Statewide survivorship care work
The Australian Cancer Survivorship Centre (ACSC) have led multiple statewide, large-scale funded survivorship care projects, with the broad aim of improving cancer survivorship care across Victoria. This page describes various projects that the ACSC has led after receiving external funding. This page also includes information about the Victorian Cancer Survivorship Program (VCSP).
Victorian Statewide Collaboration to Improve Cancer Survivorship Care 2022-2024
The ACSC and the Victorian Integrated Cancer Services (VICS) partnered to deliver the Victorian Statewide Collaboration to Improve Cancer Survivorship Care project, from April 2022 to March 24. Funded by the VICS, this project aimed to implement a statewide approach to survivorship care, utilising an experience-based co-design approach.
There were three key objectives:
- Put the Victorian Quality Cancer Survivorship Care Policy in place at Victorian public hospitals
- Co-design and implement improved survivorship models of care
- Improve VICS and member services’ confidence, capacity and capability around survivorship care.
The Executive Summary from the final project report highlights key project achievements, learnings and recommendations.
Implementing survivorship quality improvement initiatives
Objective 2 of this project involved co-designing and implementing survivorship care models. This included co-design workshops with consumers and health professionals to develop initiatives to improve the use of survivorship care plans and needs assessment for patients and carers following their initial cancer treatment. Following the workshops, ACSC and the VICS collaborated to refine and finalise the improvement initiatives.
For adult health services, three improvement initiatives were developed:
- Needs assessment
- Survivorship care planning
- Combined delivery of needs assessment and survivorship care plans
An information resource was also developed for each initiative to:
- Support health professionals to discuss with patients the concept and usefulness of needs assessment and survivorship care plans in the post-treatment phase.
- Support patients to access quality information and support services following treatment by providing links to resources and services such as the ACSC, Cancer Council and local services. The resource can be tailored by health services to include information on local services available in their region.
The details of these initiatives and associated resources that supported initiative delivery are compiled in an Implementation Toolkit. The Toolkit is designed to be used by service improvement staff and health services planning to undertake survivorship quality improvement work related to needs assessment and/or survivorship care plans.
Whilst these resources were developed for the Statewide Collaboration project, the Toolkit includes resources to support quality improvement planning and preparation which can also be used for other survivorship quality improvement work.
Improving confidence, capacity and capability around survivorship care
To support Objective 3 of this project - improve VICS and member services’ confidence, capacity and capability around survivorship care, education materials were developed and existing professional development opportunities promoted to all staff.
To support health professionals to navigate and access the various survivorship education resources available, a Survivorship Orientation Package was developed. The ACSC designed this resource to orient new health service staff to survivorship education, events, professional development and key resources for health professionals and cancer survivors.
Embed and Spread Optimal Cancer Survivorship Care across Victoria 2020-2022
The information below provides a summary of activity and results of the Embed and spread optimal cancer survivorship care across Victoria (Embed and spread) project. This project was funded by the Victorian Government from 2020 – 2022 and incorporated Project 1: Virtual roadshow and baseline survey, and Project 2: Expansion of mycareplan.org.au.
Project 1: Virtual roadshow and baseline survey (September 2020 – March 2022)
Delivered webinars on cancer survivorship care to 20 Victorian health services
Collected baseline data on cancer survivorship care practices from 20 health services and provided a summary report with recommendations to enhance care
Supported 7 services to implement a survivorship quality improvement initiative
Collected follow-up data to evaluate project impact
The Victorian Survivorship Care Data Report 2022 provides de-identified comparative statewide data of the 20 Victorian health services that participated in the baseline site survey, as part of the Embed and spread project. The report includes data on:
Presence of a survivorship care policy
Models of survivorship care
Use of survivorship care plans
Information provision
Use of needs assessment tools
Availability of services to support survivorship issues
Collection of survivorship outcome data
Strengths and challenges with the provision of survivorship care
Project 2: Expansion of mycareplan.org.au (February 2021 – December 2021)
Expanded mycareplan.org.au from 3 to 6 cancer types, now available for:
- Early-stage breast cancer
- Early-stage bowel cancer
- Localised prostate cancer
- Early-stage melanoma
- Uterine cancer (endometrial)
- Non-Hodgkin lymphoma (diffuse large B-cell)
The primary objective of Project 1 was to increase awareness of and commitment to cancer survivorship care. This project established a baseline of current cancer survivorship care practices, including the use of survivorship care plans (SCPs) at Victorian health services. Survivorship education was provided to a wide range of health professionals, and a collaborative approach was taken with a selection of services to identify opportunities for improvements in care, and to provide tailored implementation support.
Key activities
Baseline site survey
Key achievements
Baseline site survey developed and sent to 20 cancer health services across Victoria
Survey responses received from all 20 sites
Data analysed (18 final data sets as data from 3 sites within a precinct combined due to a shared operating model of care)
Responses were collated into the Victorian Survivorship Care Data Report 2022.
Virtual roadshow
Key achievements
18 tailored 60-minute educational webinars delivered
17 focused on adult cancer survivorship, 1 focused on paediatric cancer survivorship
111/472 (24%) attendees completed evaluation surveys following the webinars.
97% (108/111) rated the webinar as good, very good or excellent
98% (109/111) reported an increase in knowledge and awareness of survivorship care
99% (110/111) said they would likely use information from the webinar when caring for survivors.
Summary report with recommendations
Key achievements
This report summarised a selection of findings from the site’s baseline survey and offered six key recommendations for the site to consider implementing to enhance the survivorship care they were already providing. Recommendations were similar for each site, could be readily adopted, and considered each site's current resourcing levels. Recommendations broadly focused on:
- Referral to mycareplan.org.au to support survivorship care plan development
- Information provision, including referral to the Common Survivorship Issues Directory
- Referral to Cancer Council 13 11 20
- Referral to their local Cancer Council Cancer Wellness Program
- Completion of survivorship professional development, including Cancer Survivorship; an online introductory course for health professionals hosted on eviQ Education.
Implementation support
Key achievements
Tailored implementation support was provided to seven sites from August 2021 to January 2022. It involved two project officers at the ACSC remotely supporting sites to implement a survivorship care quality improvement initiative. Quality improvement initiatives across these sites broadly focused on information provision, the implementation of survivorship appointments and the evaluation of established survivorship clinics.
Follow-up survey
Key achievements
The follow-up survey sought feedback from all sites on the recommendations provided in the summary report, and any perceived changes in survivorship care awareness, knowledge, and confidence at the site after participating in this project. Sites that participated in the implementation phase of the project also received survey questions evaluating its effectiveness.
100% (10/10) of sites agreed that their involvement in the project raised awareness of survivorship care at their site
100% (10/10) agreed or strongly agreed that their involvement in the project increased awareness of survivorship resources available and how to access them
90% (9/10) agreed that their involvement in the project increased knowledge about survivorship.
Final site report
Key achievements
Individualised final site reports provided to all sites, including comparative statewide data based on results from the baseline site survey
De-identified data report provided and available via ACSC website
An individualised final site report was provided to the 18 sites (data from 3 sites within a precinct combined) in March 2022. This report provided statewide comparative data of responses to select questions from the baseline site survey, so sites could compare their responses to other services across Victoria. Data was de-identified, with each site able to identify only their response. Regional and metropolitan site data comparisons were provided for select questions. The report also included a summary of the follow-up survey data, including de-identified statewide comparative data of responses.
Project 2's main objective was to develop and expand mycareplan.org.au, a free online survivorship care plan (SCP) generator, from the existing three to six cancer types. The database content components include treatment categories, acute and late side-effects for all relevant treatments, wellbeing recommendations and supportive services components.
The project has expanded the current mycareplan.org.au interface to include an additional three cancer types. It allows users to produce comprehensive and evidence-based SCPs for:
These complement the existing SCPs for:
early-stage breast
early-stage bowel
The project was delivered within a ten-month period, on time and within budget.
Establishment phase
Key Achievements
Engaged non-government organisations for each cancer type (completed March 2021)
Established 3x Reference Groups (completed July 2021)
Engaged a web developer (completed March 2021)
The Embed and spread project team was committed to working with non-government organisations to achieve optimal care and outcomes for cancer survivors in addition to this being a key deliverable in this project. Reference groups were formed and engagement with stakeholders was undertaken.
Research, content development and refinement
Key Achievements
Research and core content development (completed mid-August 2021)
Content refinement for three cancer types, for user testing (completed mid-November 2021)
Comprehensive research and core content development was undertaken. Relevant national and international evidence based clinical guidelines and information were used. Members for each reference group contributed expertise, assessed content and guided refinement. As a result, six databases were developed. Two for each cancer type housing detailed and relevant ‘Treatment’ and ‘Wellbeing’ sections.
Design and web development
Key Achievements
Refined functionality of usage metrics on mycareplan.org.au (completed August 2021)
Designed and built templates for mycareplan.org.au (completed December 2021)
Enhanced functionality by incorporating five new features – special instructions, cancer staging, back to top button, and feedback widget (completed December 2021)
The usage metrics have been updated to provide more details on sessions and users by region and cities. This is available for all six cancer types on the site and can be tracked monthly. Further personalisation of the care plan allows survivors to add their staging details to their cancer diagnosis.
Comprehensive targeted user testing
Key Achievements
Development of a detailed user testing plan including the strategy, purpose, schedule, deadlines and the resources required (completed August 2021)
Comprehensive targeted user testing for the three new cancer types on mycareplan.org.au finalised (completed 30 November 2021)
Complete review of all tester responses and actioned feedback where appropriate (completed 15 December 2021)
65 testers were recruited, 30 consumers and 35 subject experts.
User testing undertaken showed that for those who responded:
100% (65/65) indicated mycareplan.org.au as easy to use
97% (62/64) indicated the language as easy to understand
94% (60/64) would recommend the site to others
90% (27/30) of consumers were highly satisfied with the care plan generated
Consumer and subject experts indicated side effects information, wellbeing, and self-help information as relevant and the care plan easy to download and share.
All feedback was assessed. Decisions regarding inclusion of feedback were made by consensus with reference groups and the project team. Changes included:
Increased linkages to primary and community-based services
Content refinement
Expansion of the psychosocial content to include loss of self, impact on carers and finances /return to work sections
Addition of optional staging section
Promotion and Go-live
Key Achievements
Promotion and dissemination
Key Achievements
Promotion and dissemination campaign completed (December 2021)
Active engagement with non-government organisations (completed December 2021)
Increased awareness and usage of mycareplan.org.au (from go-live December 2021)
A communication and promotion plan were developed and undertaken in two phases, announcing the expansion of mycareplan.org.au to include three new cancer types, and announcing go-live and available for use.
Pivotal to the project’s success was the robust establishment phase, comprehensive research and content refinement, collaboration and engagement with reference group members and external stakeholders and comprehensive targeted user testing. Key highlights of this project included 1) developing partnerships and working relationships with multiple stakeholders and 2) strong evaluation data.
The project team acknowledges the support of all health professionals, consumers and experts who have helped to develop and achieve this valuable resource.
Victorian Cancer Survivorship Program
The VCSP grants scheme represents a significant investment by the Department of Health that has supported a diverse program of survivorship activity in Victoria since 2011.
The first phase of VCSP (2011-2014) funded six pilot projects, with a focus on trialling collaborative models of care across acute, primary and community care sectors.
In 2016, an evaluation of VCSP I was undertaken.
To support consistent reporting from funded projects, an evaluation and outcomes framework was developed in 2016.
Building on the success of VCSP, the second phase (2016-2019) funded 24 projects with a focus on six objectives: implement models of post-treatment care shared across acute and primary care; create effective partnerships and capacity building; improve experiences in the post-treatment phase; contribute to the survivorship evidence base; understand the needs of specific groups; and evaluate all models with reference to the evaluation and outcomes framework.
Evaluation of the Victorian Cancer Survivorship Program Phase II
In 2019, a whole program evaluation of VCSP II was undertaken, which considered the VCSP II evaluation and outcomes framework and involved a broad range of stakeholders. The bulk of this was done externally by Alison Coughlan, following a tender process. The evaluation has resulted in two reports that cover the work of the VCSP II projects, up to May 2019:
This report provides key evaluation findings and recommendations. It includes some background and context for VCSP II, including the lessons learned from VCSP I that shaped VCSP II design. The key evaluation findings are mapped to the six overarching objectives of VCSP II.
For more information on VCSP, contact the ACSC at This email address is being protected from spambots. You need JavaScript enabled to view it. or visit the Department of Health website.
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