Providing survivorship care requires a variety of approaches to meet the needs of the growing population of survivors. Currently there are several models of care delivery available, all with distinct advantages and disadvantages. When determining the model best suited for your practice setting, the population served and level and type of resources available should be the two principal considerations. Survivors of cancer are not all alike and their needs vary across a continuum, from those who have few long-term effects from their treatment to patients with chronic conditions or significant treatment-related health issues. Regardless, all survivors require education regarding their own health risks and screening needs.

Determining the model of survivorship care delivery that works best for your patient population and practice setting requires consideration of the patient needs and risks. It also requires available resources that can help practitioners meet the key components of survivorship care. The models of care delivery provided below offer a variety of methods for addressing the needs of survivors of cancer. The fundamental differences between the approaches are the physical location of care delivery and the type of healthcare practitioner providing the long-term follow-up care.

Models of Survivorship Care Delivery

Oncology Specialist Care

Characteristics

  • Follow-up care occurs in the oncology setting with treating oncologist
  • Can be implemented in private practice, community hospitals or cancer centers
  • Can be implemented in disease-specific clinics or modality-specific practices
  • Communication and coordination with PCP

Advantages

  • Comfortable for patients and family/caregivers who have developed a relationship with the treating oncologist
  • Provides continuity of oncology care
  • Oncologists don’t feel they have to “give up” their patients to other providers
  • Patients at high risk of recurrence are closely followed

Disadvantages

  • Focus remains on illness, not wellness
  • Focus may be on relapse rather than risk-based surveillance and health promotion
  • Providers may lack time or interest in managing long-term or late effects
  • Primary care needs may be unmet

Multi-Disciplinary Survivorship Clinic

Characteristics

  • Care provided by a specialized team (i.e. oncologist, psychologist, cardiologist, etc.) in a separate clinical area
  • Can be implemented at cancer centers and other facilities with extensive resources
  • Ideal patient populations include: pediatric cancer survivors, adolescent/young adult (AYA) survivors and adult survivors of pediatric cancer
  • Communication and coordination with PCP

Advantages

  • Providers have expertise in long-term and late effects of treatment
  • Multiple services are provided in one location
  • Good model for complex patients
  • Improved survivor knowledge of long-term and late effects
  • Provides ready access to sub-specialists committed to survivorship care
  • Easy for survivors
  • Can include psychological support to complement medically focused oncology care

Disadvantages

  • Resource and time intensive
  • Not needed by all survivors
  • Available to a limited number of patients
  • May discourage survivors from re-establishing care or initiating care with primary care providers, and thus primary care needs may be unmet
  • Can be difficult to coordinate all specialists on the team

Disease/Treatment-Specific Survivor Clinic

Characteristics

  • Care can be provided by a physician, NP, PA, or multispecialty team
  • Care provided in oncology setting
  • Can be developed for a common diagnosis, such as breast cancer, or treatment modality, such as stem cell transplant
  • Can be developed in private practice, community hospital, or cancer center
  • Communication and coordination with Primary Care

Advantages

  • Providers have expertise in one particular area
  • Allows institutions and practices to pilot services with one group of patients
  • Simple to apply guidelines for surveillance and symptom management
  • Referral to outside services can be a component
  • Can focus on psychological support to complement medically focused oncology care
  • Can include psychological support to complement medically focused oncology care

Disadvantages

  • Limited to survivor populations with large numbers
  • May focus resources away from other survivor groups with significant needs
  • May discourage survivors from seeing primary care providers

General Survivorship Clinic

Characteristics

  • Care can be provided by MD, NP, or PA (not multispecialty)
  • Can be implemented at a cancer center, community hospital, or private practice
  • Communication and coordination with Primary Care

Advantages

  • Provides survivorship services for all groups
  • Financially more efficient than disease-specific services
  • Referral to outside services can be a component
  • Can focus on psychological support to complement medically focused oncology care

Disadvantages

  • Difficult to have expertise in one clinic across all survivor groups
  • Difficult to tailor services for specific needs
  • May discourage survivors from seeing primary care providers

Consultative Survivorship Clinic

Characteristics

  • Care can be provided by MD, NP, or PA
  • One-time visit with no follow-up, but has potential for another visit
  • Ideal for providing treatment summary and care plan
  • Can be implemented at a cancer center, community hospital, or private practice
  • Communication and coordination with Primary Care 

Advantages

  • Comfortable for patients and family/caregivers who have developed a relationship with the treating oncologist
  • Allows continuity of oncology care
  • Oncologists don’t feel they have to “give up” their patients to other providers
  • Requires few resources
  • Provides a plan for post-treatment care and follow-up
  • Empowers patients with knowledge and education

Disadvantages

  • One-time visit with no follow-up
  • Limited time to address long-term and late effects
  • Requires extensive knowledge across survivor groups
  • Requires providers who can bill for services—not all types of providers may be reimbursed

Integrated Survivorship Clinic

Characteristics

  • Embedded in the treatment focused oncology setting
  • Care can be provided by an MD, NP, or PA
  • Care is ongoing
  • Can be implemented at a cancer center, community hospital, or private practice
  • Provider communicates and coordinates care with primary care provider and specialists as needed

Advantages

  • Provider is a survivorship specialist who is part of the  clinical team
  • Oncologists are readily available to survivors if needed
  • Survivor receives survivorship-focused care within the oncology setting
  • Frees up the oncologist to see new patients

Disadvantages

  • Survivors may expect clinician to provide primary care; primary care needs may therefore be unmet
  • May be difficult to transition patients to primary care when appropriate
  • Requires providers who can bill for services

Community Generalist Model

Characteristics

  • Survivorship care is provided by primary care physician, NP, or PA
  • Care setting can be at a health care system or private practice
  • Communication and coordination with PCP

Advantages

  • Focus is on wellness rather than disease
  • Promotes independence and reintegrates the survivor into primary care

Disadvantages

  • Limited provider knowledge about long-term and late effects
  • Requires provider knowledge and education about survivorship issues
  • Difficult to update providers and survivors as new information becomes available

Shared-Care of Survivor

Characteristics

  • Care for all survivors is coordinated between oncology specialist, and PCP generalists

Without Transition 

  • Follow-up care occurs in oncology setting
  • Can be implemented at a cancer center, community hospital, or private practice

With Transition

  • Follow-up care occurs in oncology setting in coordination with PCP
  • At a predetermined time, care is transitioned to the PCP only
  • Consultation with the oncology specialists occurs as needed 

Advantages

Without Transition

  • Survivor continues to benefit from specialists in managing long-term and late effects
  • Works well for survivors with ongoing, complicated cancer-related health issues

With Transition

  • Survivor continues to benefit from specialists when at highest risk of recurrence
  • Works well for patients with limited risk of late effects
  • Focus is on wellness rather than disease
  • Promotes independence and allows focus on co-morbidities—important in the elderly

Disadvantages

Without Transition

  • Resource intensive since survivors require time, expertise, and a strong infrastructure of communication between specialist and PCP
  • Often roles are not clearly delineated resulting in care that is omitted or duplicated

With Transition

  • May be difficult to identify the PCP and to, therefore, transition patients to primary care when appropriate
  • Connection to oncology may be difficult to reestablish when problems arise