Colorectal cancer survivors' experiences and views of shared and telehealth models of survivorship care: A qualitative study.

OBJECTIVES: The number of colorectal cancer (CRC) survivors is increasing and current models of survivorship care are unsustainable. There is a drive to implement alternative models of care including shared care between general practitioners (GPs) and hospital-based providers. The primary objective of this study was to explore perspectives on facilitators and barriers to shared care. The secondary objective was to explore experiences of telehealth-delivered care. METHOD: Qualitative data were collected via semi-structured interviews with participants in the Shared Care for Colorectal Cancer Survivors (SCORE) randomised controlled trial. Interviews explored patient experiences of usual and shared survivorship care during the SCORE trial. In response to the COVID pandemic, participant experiences of telehealth appointments were also explored. Interviews were recorded and transcribed for thematic analysis. RESULTS: Twenty survivors of CRC were interviewed with an even number in the shared and usual care arms; 14 (70%) were male. Facilitators to shared care included: good relationships with GPs; convenience of GPs; good communication between providers; desire to reduce public health system pressures. Barriers included: poor communication between clinicians; inaccessibility of GPs; beliefs about GP capacity; and a preference for follow-up care with the hospital after positive treatment experiences. Participants also commonly expressed a preference for telehealth-based follow-up when there was no need for a clinical examination. CONCLUSIONS: This is one of few studies that have explored patient experiences with shared and telehealth-based survivorship care. Findings can guide the implementation of these models, particularly around care coordination, communication, preparation, and personalised pathways of care.

Improved models of care for cancer survivors.

The number of survivors of cancer is increasing substantially. Current models of care are unsustainable and fail to address the many unmet needs of survivors of cancer. Numerous trials have investigated alternate models of care, including models led by primary-care providers, care shared between oncology specialists and primary-care providers, and care led by oncology nurses. These alternate models appear to be at least as effective as specialist-led care and are applicable to many survivors of cancer. Choosing the most appropriate care model for each patient depends on patient-level factors (such as risk of longer-term effects, late effects, individual desire, and capacity to self-manage), local services, and health-care policy. Wider implementation of alternative models requires appropriate support for non-oncologist care providers and endorsement of these models by cancer teams with their patients. The COVID-19 pandemic has driven some changes in practice that are more patient-centred and should continue. Improved models should shift from a predominant focus on detection of cancer recurrence and seek to improve the quality of life, functional outcomes, experience, and survival of survivors of cancer, reduce the risk of recurrence and new cancers, improve the management of comorbidities, and reduce costs to patients and payers. This Series paper focuses primarily on high-income countries, where most data have been derived. However, future research should consider the applicability of these models in a wider range of health-care settings and for a wider range of cancers.

Defining research and infrastructure priorities for cancer survivorship in Australia: a modified Delphi study.

PURPOSE: The aim of this study was to establish research and infrastructure priorities for cancer survivorship. METHODS: A two-round modified online Delphi study was completed by Australian experts in cancer survivorship. Initial priorities were generated from the literature and organized into four research categories: physiological outcomes, psychosocial outcomes, population groups, and health services; and one research infrastructure category. In round 1 (R1), panelists ranked the importance of 77 items on a five-point scale (not at all important to very important). In round 2 (R2), panelists ranked their top 5 priorities within each category. Panelists also specified the type of research needed, such as biological, exploratory, intervention development, or implementation, for the items within each research category. RESULTS: Response rates were 76% (63/82) and 82% (68/82) respectively. After R1, 12 items were added, and 16 items combined or reworded. In R2, the highest prioritized research topics and the preferred type of research in each category were: biological research in cancer progression and recurrence; implementation and dissemination research for fear of recurrence; exploratory research for rare cancer types; and implementation research for quality of care topics. Data availability was listed as the most important priority for research infrastructure. CONCLUSIONS: This study has defined priorities that can be used to support coordinated action between researchers, funding bodies, and other key stakeholders. Designing future research which addresses these priorities will expand our ability to meet survivors' diverse needs and lead to improved outcomes.

Disparities in quality of life, social distress and employment outcomes in Australian cancer survivors.

PURPOSE: To examine how socio-demographic, comorbidities and information needs influence quality of life (QoL) outcomes of survivors of breast, colorectal, or prostate cancer, non-Hodgkin lymphoma or melanoma. METHODS: Cross-sectional postal survey with eligible participants identified through a population-based cancer registry. QoL outcomes were assessed by EQ-5D-5L, social difficulties index (SDI) and, for those employed at diagnosis, current employment. Regression analyses explored associations between outcome variables and cancer type, age, time since diagnosis, residential location, socio-economic disadvantage, comorbidities and unmet information needs. Mediation analyses examined whether comorbidities and information needs explained relationships between outcome variables and socio-economic disadvantage. RESULTS: 2115 survivors participated. Mean EQ-5D-5L scores (mean = 0.84) were similar to population averages and SDI scores were low for the entire sample (mean = 3.80). In multivariate analyses, being aged over 80, greater socio-economic disadvantage, comorbidities and unmet information needs decreased EQ-5D-5L scores. Higher SDI scores were associated with socio-economic disadvantage, comorbidities and unmet information needs. Not being employed was associated with being aged over 50, more comorbidities and socio-economic disadvantage. Comorbidities but not information needs partially mediated the impact of socio-economic disadvantage on EQ-5D-5L and SDI accounting for 17% and 14% of the total effect of socio-economic disadvantage respectively. Neither comorbidities nor information needs mediated the association between socio-economic disadvantage and employment outcomes. CONCLUSIONS: To improve quality of life, survivorship care should be better tailored to address the needs of individuals given their overall health and impact of comorbidities, their age and type of cancer and not simply time since diagnosis.

Facilitators and barriers to shared primary and specialist cancer care: a systematic review.

PURPOSE: To care for the growing population of cancer survivors, health services worldwide must reconsider how to deliver care to people living with and beyond a cancer diagnosis. Shared care, defined as cancer care that is shared between specialist and primary care providers, is one model that has been investigated; however, practical guidance to support implementation is lacking. This systematic review aimed to explore facilitators and barriers to implementing shared cancer care and to develop practice and policy recommendations to support implementation. METHODS: A systematic literature search was conducted in June 2019 across MEDLINE, Embase, Emcare, and PsycINFO databases. Quantitative and qualitative data relevant to the review question were extracted and synthesized following a mixed methods approach. RESULTS: Thirteen papers were included in the review, 10 qualitative and three quantitative. Included articles were from Australia (n = 8), the USA (n = 3), and one each from the UK and the Netherlands. Sixteen themes were developed under four categories of patient, healthcare professional, process, and policy factors. Key themes included the perceived need for primary care provider training, having clearly defined roles for each healthcare provider, providing general practitioners with diagnostic and treatment summaries, as well as protocols or guidelines for follow-up care, ensuring rapid and accurate communication between providers, utilizing electronic medical records and survivorship care plans as communication tools, and developing consistent policy to reduce fragmentation across services. CONCLUSION: Recommendations for practice and policy were generated based on review findings that may support broader implementation of shared cancer care.

Patient-reported outcomes in survivors of breast cancer one, three, and five years post-diagnosis: a cancer registry-based feasibility study.

INTRODUCTION AND AIMS: The burden of treatment toxicities in breast cancer requires longitudinal assessment of patient-centered outcomes. The current study aimed to assess the feasibility of collecting general and breast cancer-specific quality of life (QoL), ongoing symptoms and unmet needs, in patients identified from a population-based cancer registry, and to assess the contribution of demographic, disease, and care-related factors. METHODS: Eligible patients were identified from the Victorian Cancer Registry (Victoria, Australia) using the ICD-10 code C50, diagnosed during 2013, 2011, and 2009. Data included age, area of residence, cancer diagnosis, date of diagnosis, treatment modality, and staging. Patients completed a number of validated tools including the EQ-5D-5L and FACT-B, symptom items, and unmet needs. RESULTS: Of 1006 eligible patients, the overall response rate was 45.6%. Survivors 1 year post-diagnosis had significantly greater problems with pain or discomfort (59.2%) and with anxiety or depression (51.3%) compared with survivors 5 years post-diagnosis (45.1% with pain or discomfort, p < 0.05, and 32.7% with anxiety or depression, p < 0.01). For the 5 years group, pain or discomfort and anxiety or depression were significantly higher than for the general population (32.2% and 21.6%, respectively). Improved quality of life was found in those who did not receive chemotherapy (coefficient = 0.2269, p = 0.0409) and those who did not have a longstanding health condition (coefficient = 0.6342, p < 0.001). Poorer quality of life was associated with those who were not certain what was happening with their breast cancer (coefficient = - 0.3674, p = 0.0094) and those whose cancer had not been treated, had been treated but was still present, or had returned after treatment (coefficient = - 0.5314, p = 0.0136). Across the total cohort, women were bothered by changes in weight (21.3%) and concerned about the effects of stress on their cancer (19.6%). Fear of cancer recurrence was commonly reported and did not diminish over time (60.7%, 52.2%, and 56.9% at 1, 3, and 5 years, respectively). CONCLUSION: Collecting patient-reported outcomes from a population-based sample of breast cancer survivors was feasible. Physical symptoms and psychosocial issues are common and are persistent. Use of chemotherapy was the only treatment modality that significantly impacted on QoL.

Patient-reported outcomes in melanoma survivors at 1, 3 and 5 years post-diagnosis: a population-based cross-sectional study.

PURPOSE: There is a lack of population-based data describing patient reported outcomes (PROs) in melanoma survivors which could guide the development of interventions and resources. This study assessed overall quality of life (QoL), self-reported symptoms and unmet information needs in melanoma survivors 1, 3 or 5 years post-diagnosis. METHODS: A cross-sectional postal survey was conducted in Victoria, Australia, with eligible melanoma survivors identified from a population-based cancer registry. Patient-reported outcome measures included the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), and self-reported symptoms, difficulties and information needs. Associations between demographic, disease and care-related factors and QoL were also assessed. RESULTS: A total of 476 melanoma survivors participated in the study (response rate 46.5%). Anxiety and depressive symptoms were more prevalent in survivors compared to the general population (30.7% vs 21.6%; p < 0.01). Fear of cancer recurrence (48.3%) and fear of cancer spreading (37.8%) were the most commonly reported symptom items, and approximately one in five melanoma survivors had unmet information needs related to psychological aspects of living with melanoma. Recurrent melanoma, living in a nursing home, chronic comorbidities, and melanoma diagnosed at > 2 mm thickness were associated with lower QoL. CONCLUSION: A large proportion of melanoma survivors reported ongoing quality of life deficits, fear of cancer recurrence, as well as unmet information needs up to 5 years after diagnosis. Patients may benefit from tailored informational resources and interventions that address the psychological aspects of living with and beyond melanoma.

Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta-synthesis.

OBJECTIVES: To explore the cancer care experiences and unmet needs of people who identify as a sexual or gender minority. METHODS: A qualitative systematic review and meta-synthesis was undertaken based on a registered protocol. Following literature searching and study selection, study quality was examined by using the Critical Appraisal Skill Programme Checklist. Qualitative data were extracted verbatim from included studies and synthesized by using thematic analysis. RESULTS: Fifteen studies that included lesbian, gay, and bisexual (LGB) people living with or beyond cancer were included in the review. Studies including gender minorities were not identified. Most of the study participants were sexual minority women with breast cancer or sexual minority men with prostate cancer. Meta-synthesis of 106 individual findings generated 6 overarching themes pertaining to sexual orientation disclosure, experiences and fear of homophobia, positive and negative health-care professional behaviors, heterocentric systems and care, inadequacy of available support groups, and unmet needs for patient-centered care and LGB-specific information. Lesbian, gay, and bisexual people often reported feelings of anxiety, invisibility, isolation, and frustration throughout the cancer care continuum. CONCLUSIONS: Analysis of the experiences of LGB people with cancer care shows that LGB people face numerous challenges due to their sexual orientation and receive care that does not adequately address their needs. Training and education of health-care professionals are strongly recommended to address some of these challenges and practice gaps. Culturally appropriate care includes avoiding heterosexual assumptions, use of inclusive language, the provision of tailored information, and involving partners in care.

Patient-reported outcomes in cancer survivors: a population-wide cross-sectional study.

PURPOSE: There is a lack of robust population-based data regarding the lived experience of cancer survivors. This study assessed the quality of life (QoL) of survivors of breast, colorectal, or prostate cancer, non-Hodgkin lymphoma or melanoma 1, 3 and 5 years post-diagnosis. Associations between various demographic and disease-related factors and QoL were assessed. METHODS: A cross-sectional postal survey was undertaken. Eligible participants were identified from a population-based cancer registry. Patient-reported outcomes including QoL, symptom issues and information needs were collected using validated questionnaires. RESULTS: Difficulties with all QoL domains were more prevalent amongst cancer survivors compared with the general population, particularly difficulties with usual activities (28 vs 15%) and anxiety or depression (35 vs 22%). Symptoms such as trouble sleeping, always feeling tired, trouble concentrating and fear of cancer recurrence persisted up to 5 years post-diagnosis. Factors associated with reduced QoL included having another long-standing health condition, cancer not responding fully to treatment, not having or not being certain of having a written care plan and being female. CONCLUSIONS: Cancer survivors experience inferior QoL and cancer-related symptoms for years following diagnosis. These results support further investigation into factors that contribute to poorer survivor outcomes and enhanced identification and intervention strategies for those requiring additional support.

Provision of Meaningful Care at Diagnosis, Birth, and after Stillbirth: A Qualitative Synthesis of Parents' Experiences.

BACKGROUND: The care provided to parents experiencing stillbirth can have significant and lasting impacts on their immediate and long-term psychological well being. The aim of this qualitative synthesis was to investigate parents' experiences of care received during and after stillbirth. METHODS: Qualitative findings extracted from 20 included studies were pooled using a meta-aggregative approach. RESULTS: Four meta-syntheses encompassing parents' experiences of care at diagnosis of stillbirth, induction and birth, immediately postbirth and onwards, revealed care strategies that parents appreciated and found helpful, and also actions and behaviors that were distressing. Helpful strategies included a warm and sensitive communication style, provision of clear and understandable information, shared decision making, and respect for individual needs and preferences. Parents appreciated guidance from health care professionals about seeing and holding, including being prepared for their baby's possible appearance, information on how to spend time with their baby, and collection of memorabilia. After stillbirth, offers of follow-up care, including referrals for professional support, were appreciated. CONCLUSIONS: Care received during and after stillbirth may have lasting impacts on parents' future well being. Health care professionals may aid in improving parents' well being after stillbirth by providing care that is cognizant of parents' emotional states. Care strategies arising from the findings of this review are suggested.

Overview of reviews: mechanical interventions for the treatment and management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is characterized by a progressive and non-reversible airflow limitation and symptoms of breathlessness, sputum production and cough. COPD is the fourth most common cause of mortality worldwide and represents a significant social and economic burden. As such, effective strategies that might be employed to treat COPD and manage symptoms need to be investigated. This overview aimed to summarize the existing evidence available in the Cochrane Library regarding the use of mechanical interventions used for the treatment and management of COPD. Systematic reviews that included adult participants with diagnosed COPD who received a mechanical intervention were included. Five reviews were included, and due to the heterogeneity of these reviews, direct and indirect comparisons of the effects of the intervention were not possible. Instead, data of the effectiveness of each intervention were extracted and summarized in tables and discussed as a narrative summary. Interventions included non-invasive positive pressure ventilation (NPPV), positive airway pressure (PEP) devices and neuromuscular electrical stimulation (NMES). Evidence regarding the effectiveness of NPPV was limited, and available data do not support the use of NPPV for patients with stable COPD. NPPV might, however, be of benefit as a weaning strategy for intubated patients and for patients experiencing respiratory failure; however, more research is required. Although PEP devices are considered as a safe airway clearance technique, data do not reveal a clear clinical benefit to their use. NMES is also regarded as safe for patients with COPD, and might also be beneficial in improving exercise tolerance and improving quality of life for patients with COPD.

Factors beyond diagnosis and treatment that are associated with return to work in Australian cancer survivors-A systematic review.

Return to work (RTW) is a marker of functional recovery for working-age cancer survivors. Identifying factors that impact on RTW in cancer survivors is an essential step to guide further research and interventions to support RTW. This systematic review aimed to identify nontreatment, non-cancer-related variables impacting RTW in Australian cancer survivors. A systematic search was conducted in EMBASE, PsycINFO, CINAHL, PubMed, and Google Scholar. Studies were eligible if they included: (1) adults living post diagnosis of malignancy; (2) quantitative data for nontreatment, non-cancer-related variables impacting RTW; (3) only Australian participants. Included studies were critically appraised, and relevant data extracted and synthesized narratively. Six studies were included in the review, published between 2008 and 2020. Studies were of variable quality and mixed methodologies. One study included malignancies of any type with the remainder focusing on survivors of colorectal cancer (n = 3), oropharyngeal cancer (n = 1), and glioblastoma multiforme (n = 1). Multiple factors were related to RTW in individual studies, including older age, presence of three or more comorbidities, fewer work hours pre-morbidly, lower body mass index, longer than recommended sleep duration, and not having private health insurance; however, there was limited consistency in findings between studies. Other variables examined included: occupation type, household income, healthy lifestyle behaviors, flexibility, and duration of employment with workplace; however, no significant associations with RTW were reported. Further research is required to gather compelling evidence on factors that influence RTW in Australian cancer survivors.

"Everything's a fight": A qualitative study of the cancer survivorship experiences of transgender and gender diverse Australians.

BACKGROUND: There is widespread recognition of the need to achieve equitable outcomes for all cancer survivors. This requires understanding of the experiences and outcomes of vulnerable groups. People who identify as sexually or gender diverse are known to be at risk of inferior cancer and survivorship outcomes, however, the posttreatment survivorship experiences of transgender and gender diverse (TGD) people have not been well studied. This study explored the survivorship experiences of people who identify as TGD, focusing on the physical and psychological aspects of the posttreatment survivorship phase and their experiences of follow-up cancer care. METHODS: A qualitative study of 10 TGD cancer survivors. Interviews were transcribed verbatim and data were analyzed by thematic analysis. RESULTS: Six themes were generated from the data. TGD people reported (1) anxiety when attending appointments and avoidance of necessary follow-up care, (2) experiences of transphobia and discrimination within oncology care settings and (3) lack of consideration of TGD identity by providers. Themes further describe (4) physical aspects of being both TGD and a cancer survivor, (5) absence of inclusive and diverse supportive care resources, as well as (6) positive growth after cancer. CONCLUSION: Approaches to mitigate these issues are urgently called for. These include training in TGD health for health-care providers, inclusion of TGD health in medical and nursing curricula, processes to collect and use gender identity and preferred pronoun data in clinical settings, and development of TGD-inclusive information and peer-support resources.

Return to work in head and neck cancer survivors: a systematic review.

PURPOSE: Cancer survivors face higher rates of unemployment compared with individuals without a history of cancer. Compared to other cancer types, head and neck cancer (HNC) survivors face unique disease and treatment-specific issues that may limit return to work (RTW). This review aimed to determine employment outcomes of HNC survivors post-treatment and identify factors associated with RTW. METHODS: A systematic search was conducted in MEDLINE, CINAHL and PsycINFO in December 2021. Inclusion criteria included adults (≥ 18 years); completed treatment for HNC; data available on RTW post-treatment. Both quantitative and qualitative studies were considered. Studies were critically appraised and data synthesised narratively. RESULTS: Twenty-nine publications were included: 22 quantitative, four qualitative and three mixed methods. The proportion of HNC survivors who RTW ranged from 32 to 90%, with participants taking 3.6-11 months to RTW. Working in a professional role and having a supportive work environment were positively associated with RTW. CONCLUSIONS: The proportion of HNC survivors who RTW varies significantly which may be due to the heterogeneity between the studies including difference in clinical characteristics of the participants and/or sample size. Future studies that are longitudinal, adequately powered and measure a range of clinical and demographic variables are needed to better understand the RTW experience and assist development of effective RTW strategies. IMPLICATIONS FOR CANCER SURVIVORS: This review suggests potential areas for intervention, including enhanced symptom management and engaging with employers to foster supportive work environments to support RTW of HNC survivors.

The Feasibility, Acceptability, and Effectiveness of Electronic Patient-Reported Outcome Symptom Monitoring for Immune Checkpoint Inhibitor Toxicities: A Systematic Review.

PURPOSE: Increasing use of immune checkpoint inhibitors (ICIs) in routine cancer care will increase the incidence of immune-related adverse events (irAEs). Systems are needed to support remote monitoring for irAEs. Electronic patient-reported outcome (ePRO) symptom monitoring systems can help monitor and manage symptoms and side effects. We assessed the content and features of ePRO symptom monitoring systems for irAEs, and their feasibility, acceptability, and impact on patient outcomes and health care utilization. METHODS: A systematic literature search was conducted in May 2022 on MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials. Quantitative and qualitative data relevant to the review questions were extracted and synthesized in tables. RESULTS: Seven papers describing five ePRO systems were included. All systems collected PROs between clinic visits. Two of five used validated symptom questionnaires, 3/5 provided prompts to complete questionnaires, 4/5 provided reminders to self-report, and 3/5 provided clinician alerts for severe/worsening side effects. Four of five provided coverage of ≥26/30 irAEs in the ASCO irAE guideline. Feasibility and acceptability were demonstrated with consent rates of 54%-100%, 17%-27% of questionnaires generating alerts, and adherence rates of 74%-75%. One paper showed a reduction in grade 3-4 irAEs, treatment discontinuation, clinic visit duration, and emergency department presentations, while another showed no difference in these outcomes or the rate of steroid use. CONCLUSION: There is preliminary evidence of the feasibility and acceptability of ePRO symptom monitoring for irAEs. However, further studies are needed to confirm the impact on ICI-specific outcomes, such as the frequency of grade 3-4 irAEs and duration of immunosuppression. Suggestions for the content and features of future ePRO systems for irAEs are provided.

Impact of immune checkpoint inhibitors and targeted therapy on health-related quality of life of people with stage III and IV melanoma: a mixed-methods systematic review.

BACKGROUND: Immune checkpoint inhibitors (ICI) and targeted therapies (TT) have significantly improved disease control and survival in people with stage III and IV cutaneous melanoma. Understanding the impact of therapy on health-related quality of life (HRQL) is vital for treatment decision-making and determining targets for supportive care intervention. We conducted a mixed-methods systematic review to synthesise the impact of ICIs and TT on all domains of HRQL in these populations. METHODS: A systematic literature search was conducted in April 2022 on MEDLINE, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials. Quantitative and qualitative data relevant to the review question were extracted and synthesised in tables according to setting (adjuvant versus metastatic), treatment type (ICI versus TT) and HRQL issue. RESULTS: Twenty-eight papers describing 27 studies were included: 15 randomised controlled trials (RCTs), four cohort studies, four single arm cross-sectional studies, two qualitative studies, one case control study and one mixed-methods study. In four studies of people with resected stage III melanoma, adjuvant pembrolizumab and dabrafenib-trametinib did not clinically or statistically change HRQL compared to baseline. In 17 studies of people with unresectable stage III/IV melanoma, inconsistencies in the impact of ICI on symptoms, functioning and overall HRQL were noted across different study designs. TT was associated with improvements in symptoms, functioning and HRQL across six studies. CONCLUSION: This review highlights the key physical, psychological and social issues experienced by people with stage III and IV melanoma treated with ICI and TT. Inconsistencies in the impact of ICI on HRQL were observed in different study designs. This highlights the need for treatment-specific patient-reported outcome measures for determining the impact of these therapies on HRQL and real-world data to inform treatment decision-making and appropriate supportive care interventions.

Current landscape of cancer survivorship research in Australia.

AIM: Response to the substantial and long-term impacts that a cancer diagnosis and treatment has on the growing population of cancer survivors, requires priority-driven, impactful research. This study aimed to map Australian cancer survivorship research activities to identify gaps and opportunities for improvement and compare activities against identified survivorship research priorities. METHODS: An online survey was completed by Australian researchers regarding their cancer survivorship research, and the barriers they identified to conducting such research. Current research activity was compared to recently established Australian survivorship research priorities. RESULTS: Overall, 178 participants completed the online survey. The majority of the research undertaken utilized survey or qualitative designs and focused on breast cancer, adult populations, and those in early survivorship (<5 years post-treatment). Barriers to conducting survivorship research included funding, collaboration and networking, mentoring, and time constraints. There was moderate alignment with existing research priorities. Investigating models of care and health service delivery were the most frequently researched priorities. Research priorities that were less commonly investigated included patient navigation, patient-reported outcomes, multimorbidity, fear of cancer recurrence, and economic issues. CONCLUSION: This study provides the first snapshot of Australian survivorship research activity. Comparison to established priorities demonstrates health services research is receiving attention and highlights areas for potential pursuits, such as rare cancers or multimorbidity. Findings indicate the need for improved funding and infrastructure to support researchers in advancing the survivorship research agenda.

Effectiveness and implementation of models of cancer survivorship care: an overview of systematic reviews.

PURPOSE: To critically assess the effectiveness and implementation of different models of post-treatment cancer survivorship care compared to specialist-led models of survivorship care assessed in published systematic reviews. METHODS: MEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases were searched from January 2005 to May 2021. Systematic reviews that compared at least two models of cancer survivorship care were included. Article selection, data extraction, and critical appraisal were conducted independently by two authors. The models were evaluated according to cancer survivorship care domains, patient and caregiver experience, communication and decision-making, care coordination, quality of life, healthcare utilization, costs, and mortality. Barriers and facilitators to implementation were also synthesized. RESULTS: Twelve systematic reviews were included, capturing 53 primary studies. Effectiveness for managing survivors' physical and psychosocial outcomes was found to be no different across models. Nurse-led and primary care provider-led models may produce cost savings to cancer survivors and healthcare systems. Barriers to the implementation of different models of care included limited resources, communication, and care coordination, while facilitators included survivor engagement, planning, and flexible services. CONCLUSIONS: Despite evidence regarding the equivalent effectiveness of nurse-led, primary care-led, or shared care models, these models are not widely adopted, and evidence-based recommendations to guide implementation are required. Further research is needed to address effectiveness in understudied domains of care and outcomes and across different population groups. IMPLICATIONS FOR CANCER SURVIVORS: Rather than aiming for an optimal "one-size fits all" model of survivorship care, applying the most appropriate model in distinct contexts can improve outcomes and healthcare efficiency.

SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer.

Background: SCORE is the first randomised controlled trial (RCT) to examine shared oncologist and general practitioner (GP) follow-up for survivors of colorectal cancer (CRC). SCORE aimed to show that shared care (SC) was non-inferior to usual care (UC) on the EORTC QLQ-C30 Global Health Status/Quality of Life (GHQ-QoL) scale to 12 months. Methods: The study recruited patients from five public hospitals in Melbourne, Australia between February 2017 and May 2021. Patients post curative intent treatment for stage I-III CRC underwent 1:1 randomisation to SC and UC. SC replaced two oncologist visits with GP visits and included a survivorship care plan and primary care management guidelines. Assessments were at baseline, 6 and 12 months. Difference between groups on GHQ-QoL to 12 months was estimated from a mixed model for repeated measures (MMRM), with a non-inferiority margin (NIM) of -10 points. Secondary endpoints included quality of life (QoL); patient perceptions of care; costs and clinical care processes (CEA tests, recurrences). Registration ACTRN12617000004369p. Findings: 150 consenting patients were randomised to SC (N = 74) or UC (N = 76); 11 GPs declined. The mean (SD) GHQ-QoL scores at 12 months were 72 (20.2) for SC versus 73 (17.2) for UC. The MMRM mean estimate of GHQ-QoL across the 6 month and 12 month follow-up was 69 for SC and 73 for UC, mean difference -4.0 (95% CI: -9.0 to 0.9). The lower limit of the 95% CI did not cross the NIM. There was no clear evidence of differences on other QoL, unmet needs or satisfaction scales. At 12 months, the majority preferred SC (40/63; 63%) in the SC group, with equal preference for SC (22/62; 35%) and specialist care (22/62; 35%) in UC group. CEA completion was higher in SC. Recurrences similar between arms. Patients in SC on average incurred USD314 less in health costs versus UC patients. Interpretation: SC seems to be an appropriate and cost-effective model of follow-up for CRC survivors. Funding: Victorian Cancer Agency and Cancer Australia.