Follow‐up strategies following completion of primary cancer treatment in adult cancer survivors

Follow‐up strategies following completion of primary cancer treatment in adult cancer survivors
Cochrane Systematic Review 21 November 2019 https://doi.org/10.1002/14651858.CD012425.pub2

• Fifty three trials (n=20,832) which presented follow‐up strategies following completion of primary cancer treatment involving non‐specialist are providers, different intensity of procedures, or addition of survivorship care packages were identified.
• Non‐specialist‐led follow‐up, such as follow‐up provided by a general practitioner (GP) or nurse, makes little or no difference to health‐related quality of life, anxiety or depression, when compared to specialist‐led follow‐up. Effects on overall survival and detection of a cancer returning after treatment (recurrence) are uncertain.
• Less intensive follow‐up, such as follow‐up with fewer examinations or tests, may make little or no difference to overall survival but probably delays detection of recurrence when compared to more intensive follow‐up. However, other types of studies are needed before we can be certain about the effects of early detection of recurrence on survival. We also cannot be sure about its effect on health‐related quality of life, anxiety and depression.
• There was little evidence for the final type of follow‐up, which integrated additional components relevant for detection of recurrence, such as patient symptom education or monitoring, or survivorship care plans.

Breast open access follow up programme Royal Marsden NHS FT

Breast open access programme
NHS Improvement 15 February 2019

• This case study from The Royal Marsden NHS Foundation Trust provides information on the change in pathway that allowed the trust to absorb a 22% increase in outpatient breast referrals through through a breast open access follow-up programme.

Oral and Maxillofacial Surgery: GIRFT Programme National Specialty Report

Oral and Maxillofacial Surgery: GIRFT Programme National Specialty Report
Getting It Right First Time, 28 November 2018

• The GIRFT review into oral and maxillofacial surgery across England outlines the need to centralise services and build on existing hub and spoke networks for the specialty, especially in the treatment of patients with head and neck cancer and those needing corrective jaw surgery. This configuration will enable central hubs to focus on in-patient work, while outlying spoke hospitals take care of day cases and out-patients, which form a high proportion of oral and maxillofacial work.
• The report also urges providers to consider allocating dedicated oral and maxillofacial theatre time for emergency cases, which in turn will help prevent out-of-hours operations and the cancellation of planned procedures, and reduce pre and post-operative length of hospital stay.
• It further calls for a standard protocol to be introduced across the country to reduce unwarranted variations in the number of hospital follow-up appointments after surgery. In the most straight-forward of cases, eg; dental extractions, the report suggests a target of zero follow-up appointments.

Recommendations fall within four key themes:

Open access programme for patients following breast cancer treatment

Breast cancer survivors control their follow-up care in Maidstone
NHS England Case study [no date]

• Open Access Programme at Maidstone hospital puts patients in control of their breast cancer recovery. The programme, supported by the Kent and Medway Cancer Alliance, is based on a similar model at the Royal Marsden Hospital. Patients have access to telephone support, advice and appropriate clinical follow-up, in addition to regular mammograms, for a period of five years following treatment for breast cancer.
• See also patient leaflet on Open Access Follow up service at Imperial College 
• See all NHS England Cancer case studies.