Survivorship, MDT working and the generalist's role — surveillance schedules, late effects and transition to shared care

A 58-year-old woman sits in your general gynaecology clinic two years after a radical hysterectomy and pelvic radiotherapy for stage IIB cervical cancer. Her oncology team has signed her off to "shared care." She has a swollen left leg she has not mentioned, pain with intercourse she is too embarrassed to name, hot flushes from abrupt menopause, and a quiet, daily terror that the cancer is coming back. She is every gynae-oncology survivor — and she is now your patient. This topic teaches the generalist O&G how to run that long phase well.[2][6]

Overview — survivorship is a phase, not an afterthought

Cancer survivorship, in the consensus sense, spans from the moment of diagnosis through the balance of life, encompassing physical, psychosocial, and existential health. It is not what happens after treatment ends — it is a restructuring of care that begins at diagnosis and runs in parallel with active treatment, then takes over as the dominant mode once curative-intent therapy is complete.[2][3]

The GCIG long-term survivorship position paper (Woopen et al 2022) defines a long-term survivor as a woman at least five years from diagnosis, irrespective of recurrence. Most gynae-cancer survivors reach this milestone: endometrial cancer has an all-stage five-year survival of roughly 80 per cent, cervical 60 to 70 per cent, and ovarian 30 to 50 per cent. Survival is disproportionately good relative to incidence — gynaecological cancers are about 12 per cent of new cancers in women but about 15 per cent of female cancer survivors. The survivor cohort is large, growing, and increasingly yours.[2]

The survivorship phases

Survivorship has three recognised phases that the generalist must navigate:[2]

• Acute survival — diagnosis through the end of active treatment. The oncology MDT leads; the generalist supports comorbidity, acute effects, and the woman's psychosocial needs.
• Extended survival — the transition. Active treatment ends; the woman moves from specialist-dominated surveillance toward shared care. This is where the survivorship care plan is handed over and where most survivors are lost to late-effect monitoring.
• Permanent survival (long-term re-entry) — years out, the woman is back in the community. Late effects accumulate over decades; follow-up should be offered lifelong in a shared-care model.[2]