Cancer patients, their cancer specialists and GPs were interviewed about expanding the role of GPs in the long term care of patients with cancer.  This identified the need for a shared care plan between the hospital specialist services and GPs.  

Project Status

Completed Projects

Project Rationale

In 2008–2012 in Australia, individuals diagnosed with cancer had a 67% chance of surviving for 5 years compared to their counterparts in the general Australian population: 68% for colon cancer. Between 1983–1987 and 2008–2012, 5-year relative survival from breast cancer improved from 72% to 90%.  This means that in many cases cancer has become a long term condition. This long term management includes the early detection of recurrence or new tumours, management of psychosocial problems, early detection and management of long term consequences of cancer therapy. Existing models of care can see survivors continuing to attend hospital-based follow-up appointments for many years, despite not necessarily requiring the expertise of a specialist oncology team for many parts of their care. This is challenging an already stretched health care system and increasing costs. 

Project Aim/s

  1. To explore the views of cancer survivors, general practitioners and cancer specialists (medical, radiation and surgical) about a model of care in which the GP is more active in the long term monitoring and care

To develop specifications and design for a e-shared care plan for cancer long term care of cancer patients.

Project Design and Method

  1. Semi structured interviews were conducted face-to-face or over the telephone according to the preference of the respondent, at a location convenient for them. These explore How feasible and acceptable is it for low risk stable cancer patients to be followed up in general practice rather than in hospital outpatient clinics? We compared the views of all three parties: patients, their oncologists and their FPs – all focused around an individual patient.
  2. Interviews were conducted with key stakeholders involved in the care of patients and information systems used by cancer services and general practice to identify a preferred model for a web based care plan for continuing care of cancer survivors in the community.

Any Publications

In progress.


Mark Harris Phone: 02 93858384 Email:

Key Partners

Prince of Wales Cancer Services, South East Sydney LHD, Central and Eastern PHN


TCRN Translational Cancer Research Network (NSW Cancer Institute)

Project lead centre
Project stream
Prevention and Management of Long Term Conditions
Project start date
Project end date