Poster Presentation Cancer Survivorship 2017

Aims

The Peter MacCallum Cancer Centre Late Effects service was established in 1999 to provide follow up of long-term cancer survivors of paediatric malignancies, and was the first service in Australia of its type in an adult hospital. The service currently provides ongoing care for 1006 patients, and receives up to 100 new referrals annually. With ever rising numbers of cancer survivors and demands on the service, it became increasingly difficult to provide ongoing care for existing patients whilst accepting increasing numbers of newly referred complex cancer survivors.

Methods

In 2008 a GP Shared Care program was established to provide an alternative model of care to manage increasing clinic demand and facilitate best practice care of patients in the community setting with their own GP. This included:

• The establishment of a GP Liaison position, employing a general practitioner who had a clinical role in the Late Effects service and implemented the program;
• Development of long-term follow up guidelines to provide advice on best practice screening and surveillance of late effects of cancer therapies;
• Risk stratification of patients to surveillance levels depending on complexity of needs and follow up requirements;
• Coordination of follow up with the patient’s own GP, and provision of clinical support.

Results

In 2011, 13 patients were allocated to GP follow up; this number has increased annually such that 114 patients were allocated to GP shared care follow up in 2016. The shared care model supports screening and surveillance of late effects of treatment and ongoing management of chronic complications for cancer survivors close to home, with their regular GP, in a convenient and timely manner.

Conclusions

This model provides best practice care of long term survivors of complex cancer treatment which is sustainable and highly acceptable to specialist clinicians, patients and their GPs.