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Am Soc Clin Oncol Educ Book. 2019 Jan;39:625-639. doi: 10.1200/EDBK_238267. Epub 2019 May 17.

Building Personalized Cancer Follow-up Care Pathways in the United States: Lessons Learned From Implementation in England, Northern Ireland, and Australia.

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1 American Cancer Society, Inc., Washington, DC.
2 The University of Melbourne, Melbourne, Victoria, Australia and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
3 Macmillan Cancer Support, London, United Kingdom.
4 Gillings School of Global Public Health & Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill; Chapel Hill, NC.
5 School of Nursing and Linegerger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, Chapel Hill, NC and National Cancer Institute, Rockville, MD.


There is a global need to transform cancer follow-up care to address the needs of cancer survivors while efficiently using the health care system to limit the effects of provider shortages, gaps in provider knowledge, and already overburdened clinics; improve the mental health of clinicians; and limit costs to health care systems and patients. England, Northern Ireland, and Australia are implementing an approach that triages patients to personalized follow-up care pathways depending on the types and levels of resources needed for patients' long-term care that has been shown to meet patients' needs, more efficiently use the health care system, and reduce costs. This article discusses lessons learned from these implementation efforts, identifying the necessary components of these care models and barriers and facilitators to implementation of this care. Specifically, the United States and other countries looking to transform follow-up care should consider how to develop six key principles of this care: algorithms to triage patients to pathways; methods to assess patient issues to guide care; remote monitoring systems; methods to support patients in self-management; ways to coordinate care and information exchange between oncology, primary care, specialists, and patients; and methods to engage all stakeholders and secure their ongoing buy-in. Next steps to advance this work in the United States are discussed.


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