{"entity":{"id":"rejuv-rehab-prospective-surveillance","kind":"technology","name":"Prospective surveillance: looking for the problem before it becomes a disability","aka":[],"tldr":"The usual model waits for a patient to complain, by which time an arm has been swollen for a year. The prospective surveillance model measures function before treatment starts and again at set points afterwards, so a small problem is found while it is still small. One costing study put the price of managing early arm swelling at 636 dollars a year against 3,125 dollars for late swelling.","summary":"The model was written down in 2012 by a multidisciplinary group convened around breast cancer, and published as a set of papers in the journal Cancer. Its proposal is simple and structural: take a baseline measurement of function before treatment begins, repeat it at defined points during and after treatment, and refer the moment a measure moves. The authors list the impairments it is meant to catch, which is a useful list in itself: \"pain, fatigue, upper-extremity dysfunction, lymphedema, weakness, joint arthralgia, neuropathy, weight gain, cardiovascular effects, and osteoporosis\".\n\nThe cost argument came from the same group. Comparing a surveillance programme with the traditional referral-when-it-is-bad model for breast cancer related arm swelling, and costing both from the 2009 Medicare physician fee schedule, they estimated 636.19 dollars per patient per year to manage early-stage swelling found by surveillance against 3,124.92 dollars per patient per year to treat late-stage swelling found the old way. That is a modelled comparison, not a trial, and the authors say so: they call for analysis of indirect costs and utility before claiming cost-effectiveness.\n\nThe electronic version is where the field has moved. An electronic prospective surveillance model asks patients to complete short impairment questionnaires at set points on a phone or web form; a score that crosses a threshold produces self-management material, a community programme or a referral. The REACH system running across four Canadian centres covers breast, colorectal, lymphoma and head and neck cancer and follows patients up to two years after treatment. Its own protocol is careful about the state of the evidence: it says randomised trials show these systems \"can effectively manage cancer-related impairments\", and then that they \"are not routinely embedded into practice and evidence-based approaches to implement them are limited\".\n\nThe implementation problem is the real one. A 2023 account of running the model in one breast centre describes what it took: clinical pathways, order sets in the electronic record, automated referrals, new staffing models and changed clinic workflows. Its first sentence about uptake is the honest one, that the model \"is empirically validated and feasible in practice\" but that \"implementation into cancer care delivery has languished\".\n\nWhat comes back, and when: nothing, by itself. Surveillance treats no one. Its claim is that the same treatment started earlier works better and costs less, which is well supported for arm swelling and plausible but less tested for the rest of the list.","status":"emerging","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Cancer_survivor","links":[{"label":"A prospective surveillance model for rehabilitation for women with breast cancer (Cancer 2012)","url":"https://doi.org/10.1002/cncr.27476"},{"label":"Breast cancer-related lymphedema: comparing direct costs of a prospective surveillance model and a traditional model of care (Phys Ther 2012)","url":"https://doi.org/10.2522/ptj.20100167"},{"label":"Upper-body morbidity after breast cancer within a prospective surveillance model of care (Cancer 2012)","url":"https://doi.org/10.1002/cncr.27467"},{"label":"Implementation of an electronic prospective surveillance model for cancer rehabilitation: protocol (BMJ Open 2024)","url":"https://doi.org/10.1136/bmjopen-2024-090449"},{"label":"Implementing and sustaining a breast cancer prospective surveillance rehabilitation program (J Cancer Surviv 2023)","url":"https://doi.org/10.1007/s11764-022-01304-x"}],"tags":["rejuvenation","survivorship","rehabilitation","evidence:moderate"],"related":["idea-acc-return-to-work-rehabilitation"],"cancers":["breast-hr-positive","colorectal","head-and-neck","dlbcl"],"sections":["rejuvenation","supportive-care"],"technologies":["rejuv-rehab-cancer-rehabilitation","epro-symptom-monitoring","survivorship-care-plan","lymphoedema-surgery-and-early-detection","lymphoedema-decongestive-therapy","remote-patient-monitoring","rejuv-rehab-provision-gap"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["late-effects","quality-of-life"],"trials":[],"people":[],"bottlenecks":["b-survivorship"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Impairments after cancer treatment follow a gradient from reversible to fixed. Measuring function at fixed intervals converts the question from whether a patient complains loudly enough to whether a number has moved, which detects the reversible phase. The mechanism is the same as any screening programme, and so are its weaknesses: it finds things that would not have mattered, and it only works if a service exists to refer into.","strengths":["A baseline measurement makes later change interpretable","Electronic delivery scales without a clinic visit","A modelled fivefold cost difference for early versus late arm swelling"],"limitations":["Screening without a rehabilitation service to refer into changes nothing","The cost figure is a model, not a trial result","Uptake has been slow for fourteen years, which is itself evidence about feasibility"],"since":2012},"route":"/technologies/rejuv-rehab-prospective-surveillance/","neighbours":{"idea":[{"id":"idea-acc-return-to-work-rehabilitation","kind":"idea","name":"Vocational rehabilitation integrated into cancer care so survivors can return to work","route":"/ideas/idea-acc-return-to-work-rehabilitation/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"rejuv-rehab-cancer-rehabilitation","kind":"technology","name":"Cancer rehabilitation: the discipline that puts function back","route":"/technologies/rejuv-rehab-cancer-rehabilitation/"},{"id":"lymphoedema-decongestive-therapy","kind":"technology","name":"Compression, decongestive therapy and exercise for lymphoedema","route":"/technologies/lymphoedema-decongestive-therapy/"},{"id":"epro-symptom-monitoring","kind":"technology","name":"Electronic patient-reported outcome (ePRO) symptom monitoring","route":"/technologies/epro-symptom-monitoring/"},{"id":"remote-patient-monitoring","kind":"technology","name":"Electronic patient-reported outcomes and remote monitoring","route":"/technologies/remote-patient-monitoring/"},{"id":"lymphoedema-surgery-and-early-detection","kind":"technology","name":"Lymphoedema: catching it early, and the operations for it","route":"/technologies/lymphoedema-surgery-and-early-detection/"},{"id":"rejuv-rehab-scar-contracture","kind":"technology","name":"Scars, stiffness and contracture: shoulders, necks and jaws","route":"/technologies/rejuv-rehab-scar-contracture/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"rejuv-rehab-provision-gap","kind":"technology","name":"The gap between the rehabilitation people need and the rehabilitation they are offered","route":"/technologies/rejuv-rehab-provision-gap/"},{"id":"rejuv-rehab-commissioning-inequity","kind":"technology","name":"Where rehabilitation is commissioned, and who misses out","route":"/technologies/rejuv-rehab-commissioning-inequity/"}],"term":[{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}]}}