors: Chulak
authors: S
authors: S
authors: Mayo
authors: M
authors: M
authors: Aubin
authors: M
authors: M
authors: Chasen
authors: C C
authors: CC
authors: Earle
authors: A J
authors: AJ
authors: Friedman
authors: E
authors: E
authors: Green
authors: G W
authors: GW
authors: Jones
authors: J M
authors: JM
authors: Jones
authors: M
authors: M
authors: Parkinson
authors: N
authors: N
authors: Payeur
authors: C M
authors: CM
authors: Sabiston
authors: S
authors: S
authors: Sinclair
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand; D006801:Humans; D017146:Models, Organizational; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D012107:Research Design / Q000706:statistics & numerical data; D012944:Social Support; D017741:Survivors / Q000706:statistics & numerical data