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This section provides tools and resources to support the delivery of shared follow-up and survivorship care for women with early breast cancer.

Clinical practice guidelines recommend long-term follow-up care after treatment for early breast cancer or ductal carcinoma in situ (DCIS). Cancer Australia has developed a best practice model of shared follow-up care for early breast cancer in Australia.

Guidance for the management of early breast cancer has a section on follow-up and survivorship, including a recommended follow-up schedule.

Tools and resources

This resource outlines recommendations and practice points for the management and care of early breast cancer, developed through a meta-guideline process. It includes a section on survivorship and follow-up care.

Shared follow-up care for early breast cancer is a safe, effective, acceptable, and cost-efficient alternative to specialist led follow-up care after treatment for early breast cancer. Cancer Australia has developed an evidence base to support a shared follow-up care model for early breast cancer.

This resource supports all members of the shared follow-up and survivorship care team, including the specialist, registrar, cancer nurse, breast care nurse, cancer care coordinator, general practitioner (GP) and primary care nurse. It provides information about delivering best practice follow-up and survivorship care for patients with early breast cancer or DCIS.

This resource outlines the roles and responsibilities of the specialist, GP, nurses, and their respective teams, in delivering shared follow-up and survivorship care for patients with early breast cancer and DCIS.

This fact sheet outlines the 7 principles of shared follow-up care.

This template is for GPs to use when a follow-up raises a clinical issue requiring urgent specialist consultation or advice. It is an integral part of the shared follow-up care model and helps facilitate effective communication between the GP and specialist.

This care plan template helps general practitioners, specialist and patient to manage follow-up and survivorship care for early breast cancer and DCIS. It should be developed within the specialist setting at the initial follow-up appointment 3 months after active treatment ends. The template contains all the key elements required for follow-up care including a record of diagnosis and treatment summaries, appointment schedule, follow-up actions required and contact details of all involved.

This consumer-focused document explains shared follow-up and survivorship care, including the benefits of shared care and who is involved.

This optimal cancer care pathway for women with breast cancer explains the cancer pathway and its distinct components through mapping the patient journey, to promote quality cancer care and patient experiences.

Online continuing professional development

Cancer Australia has developed 6 accredited online courses for general practitioners, practice nurses and other health professionals to support learning and improved practice of evidence-based breast cancer treatment and care.

‘Follow-up and survivorship care for early breast cancer’ addresses best practice follow-up care for women who have completed active treatment for early breast cancer, including shared follow-up care arrangements.

Consumer information

This fact sheet provides information on fear of cancer recurrence for people who have been diagnosed with early breast cancer, and their partners, families, friends, colleagues and others who support people with early breast cancer.

Supportive care resources

  • The Australian Cancer Survivorship Centre - My Care Plan - an online tool that can be used to create a personalised survivorship care plan following treatment for early breast cancer. The personalised survivorship care plan can be used in conjunction with the Shared care plan for early breast cancer follow-up and survivorship care. It helps patients to better understand their personal health risks depending on the type and combination of cancer treatments they received.
  • Breast Cancer Network Australia (BCNA) – Fear of Cancer Recurrence - This BCNA fact sheet provides information on fear of cancer recurrence for people who have been diagnosed with early breast cancer; their partners, families, friends, and colleagues; and others who support people with early breast cancer.
  • National Comprehensive Cancer Network distress thermometer and problem list – a tool that measures distress in a similar way to pain – on a scale of zero to ten (ten being the worst). This tool makes it easier for people to talk to their doctors about the emotional effects caused by the diagnosis, symptoms, and treatment of cancer.
     

Clinical practice guidelines ​

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