Risk-stratified follow-up: low-risk survivors to primary care with fast re-entry
Not every survivor needs to see an oncologist every six months for years. Sort people by recurrence risk, send low-risk survivors back to their family doctor with a clear plan, and guarantee rapid return if something changes.
Hospital-based follow-up for all survivors consumes specialist capacity without evidence of survival benefit for most low-risk patients. Risk-stratified models (as in England's personalised stratified follow-up) move low-risk patients to supported self-management and primary care, with remote surveillance tests and an open re-access route, reserving specialist follow-up for high-risk patients. Randomised evidence shows equivalence for recurrence detection in breast and colorectal cancer.
- Survivorship and late effects are neglected · Tens of millions of people live after cancer with heart damage, infertility, second cancers and fear, and few services.
- Not enough oncologists, nurses, pathologists, physicists · The number of people with cancer is rising faster than the workforce trained to treat them.
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