Edinburgh Napier University

  Background: The Transforming Care after Treatment (TCAT) programme in Scotland, funded by Macmillan Cancer Support, oversees the implementation of different local approaches to achieving ‘good survivorship’ through enhancing follow up and assessment. A multidisciplinary team at Edinburgh Napier University is conducting the five-year national evaluation that includes exploring cost-effective solutions and changes in use of resources.
Methods: Tailored health economic evaluations for nine local projects. Quantitative and qualitative data collection was designed to inform cost-effectiveness, cost benefit and cost minimisation analysis as appropriate.
Results: Outcomes included patient-derived measures of increased self-reported quality of life; improved self-reported health and well-being; increased self-management and reduced self-reported unmet concerns. Service outcome measures included reduction in routine follow-up and changes in the use of resources.
Understanding both the benefits and the costs of newly developing local models of aftercare for the growing number of cancer survivors is of critical importance. However, we found that the transferability of findings is undermined by, for example, limited scale of local tests of change, evaluation activity focusing only on participants of the intervention with no control group, the short duration of many pilot studies resulting in dependence on short-term outcome measures, issues of attribution and the ‘meaning’ of various outcome measures.
Conclusions: Our work highlights the challenges in evaluating the health economic value of survivorship services. It evidences the need for further work to determine the meaning of outcomes for services and patients and to develop consensus as to how best to measure them. It makes an important and timely contribution to the development of a robust evidence base for cancer strategies that encompass the whole system and the holistic needs of people affected by cancer.