# End of treatment: treatment summary, survivorship care plan and handover to primary care

Source: https://onco.cc/protocols/survivorship-care-plan-and-treatment-summary/  
OnCo record `survivorship-care-plan-and-treatment-summary` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

When main treatment ends, you should get a written summary of the treatment you had, side effects to look out for, signs the cancer might be back, who to contact, and the follow-up planned. In England it goes to you and your GP. Trials found the written plan alone did not make people feel better; it works best with a real conversation about who looks after you next.

## Summary

The Institute of Medicine's 2006 report recommended that every survivor receive a survivorship care plan: a treatment summary and a follow-up care plan, to improve communication with the patient and between the oncology team and primary care (as summarised in ASCO's 2014 statement, which also revised the template because plans were rarely completed). The NCI tells patients they should receive one when treatment ends. In England the same handover is part of personalised care and support planning: a holistic needs assessment and a personalised care and support plan; an end of treatment summary written by the hospital clinician and shared with the patient and GP, containing the treatment given, possible side effects, the signs and symptoms of recurrence and contact details; and a cancer care review in primary care, which the Quality and Outcomes Framework requires within 12 months of the end of acute treatment. ESMO's 2022 consensus names five components of survivorship care (physical effects, psychological effects, social, work and financial effects, surveillance for recurrence and second cancers, and prevention and health promotion) and leaves the care model to local circumstances.

The evidence on the written plan is consistently negative for patient-reported outcomes. In a randomised trial of 408 women after early breast cancer, a care plan reviewed with a nurse made no difference to distress or any patient-reported secondary outcome; its one gain was that more patients knew their GP was now responsible. A cluster randomised trial of automatically generated plans in endometrial cancer found more information received but no gain in satisfaction, and more symptoms and concern reported. A 2018 systematic review (13 randomised studies) and a 2020 meta-analysis (eight trials, 1,286 survivors) found no improvement in patient-reported outcomes, with more positive signals for information received and for care delivery when the plan comes with counselling. The defensible protocol is therefore the handover itself (the summary, the named responsible clinician, the needs assessment and the follow-up schedule) rather than the document as an end in itself.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: survivorship care plan; SCP; end of treatment summary; treatment summary; follow-up care plan; personalised care and support plan; cancer care review; Recovery Package
- Tags: protocol; survivorship

## Connected records

- ideas: [Formal shared-care agreements between oncology and family doctors, with same-day e-consult](https://onco.cc/ideas/idea-acc-primary-care-shared-care-agreements/), [Risk-stratified follow-up: low-risk survivors to primary care with fast re-entry](https://onco.cc/ideas/idea-acc-risk-stratified-follow-up/), [Survivorship care plans generated automatically from the treatment record](https://onco.cc/ideas/idea-acc-auto-generated-survivorship-plans/)
- protocols: [Distress screening with the distress thermometer, and referral by need](https://onco.cc/protocols/distress-screening-and-referral/), [Follow-up after curative treatment for colorectal cancer](https://onco.cc/protocols/colorectal-cancer-follow-up-after-curative-treatment/), [Follow-up after treatment for early breast cancer](https://onco.cc/protocols/breast-cancer-follow-up-after-treatment/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [After treatment in the UK: personalised care, and follow-up you lead yourself](https://onco.cc/technologies/rejuv-access-survivorship-care-uk/), [After treatment in the United States: the survivorship care plan, and what the trial found](https://onco.cc/technologies/rejuv-access-survivorship-care-us/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Macmillan Cancer Support](https://onco.cc/institutions/macmillan-cancer-support/), [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- terms: [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Lost in Transition: the 2006 report that defined survivorship care, and the care plan it invented](https://onco.cc/terms/rejuv-history-lost-in-transition/), [Quality of life](https://onco.cc/terms/quality-of-life/), [The National Cancer Survivorship Initiative in England, and the Recovery Package](https://onco.cc/terms/rejuv-history-ncsi-england/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)

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