Enhanced quality and productivity of long-term aftercare of cancer in young people.

Abstract

Long-term morbidity associated with survival from childhood cancer is well defined. Traditional models of hospital-based long-term aftercare are not sustainable and may not be necessary for all. A programme to support development and implementation of redesigned care pathways is reported. Application of service improvement methodologies to identify the case for change, to evidence development of, and test, new aftercare pathways. Four models of aftercare were identified; traditional cancer centre-delivered medical follow-up, shared care with local hospitals or primary care, specialist nurse-led supported management and self-management. Key components required for successful implementation of risk-stratified care included; comprehensive information transfer with treatment summaries and care plans, provision of care coordinators, effective transition across services, remote monitoring systems, educating professionals, maintaining patient choice. Adoption of risk-stratified evidence-based aftercare pathways, generated through application of service improvement methodologies, can result in the delivery of enhanced quality and productivity.