Table 5.

Recommendations for Sydney Cancer Survivorship Centre clinic improvements

Time frame	Resources required for implementation	Recommendations
Short term	Low	- Provide information to survivors about what to expect during the first clinic, e.g. provide an A4 summary sheet and/or short video of how the clinic runs - Survivors should be advised to bring a friend or family member (i.e. caregiver) with them to clinics - An individual (e.g. final team member seeing a survivor or the Survivorship Nurse Consultant) should (i) verbally inform survivors they have seen every team member and their clinic review is complete; (ii) provide the follow-up plan, including recommended dates; and (iii) answer remaining questions - Communicate to survivors the purpose and value of discussing symptoms (i.e. acknowledgement is important even if treatment not available) - Better clinician communication of interventions available to mitigate effects of long-term treatment sequelae (e.g. peripheral neuropathy) - Use of patient connect services to link people recently completed treatment to longer-term survivors for support - Educate survivors and caregivers regarding the interaction between each of their feelings of stress - Advise caregivers to be aware of their own mental health and wellbeing, and to seek professional help if required
	High	- Provide annual feedback to survivors and GPs on their PROMs - Feedback should include individual progress, change in symptoms, mood and health - Access to stories from other survivors with similar diagnosis, age, and sex about comparative recovery trajectories (e.g. video interview) - Make it clear to survivors that, based on needs assessed in follow-up clinics, access to additional MDT members beyond the medical oncologist and clinical nurse consultant is available
Long term	Low	- Telehealth (i.e. video) consultations for longer-term clinic follow-up based on survivor preference, symptom profile, and needs - Introduction should follow a period of in-person clinic reviews, during which survivor education and confidence regarding symptom recognition and self-examination are developed - Improve communication between the SCSC clinic and GPs of survivors about individuals’ health, progress, and plans
	High	- Alternate locations for the SCSC clinic to distinguish it from chemotherapy treatment - Increased allocation of resources to the adjunctive SCSC clinic services, including the gym and cottage - Increase total capacity of each service to accommodate a greater number of survivors, length of time survivors may access the service, and increase service hours to accommodate working survivors - Greater community education about cancer-specific needs and capabilities, specifically for GPs and personal trainers at community gyms, should be supported with information seminars run by the SCSC clinic MDT members

Classification of low and high resource recommendations was based on assumptions regarding resources (staff, Information Technology, policy change, etc.) required to implement them in practice