The survivorship tsunami: Sustainability of current models of follow-up care.

Abstract

48 Background: Annual statistics describe the number of anticipated new cancer cases and deaths as well as the prevalence of those living with cancer. In practice, the number of new cases is used as a proxy for cancer program size, planning program growth and determining workforce needs. While the number of new cases and prevalence has been growing linearly, it may be a poor measure for anticipating health care workforce and clinical resource needs. We explored modeling growth curves of follow-up visits based on anticipated number of new cases alone or with follow-up visits to compare these two approaches. Methods: We used the following assumptions in creating the growth curves: 1) only 50% of new cancer cases would be counted to adjust for those with metastatic disease or different follow-up schedules; 2) the first year of diagnosis would be considered treatment; 3) a common solid tumor follow-up regimen would be used that included 4 visits in year 2, 3 visits in year 3, 2 visits in year 2 and 1 visit in year 5 and thereafter; and 4) new cases would grow at a rate of 10%/year. We then modeled discharging the 50% included in the model at 5 or 10 years. We did not factor in existing patients being seen in a program. Results: If a program had 5,000 new cases in the first year, with a 10% annual growth, there would be 11,790 new cases at 10 years. If you just looked at the 50% receiving follow-up care for 10 years after diagnosis, there would be 35,928 follow-up visits at 5 years and 70,662 visits at 10 years. If you just looked at the 50% receiving follow-up care for only 5 years after diagnosis, there would be 33,428 follow-up visits at 5 years and 53,870 visits at 10 years. Further analysis based on different program sizes and assumptions will be presented. Conclusions: Planning workforce and clinical resources based on number of new cancer cases alone will be inadequate to predict those needs. Risk based modeling and triage will be needed in a new model of follow-up or survivorship care that remains to be developed, tested and deployed to avoid a crisis in cancer survivorship care.