OnCo
ideasIdea

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.

Hypothesis
Risk-stratified follow-up will release at least a quarter of oncology follow-up capacity and will not worsen stage at recurrence or survivor-reported unmet needs.
Rationale
Recurrences are mostly detected by symptoms between visits, not at scheduled visits; the visits serve reassurance that can be delivered differently.
What would test it
A regional implementation with capacity released, stage at recurrence, time from symptom to re-access, and patient-reported outcomes as endpoints.
Maturity
being tested at scale
Who has to act
policy
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks

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