Breast Cancer Survivorship Program and shared care

Our Breast Cancer Survivorship Program improves follow-up care. It is for people who have completed active breast cancer treatment at Victorian Comprehensive Cancer Centre (VCCC) hospitals

The model of care involves patients and their GPs (General Practitioners). It recognises the specific issues and opportunities at the end of active breast cancer treatment. And its aim is to support survivors to live well. We would like you to feel more empowered to manage your ongoing healthcare.

This program will:  

  • find and address immediate and future needs in terms follow-up care 

  • improve systems that share information between: 

    • people

    • GPs

    • other community services 

    • the hospitals to improve the quality of care. 

Your model of care will include: 

  • a consultation with a breast care nurse at the end of active breast cancer treatment 

  • an individualised follow-up care plan 

  • shared care between the hospital and your GP.  

The care plan includes: 

  • information on diagnosis, history and treatment 

  • a health and wellbeing assessment, including referrals. This can include mental health, lifestyle, menopause, sexuality, fertility, and so on. 

  • an individualised follow-up schedule for future examinations and investigations 

  • referral and contacts for different services 

  • resources. 

You and your GP will receive a copy of the care plan. We will ask you to make an appointment with your GP within one month of receiving the care plan. This gives us a chance to discuss ongoing care. This also provides GPs with the opportunity to set up their recall systems. They can then develop the proper team care plans or management plans. 

Pages related to the Breast Cancer Survivorship Program and shared care

Royal Melbourne Hospital