title: Implementing novel models of posttreatment care for cancer survivors: Enablers, challenges and recommendations.
abstract: OBJECTIVE
  The American Society of Clinical Oncology and US Institute of Medicine emphasize the need to trial novel models of posttreatment care, and disseminate findings. In 2011, the Victorian State Government (Australia) established the Victorian Cancer Survivorship Program (VCSP), funding six 2-year demonstration projects, targeting end of initial cancer treatment. Projects considered various models, enrolling people of differing cancer types, age and residential areas. We sought to determine common enablers of success, as well as challenges/barriers.
  
  
  METHODS
  Throughout the duration of the projects, a formal "community of practice" met regularly to share experiences. Projects provided regular formal progress reports. An analysis framework was developed to synthesize key themes and identify critical enablers and challenges. Two external reviewers examined final project reports. Discussion with project teams clarified content.
  
  
  RESULTS
  Survivors reported interventions to be acceptable, appropriate and effective. Strong clinical leadership was identified as a critical success factor. Workforce education was recognized as important. Partnerships with consumers, primary care and community organizations; risk stratified pathways with rapid re-access to specialist care; and early preparation for survivorship, self-management and shared care models supported positive project outcomes. Tailoring care to individual needs and predicted risks was supported. Challenges included: lack of valid assessment and prediction tools; limited evidence to support novel care models; workforce redesign; and effective engagement with community-based care and issues around survivorship terminology.
  
  
  CONCLUSIONS
  The VCSP project outcomes have added to growing evidence around posttreatment care. Future projects should consider the identified enablers and challenges when designing and implementing survivorship care.
authors.affiliation: Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Australia.|Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.|Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Jefford
authors.affiliation: Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kinnane
authors.affiliation: North Eastern Melbourne Integrated Cancer Service (NEMICS), Melbourne, Australia.
authors.forename: Paula
authors.initials: P
authors.lastname: Howell
authors.affiliation: Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Nolte
authors.affiliation: Cancer Strategy and Development, Department of Health and Human Services, State Government of Victoria, Melbourne, Australia.
authors.forename: Spiridoula
authors.initials: S
authors.lastname: Galetakis
authors.affiliation: Department of Surgery, University of Melbourne, Melbourne, Australia.|The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Bruce Mann
authors.affiliation: Systems and Workforce Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors.forename: Lucio
authors.initials: L
authors.lastname: Naccarella
authors.affiliation: Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Lai-Kwon
authors.affiliation: North Eastern Melbourne Integrated Cancer Service (NEMICS), Melbourne, Australia.
authors.forename: Katherine
authors.initials: K
authors.lastname: Simons
authors.affiliation: Malignant Haematology and Stem Cell Transplantation Service, The Alfred, Melbourne, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Avery
authors.affiliation: ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Thompson
authors.affiliation: The Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia.|School of Medicine, Deakin University, Geelong, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ashley
authors.affiliation: Peninsula Dermatology, Melbourne, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Haskett
authors.affiliation: Cancer Strategy and Development, Department of Health and Human Services, State Government of Victoria, Melbourne, Australia.
authors.forename: Elise
authors.initials: E
authors.lastname: Davies
authors.affiliation: Cancer Strategy and Development, Department of Health and Human Services, State Government of Victoria, Melbourne, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whitfield
mesh_terms: D000359:Aftercare / Q000458:organization & administration*; D001315:Australia; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology; D009859:Oncology Nursing / Q000379:methods*; D017741:Survivors / Q000523:psychology*; D014481:United States
keywords: aftercare; long-term care; neoplasms; survivors