What features of interventions used at the transition to primary care follow-up affect the outcomes and satisfaction of adult cancer survivors? A systematic review

Problem

The number of cancer survivors is growing due to advances in detection and management of malignancy and the ageing population. Traditional models of hospital outpatient follow-up are no longer sustainable and primary care practitioners are expected to take on more survivorship care responsibilities. The use of survivorship care plans to aid the transition from secondary to primary care has been recommended but evidence of their efficacy is limited. Primary care research is needed to provide evidence-based interventions that deliver cost-effective, patient-centred, high quality care to this growing population.The aim of this review is to classify the types of interventions used in the transition from oncology to primary care follow-up of cancer survivors, and summarise evidence of their effectiveness at improving patient outcomes (e.g. symptom severity, quality of life, psychological status). A secondary aim is to identify the features of interventions that have more favourable process outcomes (e.g. sustainability, cost).

Approach

Systematic review of studies and reviews that evaluate patient outcomes or satisfaction after any intervention used to support the transition of cancer survivors from hospital to primary care follow-up, including experimental and descriptive quantitative, qualitative and mixed methods studies. Systematic searches of English language publications in MEDLINE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and BNI from January 1995 to June 2019 were supervised by an experienced clinical librarian with hand searching of references from included studies. Data was extracted by two independent reviewers and summarised using narrative synthesis with quality assessment using the mixed methods appraisal tool. Interventions were classified according to EPOC taxonomy to determine what features of interventions or factors affecting implementation have the greatest effect on patient outcomes. PROSPERO 2018 registration: CRD42018112877.

Findings

Searches identified > 400 articles for appraisal. Common themes include the use of survivorship care plans and treatment summaries (n=87), nurse-led interventions (n=91), educational initiatives for patients (n=38) and healthcare providers (n=30) and use of technology (n=42). 61 abstracts relate to mental health and psychosocial needs but only 8 discuss pain management. A variety of professionals have been involved in these interventions, including professional navigators, psychologists/therapists, and social workers. 21 abstracts assess the needs of family caregivers in the intervention and 9 are aimed at patients living in rural locations.

Consequences

We have identified a rich dataset to evaluate the current interventions that have been used to aid the transition for oncology patients from treatment to survivorship. We aim to describe the most common types of interventions and factors that make them successful, while also highlighting areas that need further research. The results of this systematic review will be valuable in implementing future interventions for cancer survivors in primary care and identifying gaps in existing literature.