June 7, 2021
This scan looks at the challenges cancer survivors face as they transition back to their daily lives, including returning to work and it also outlines approaches used in Canada and internationally to improve survivorship care
- Many cancer survivors do not receive adequate support for their physical, psychosocial and mental health needs when transitioning to post-treatment care.
- Few survivorship programs provide dedicated one-on-one or group support for return-to-work challenges.
- Because cancer survivors have diverse needs, multi-modal, interprofessional and multi-agency approaches are needed to deliver more effective survivorship plans and programs.
- Survivorship care plans and psychosocial interventions should be tailored to individual needs, risks and circumstances.
- Survivors at all levels of risk can benefit from an à la carte selection of programs and services: from low-intensity to professionally-led psychosocial interventions.
Returning to work is an important step for working-age cancer survivors. Not only does employment help alleviate the financial stress they may have experienced during treatment, it also enhances their overall quality of life.
As survivors transition to life after cancer and return to work, they may experience physical, psychosocial and mental health challenges. They may also require supportive interventions to address needs that vary in nature, complexity and severity. Yet despite increasing recommendations and guidelines for such care, many do not receive adequate support. Few have survivorship care plans and where plans do exist, they tend not to provide dedicated support for return-to-work challenges. As a result, many survivors’ needs remain unmet.
Reviewing the best programs in Canada and abroad
To address this gap in the continuum of cancer care, the Partnership completed an environmental scan exploring Canadian and international return-to-work models of care, programs and services for cancer survivors.
In general, the scan found that survivorship programs for working-age survivors should:
- Take a more holistic approach to defining and addressing survivors’ needs
- Identify and support survivors’ unique goals and priorities to develop individualized survivorship care plans
- Create tiered or stratified care pathways tailored to individual risk profiles, needs and circumstances (along with consideration for the needs of certain population groups, such as Indigenous cancer survivors)
Approaches for improving survivorship plans and programs
While survivorship care plans can play a very important role in survivorship transitions, their actual implementation has shown mixed results in terms of improved patient outcomes. This is because plans vary widely in content, format, timing and mode of delivery.
Given the diverse needs of cancer survivors, experts support multi-modal, interprofessional and, in some cases, multi-agency approaches to survivorship programs. Such programs can result in a better patient experience, closer adherence to care guidelines, increased attendance at survivorship services and improved survivor wellbeing.
These approaches can be delivered through three main models:
- Standalone, multi-modal survivorship programs within cancer centres
- Programs and services embedded within the cancer treatment system
- Community-based and regional programs
Many survivors with low- to moderate-level psychosocial risk have been shown to benefit from low-intensity peer, group, telephone and web-based interventions. Online counselling and mobile apps can also address survivors’ needs in an accessible, cost-effective and convenient way.
Return-to-work support and guidance should be a part of any survivorship offering. The many examples of integrative, multi-modal cancer survivorship programs profiled in the scan show that survivors at all levels of risk can benefit from an à la carte selection of programs and services to meet their unique needs. Peer support, social networking, educational interventions and recreational programs can all enhance mental health and wellbeing. Cancer survivors with greater mental health needs may require more intensive, professionally-led psychosocial interventions.
Access to these kinds of programs and services remains an issue. More systematic, universal approaches may result in more cancer survivors getting the supports they need. The mental health and return-to-work programs described in this scan, combined with input from survivors and primary care providers, may help inform improvements to existing plans and programs.