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How Do We Define and Measure Optimal Care for Cancer Survivors? An Online Modified Reactive Delphi Study With improvements in the detection and treatment of cancer, the number of people living beyond cancer continues to grow worldwide Living beyond cancer remains a Cancers 2021, challenge for many survivors who may experience persisting physical and psychosocial issues, as well as late effects, including the risk of developing a new cancer and risk of premature death . Current cancer survivorship care is suboptimal, leaving substantial proportions of survivors with persistent symptoms and unmet needs, and insufficient support to return to optimal functioning. Provision of care in Australia is not adequately tailored to individual circumstances and needs, nor is there adequate support for survivors to improve their wellbeing . Care is frequently poorly coordinated and there is an absence of clear responsibility for delivering follow-up care between oncology and primary care providers . There is widespread recognition that new models of care are needed to improve outcomes for survivors . Progress in the development of these models may be hindered by the limited availability of measures to assess the quality of care delivery and to assess survivorship outcomes . The US Institute of Medicine (IOM, now the National Academy of Medicine) 2001 publication ‘Crossing the Quality Chasm’ proposed that quality health care should be safe, effective, patient-centered, timely, efficient and equitable . Building on these principles, the landmark 2006 report, ‘From Cancer Patient to Cancer Survivor: Lost in Transition’ suggested a shift in the focus of existing survivorship care models from a dominant emphasis on surveillance for disease recurrence to a broader focus, adding the prevention of recurrent and new cancers, as well as late effects; interventions to deal with the consequences of cancer and its treatment, and effective coordination between specialists and primary care providers . The IOM report also recommended development of public/private partnerships and quality assurance programs to monitor and improve the care that all survivors receive . Concerning a focus on the quality of survivorship care, the American Society of Clinical Oncology, in its 2013 statement, recommended standardized ways to monitor and improve quality care, encouraged the implementation of quality improvement programs and advised the development of quality measures, to monitor and improve the care that all survivors receive . Nekhlyudov et al. (2019) developed a quality survivorship framework aligning with the IOM components, more explicitly calling out a focus on health promotion and disease prevention . The report also suggested the development of recommendations and assessments to improve the quality of survivorship care. Previously, Malin, Sayers and Jefford (2011) proposed that better outcomes for survivors might be achieved by improving the quality of policies and processes of survivorship care. There is a growing focus on improved models of care for cancer survivors in the Australian state of Victoria, as well as a recognition that to improve care, it is imperative to understand what constitutes optimal survivorship care and to develop measures to assess this. There remains, however, a lack of consensus on metrics to assess the quality of survivorship care or indeed agreed processes and process structures to facilitate optimal care. This work aimed to develop consensus-based quality criteria for optimal survivorship care in Victoria, Australia. The principal research question was ‘what quality criteria do survivorship experts consider to be important in achieving optimal cancer survivorship care?’

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