{"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":"Bottleneck evidence (Survivorship and late effects are neglected): NCI Office of Cancer Survivorship statistics","url":"https://cancercontrol.cancer.gov/ocs/statistics"}],"tags":[],"related":["idea-acc-nurse-led-follow-up-clinics"],"cancers":["breast-hr-positive","colorectal","prostate"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-workforce"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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/"}],"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/"}]}}