Care After

Initial Treatment

& Recovery

Care after initial treatment and recovery

Care after initial treatment and recovery is the fifth of seven steps of the cancer continuum as set out in the Optimal Care Pathways.

This step describes the transition from active treatment to post-treatment or survivorship care. Depending on the stage of cancer, some people will need ongoing, hospital-based care, and in other cases a shared follow-up care arrangement with their general practitioner may be appropriate.

ACTIONS RELEVANT TO THIS step

2 Years

5 Years

STEP 5

Care after initial treatment and recovery

Actions

1.2.1

Deliver cancer prevention and health promotion activities, including healthy lifestyles, immunisation, and population screening participation, co-designed and tailored to a range of settings.

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1.2.2

Strengthen cancer prevention in broader health strategies and public health partnerships.

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1.2.3

Promote translational research on the impact of social, cultural, commercial and environmental determinants of health on cancer outcomes for priority populations to inform policy and practice.

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1.2.4

Undertake ongoing assessment of the evidence for risk-based, cost-effective population cancer screening.

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1.2.5

Strengthen health literacy for Aboriginal and Torres Strait Islander people through co-designed health promotion and lifestyle strategies for cancer prevention.

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3.2.2

Develop a national framework for networked, distributed comprehensive cancer care, to facilitate provision of services as close as safely possible to where patients live. This will include the role of Comprehensive Cancer Centres to enhance patient outcomes, strengthen transparency and accountability, and drive continuous improvements for all patients across the network regardless of where the care is provided.

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3.2.3

Implement innovative, evidence-based and cost-effective models of care for people living with and beyond cancer.

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3.2.4

Develop and refine integrated care models to maximise access to high-quality, timely and evidence-based palliative and end-of-life care, including voluntary assisted dying.

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3.2.5

Lead a national approach to identifying and reporting Indigenous status in cancer care.

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4.2.2

Ensure targeted and innovative research investment into areas of unmet and emerging need; and improve clinical trial design and equitable access.

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4.2.3

Identify opportunities to improve equitable cancer care through the digital health ecosystem.

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5.2.1

Identify current and emerging workforce undersupply in line with cancer workforce modelling and other national health workforce strategies, and initiate planning with the sector towards building future workforce capacity and capability.

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5.2.2

Build on existing capability of the primary care workforce to collaboratively and sustainably support the needs of consumers.

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5.2.3

Evaluate and extend cultural safety training programs to cancer service providers, including through community-based partnerships with priority population groups.

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5.2.4

Identify priority areas of need for Aboriginal and Torres Strait Islander cancer care workforce and develop a plan to recruit, train and retain the Aboriginal and Torres Strait Islander cancer care workforce.

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2 Years

STEP 5

Care after initial treatment and recovery

Actions

1.2.1

Deliver cancer prevention and health promotion activities, including healthy lifestyles, immunisation, and population screening participation, co-designed and tailored to a range of settings.

View action page

1.2.2

Strengthen cancer prevention in broader health strategies and public health partnerships.

View action page

1.2.3

Promote translational research on the impact of social, cultural, commercial and environmental determinants of health on cancer outcomes for priority populations to inform policy and practice.

View action page

1.2.4

Undertake ongoing assessment of the evidence for risk-based, cost-effective population cancer screening.

View action page

1.2.5

Strengthen health literacy for Aboriginal and Torres Strait Islander people through co-designed health promotion and lifestyle strategies for cancer prevention.

View action page

3.2.2

Develop a national framework for networked, distributed comprehensive cancer care, to facilitate provision of services as close as safely possible to where patients live. This will include the role of Comprehensive Cancer Centres to enhance patient outcomes, strengthen transparency and accountability, and drive continuous improvements for all patients across the network regardless of where the care is provided.

View action page

3.2.3

Implement innovative, evidence-based and cost-effective models of care for people living with and beyond cancer.

View action page

3.2.4

Develop and refine integrated care models to maximise access to high-quality, timely and evidence-based palliative and end-of-life care, including voluntary assisted dying.

View action page

3.2.5

Lead a national approach to identifying and reporting Indigenous status in cancer care.

View action page

4.2.2

Ensure targeted and innovative research investment into areas of unmet and emerging need; and improve clinical trial design and equitable access.

View action page

4.2.3

Identify opportunities to improve equitable cancer care through the digital health ecosystem.

View action page

5.2.1

Identify current and emerging workforce undersupply in line with cancer workforce modelling and other national health workforce strategies, and initiate planning with the sector towards building future workforce capacity and capability.

View action page

5.2.2

Build on existing capability of the primary care workforce to collaboratively and sustainably support the needs of consumers.

View action page

5.2.3

Evaluate and extend cultural safety training programs to cancer service providers, including through community-based partnerships with priority population groups.

View action page

5.2.4

Identify priority areas of need for Aboriginal and Torres Strait Islander cancer care workforce and develop a plan to recruit, train and retain the Aboriginal and Torres Strait Islander cancer care workforce.

View action page

5 Years

STEP 5

Care after initial treatment and recovery

Actions

1.5.1

Strengthen the policy and regulatory environment to address known modifiable lifestyle factors and social, cultural, commercial, and environmental determinants of health.

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1.5.2

Expand access to culturally safe and responsive immunisation programs to reduce risk of cancers, including in partnership with Aboriginal Community Controlled Health Services and community-led priority population groups.

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1.5.3

Implement new, and improve existing, evidenced-based, risk-stratified cancer screening programs.

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1.5.5

Increase access to and uptake of health assessments through Medicare for cancer prevention and early detection for Aboriginal and Torres Strait Islander people.

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2.5.3

Ensure multidisciplinary cancer care teams for Aboriginal and Torres Strait Islander people are trauma-aware and healing-informed.

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3.5.2

Establish an Australian Comprehensive Cancer Network (ACCN) to ensure connectivity and sharing of expertise between Comprehensive Cancer Centres, other cancer services, regional hospitals, community and primary care. The establishment of an ACCN will increase equity of access across services for all patients, deliver cancer care close to home, and monitor evidence-based system performance.

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4.5.1

Design and embed patient reported experience and patient reported outcomes into national performance monitoring and reporting for all providers, to assess services for all population groups and establish an evidence base.

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4.5.2

Expand access to digitally enabled cancer care to improve equity and access to quality cancer care, particularly in regional, rural and remote areas.

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4.5.3

Explore and test innovative approaches to health service funding models to address areas of need, and system improvement, in cancer care.

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5.5.1

Implement a cancer care workforce pipeline that meets demand for optimal cancer care, with diversity measures in training, recruitment and talent management to ensure the cancer workforce represents the diversity of patient populations.

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5.5.2

Assist the sector to support all cancer care practitioners to work at the top of their scope of practice, increase retention and ensure ongoing access to continuing professional development.

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5.5.3

Routinely integrate cultural safety training programs for cancer service providers, including through community-based partnerships with priority population groups.

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5.5.4

Support national coordination and implementation of a plan to recruit, train and retain the Aboriginal and Torres Strait Islander cancer care workforce

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6.5.2

Implement strategies to embed culturally safe care within cancer-related services for Aboriginal and Torres Strait Islander people.

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