Personalised approach to cancer follow-up

'After treatment, patients will move to a follow-up pathway that suits their needs and ensures they can get rapid access to clinical support where they are worried that their cancer may have recurred.'

Personalised Stratified Follow-Up (PSFU)

The implementation of patient centred follow-up personalised stratified follow-up pathways (PSFU), tailored to individual needs, aims to improve patient experience and quality of life for people following treatment for cancer.

Having PSFU pathways means that when a person completes their primary treatment, they will be offered:

  • information about signs and symptoms to look out for which could suggest their cancer has recurred;
  • rapid re-access to their cancer team, including telephone advice and support
  • regular surveillance scans or tests (depending on cancer type), with quicker and easier access to results so that any anxiety is kept to a minimum; and
  • personalised care and support planning and support for self-management, to help them to improve their health and wellbeing in the long-term.

The Peninsula Cancer Alliance  will continue to support health and care systems to develop further PSFU pathways recognising the key factors influencing development of an effective PSFU service including:

  • A whole pathway approach where PSFU is viewed as integral to the whole cancer pathway.
  • Use of digital solutions to track patient pathways and enable remote monitoring.
  • Appropriately skilled and resourced workforce to operate an effective PSFU service. Our Cancer Alliance teams have supported workforce development across the Peninsula Cancer Alliance including the implementation of the cancer support worker (or similar) role to provide additional support for patients and the wider workforce.
  • Health inequalities including health literacy, digital and service accessibility.
  • Moving PSFU pathways to business as usual for all cancer sites in the long term.
  • Impact of COVID-19: The pandemic has resulted in a different approach to the delivery of all cancer care with increasing use of virtual consultations.

Useful Links and Documents 

Cancer_Stratified_Follow_Up_Handbook_v1_March2020 (3)

stratifiedpathwaysNCSI_guide_2013