Table 2.

Systematic review details and study outcomes

Author, search years, number of studies	Purpose of systematic review	Models of care examined and participants	Results	Quality of included studies	Authors’ conclusions and recommendations
Aubin et al, 2012, Canada17 Search from database inception to Feb 2009 51 studies (49 RCTs)	To classify, describe and evaluate the effectiveness of interventions aiming to improve patient, healthcare provider and process outcomes.	Primarily case management, shared care and interdisciplinary teams n=12967 (approximate); Any type of cancer was considered; Only adult patients were considered.	Based on the median effect size estimates, there were no significant differences found between patients assigned to interventions and those assigned to usual care, in regards to patient health-related outcomes.	All studies were of ‘very low quality’ due to inconsistent results and high heterogeneity among studies.*	Evidence is lacking from the majority of studied outcomes; therefore, no conclusions regarding most effective interventions could be made. Future research should evaluate interventions for which improvement in continuity is the primary objective.
Howell et al, 2012, Canada18 Search from 1999 to Dec 2000 19 studies (9 RCTs; 10 practice guidelines)	To determine the optimum organisation and care delivery structure for cancer survivorship services.	Nurse-led and primary care physician-led n=3112; Any type of cancer was considered; Only adult patients were considered.	Nurse-led and primary care physician models of follow-up care were equivalent for detecting recurrence. Consensus also suggested that cancer survivors may benefit from coordinated transition planning that includes the provision of survivorship care plans as a standardised part of care.	The evidence was rated as low quality, due to non-blinding of participants or outcome assessors, poor reporting of randomisation procedures, and lack of power to detect statistically significant differences between treatment groups.†‡	Evidence is limited; however, the realignment of models of care should be identified as a health system priority, in order to meet the supportive care and surveillance needs of the survivor population. Further research is required to evaluate the efficacy of models of care in a broader population of cancer survivors with differing needs and risks.
Lamb et al, 2011, UK19 Search from 1999 to May 2009 37 studies (1 RCT)	To examine the evidence on clinical, social and technological factors that affect the quality of MDT clinical decision-making.	MDTs n=not available; Any type of cancer was considered; Patients of any age were considered.	Failure to reach a decision at MDT discussions was found in 27–52% of cases. The majority of team decisions were made by physicians (without the inclusion of nurses) and patient preferences were not discussed. The following factors negatively affected decision-making: time pressure; excessive caseload; low attendance; poor team work; and lack of leadership. Telemedicine is effectively being used in developed countries.	Overall study quality was low to medium. The median quality score for quantitative papers was 9/18 (range 3–15) and for qualitative papers was 13/24 (range 9–14).§	Team/social factors affect management decisions by cancer MDTs. The following may have a positive impact on team decision-making: allowing adequate time for team members to prepare for MDT meetings; making team and leadership skills training available to team-members; and considering systematic input from nursing personnel.
Lewis et al, 2009, UK20 Search from database inception to February 2007 21 publications and 10 studies (6 RCTs)	To compare the effectiveness and cost-effectiveness of nurse-led follow-up of cancer patients, with conventional physician-led follow-up.	Nurse-led and primary care physician-led n=927 (for the review's focal four RCTs); Any type of cancer was considered; Patients of any age were considered.	There were no statistically significant differences in survival, recurrence or psychological morbidity. Patients with lung cancer were more satisfied with nurse-led telephone follow-up. Patients with breast cancer thought patient-initiated follow-up was convenient. No significant observations regarding cost-effectiveness were made.	Study quality ranged from poor to well-conducted; total quality score for internal validity ranged from 7 (47%) to 13 (87%). The statistical tests used in three studies were poorly-reported.¶	Patients appeared satisfied with nurse-led follow-up. Patient-initiated or telephone follow-up could be practical alternatives to routine hospital follow-up care; however, more evaluations are required and the duration of follow-up needs to be sufficient to allow for comparison of recurrence rates.
Ouwens et al, 2009, Netherlands21 Search from Jan 1996 to Oct 2006 33 studies (31 RCTs/ quasi-RCTs)	To review integrated care interventions and their effects on the quality of cancer care.	Interventions comprising at least one of the three integrated care principles: patient-centeredness; organisation or care; and multidisciplinary care n=not available; Any type of cancer was considered; Only adult patients were considered.	Effective interventions to improve patient-centeredness were: providing patients with an audiotape of the consultation, and with information, and using decision aids. Effective interventions to improve the organisation of care were follow-up and case management, (particularly by nurses and one-stop clinics).	Only studies that met at least three of the five quality criteria described by the Cochrane Collaboration were included in the review.**	In order to improve integrated care for patients with cancer, a multicomponent intervention programme which focuses on patients, professionals and the organisation of care, is required. It is suggested that interventions found in this review should help to structure a future programme which would be evaluated using rigorous methods and explicit outcome measures linked to the intervention.

*The GRADE approach was used to assess the quality of the evidence.

†The AGREE II instrument was used to assess the quality of the practice guidelines.

‡The SIGN guideline development handbook was used to assess the quality of the randomised controlled trials.

§Included studies were assessed against a quality score. Quantitative papers were scored out of a total of 18, and qualitative papers out of 24 (more detail included in online supplementary material of the original review).

¶A modified Downs and Black checklist was used to assess the quality of the evidence.

**Five methodological criteria described by the Cochrane Collaboration (ie, completeness of follow-up, reliability of outcomes, protection against contamination, baseline measurement and concealment of allocation) were used to assess the quality of the evidence.

MDT, multidisciplinary care team; RCTs, randomised controlled trials.