{"entity":{"id":"idea-acc-risk-stratified-follow-up","kind":"idea","name":"Risk-stratified follow-up: low-risk survivors to primary care with fast re-entry","aka":[],"tldr":"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.","summary":"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.","asOf":"2026-09-08","links":[{"label":"Moschetti et al., Follow-up strategies for women treated for early breast cancer (Cochrane Database Syst Rev 2016)","url":"https://doi.org/10.1002/14651858.CD001768.pub3"},{"label":"Jeffery et al., Follow-up strategies for patients treated for non-metastatic colorectal cancer (Cochrane Database Syst Rev 2019)","url":"https://doi.org/10.1002/14651858.CD002200.pub4"},{"label":"Bottleneck evidence (Survivorship and late effects are neglected): NCI Office of Cancer Survivorship statistics","url":"https://cancercontrol.cancer.gov/ocs/statistics"}],"tags":["protocol-upgrade","upgrade:proven-unevenly-used","evidence:moderate"],"related":["idea-acc-nurse-led-follow-up-clinics"],"cancers":["breast-hr-positive","colorectal","prostate"],"sections":[],"technologies":["rejuv-access-survivorship-care-uk"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-workforce"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Protocol upgrade, graded proven but unevenly used, with moderate evidence. In breast cancer, the Cochrane review of five trials with 4,023 women found no survival difference between intensive testing and follow-up by clinical visits and mammography (hazard ratio 0.98), and no difference in survival or time to detection of recurrence between follow-up by a hospital specialist and by a general practitioner, with greater satisfaction in general practice. In colorectal cancer, 19 studies with 13,216 participants found intensive follow-up made little or no difference to overall survival (hazard ratio 0.91) but doubled salvage surgery with curative intent (risk ratio 1.98), which is why stratified pathways keep scheduled surveillance tests while removing routine clinic visits. OnCo found no national measure of how many survivors are on a stratified pathway."],"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.","test":"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","actor":"policy","cost":"small","horizonYears":2},"route":"/ideas/idea-acc-risk-stratified-follow-up/","neighbours":{"idea":[{"id":"idea-acc-nurse-led-follow-up-clinics","kind":"idea","name":"Nurse-led follow-up clinics for survivors, freeing oncologists for active treatment","route":"/ideas/idea-acc-nurse-led-follow-up-clinics/"},{"id":"idea-prostate-other-cause-mortality-as-a-reported-service-outcome","kind":"idea","name":"Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity","route":"/ideas/idea-prostate-other-cause-mortality-as-a-reported-service-outcome/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"technology":[{"id":"rejuv-access-survivorship-care-uk","kind":"technology","name":"After treatment in the UK: personalised care, and follow-up you lead yourself","route":"/technologies/rejuv-access-survivorship-care-uk/"}],"bottleneck":[{"id":"rejuv-agenda-nobody-owns-the-follow-up","kind":"bottleneck","name":"Nobody owns the follow-up once the oncology clinic lets go","route":"/bottlenecks/rejuv-agenda-nobody-owns-the-follow-up/"},{"id":"b-workforce","kind":"bottleneck","name":"Not enough oncologists, nurses, pathologists, physicists","route":"/bottlenecks/b-workforce/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}],"roadmap":[{"id":"rejuvenation-roadmap","kind":"roadmap","name":"Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it","route":"/roadmaps/rejuvenation-roadmap/"},{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}]}}