Transition to Survivorship

Transition to Survivorship: Unmet Needs in Research and Practice

November 2018

Early detection and advances in cancer treatment have resulted in many more cancer survivors than ever before. In 2012, there were more than 32 million 5-year cancer survivors around the world and the number is estimated to be much higher today. Recent research has shown that many survivors experience gaps in ongoing care after primary cancer treatment, including problems with the availability and coordination of services, and in being prepared for the transition to follow-up care.

In March of this year, Study Group Vice-Chair Margaret Fitch published a review of research on the subject of transition to survivorship.1 While the transition from primary cancer treatment to follow-up care is critical to survivors’ long-term health, there is little understanding of this important period — both in terms of patients’ needs and the best practice for introducing survivorship care plans. Dr. Fitch has reviewed the literature in this area over a recent 12-month period. She highlights gaps in care experienced by cancer survivors and progress toward improving the transition process, as well as spelling out the implications for both practice and research.


Some key points emerged from Fitch’s review:

  • The ever-growing number of cancer survivors calls for effective models of survivor follow-up care.
  • Many cancer survivors report unmet needs following the end of primary treatment and a rather chaotic care system.
  • Transition from the end of primary treatment to follow-up survivorship care is a pivotal process.
  • Primary care settings have been slow to implement transition approaches to follow-up care, even when the need is recognized.
  • Increasing evidence can inform best practices for effective transitions from specialist cancer care to follow-up survivorship care.

Fitch cites the need for evaluation of existing models in terms of feasibility, survivor friendliness, cost-effectiveness, and achievement of sustainable outcomes. In particular, when and how to introduce plans for transition to the patient are important considerations. She concludes that survivorship care plans are a promising tool to assist both patients and healthcare providers, but research is needed to identify best practice for their introduction and implementation.
1Fitch MI. Transition to survivorship: Can there be improvement? Curr Opin Support Palliat Care. 2018 Mar;12(1):74-79.