Risk-Stratified Pathways for Cancer Survivorship Care: Insights from a Deliberative Multi-Stakeholder Consultation

A key challenge in cancer care delivery is the complexity of involving multiple care providers over long time periods now that many cancers are experienced as a chronic disease. Risk-stratified pathways of survivorship care seek to optimize coordination between cancer specialists and primary care physicians based on the whole person needs of the individual. While there has been some experimentation with risk-stratified models, they have yet to be widely adopted in practice. This article presents findings from a deliberative consultation (in Quebec) that sought to understand the perspectives of cancer specialists, primary care physicians, oncology nurses, allied professionals, cancer survivors and researchers regarding the following questions: (1) what does a risk stratified model of cancer survivorship care mean to care providers and users?; (2) What are the prerequisites for translating risk stratification into practice?; and (3) What challenges are involved in establishing these prerequisites?

The findings suggest that risk-stratified pathways serve as a valuable trigger for discussion about models of survivorship care; however, translating the concept into practice and assuring its contribution to value-based care remains a challenge. Three main themes emerged from the analysis: conceptual ambiguity, overcoming ill-defined and organizational monoliths, laying the groundwork. Efforts will be needed to counter rigidities in the system, more clearly define roles, create links between care settings (joint meetings, committees, training) and more actively involve cancer survivors at an early stage. Overall findings from this deliberative consultation provide valuable information on the groundwork that needs to be laid before attempting to implement a risk-stratified model of follow-up care for cancer survivors.

Read full text