Evidence map›Paper›PMID 39375279›Full record

ArticleJournal of cancer survivorship : research and practice2026

Step-by-step: A clinical pathway for stepped care management of fear of cancer recurrence-results of a three-round online delphi consensus process with Australian health professionals and researchers.

Allan 'Ben' Smith, Afaf Girgis, Natalie Taylor, Alison Pearce, Jia Liu, Heather L Shepherd, Verena S Wu, Gail Garvey, Laura Kirsten, Iman Zakhary and 4 more

Abstract readConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of cancer survivorship : research and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
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  4. A qualitative exploration of factors that influence engagement with a digital mental health intervention for women with metastatic breast cancer: Finding My Way-Advanced.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Allan 'Ben' SmithThe Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia. ben.a.smith@sydney.edu.au.
Afaf GirgisSouth West Sydney Clinical Campuses, UNSW Medicine & Health, UNSW Sydney, Liverpool, NSW, Australia.
Natalie TaylorSchool of Population Health, UNSW Sydney, Sydney, NSW, Australia.
Alison PearceThe Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia.
Jia LiuSt Vincent's Hospital, Sydney, NSW, Australia.
Heather L ShepherdSusan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Verena S WuThe Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia.
Gail GarveyThe School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Laura KirstenNepean Cancer Services, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia.
Iman ZakharyMulticultural Services, South Western Sydney Local Health District, Liverpool, NSW, Australia.
Carolyn EeCaring Futures Institute, Flinders University, Bedford Park, SA, Australia.
Daniel EwaldLennox Head Medical Centre, Lennox Head, NSW, Australia.
Annie MillerCancer Council NSW, Woolloomooloo, NSW, Australia.
Joanne ShawSchool of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia.

Funding

Cancer Institute NSW 2021/CDF1138
6 · The paper itself

Abstract

purposeFear of cancer recurrence (FCR) is not routinely addressed in clinical practice, meaning many cancer survivors forego effective interventions. We established expert consensus on a clinical pathway to help health professionals identify and manage FCR in early-stage cancer survivors.

methodsAustralian health professionals and researchers working with adult cancer survivors participated in a three-round Delphi study promoted via oncology professional bodies and social media. The Round 1 online survey presented 38 items regarding FCR screening, triage, assessment, referral, and stepped care, based on a literature review, related pathways/guidelines, and expert input. Participants rated how representative of best-practice items were on a 5-point scale (strongly disagree-strongly agree), with optional qualitative feedback. Consensus was defined as ≥ 80% of participants strongly/agreeing with items. Items not reaching consensus were re-presented to Round 1 participants in two subsequent rounds with new items, derived from content analysis of qualitative feedback.

resultsFrom 94 participants in Round 1 (89% health professionals), 26/38 (68%) items reached consensus. By round 3, 35/38 (92%) items, including 8 new items, reached consensus. Routine FCR screening and triage conversations and stepped care management (i.e. tailored and staged treatment) were endorsed. However, the timing of FCR screening/triage did not reach consensus.

conclusionsThis world-first FCR clinical pathway incorporating contemporary evidence and expert opinion recommends routine screening and triage to stepped care management of FCR. Some pathway components, such as screening or triage timing, may need tailoring for different contexts. IMPLICATIONS FOR CANCER SURVIVORS: Implementation of the pathway could aid routine identification and management of FCR, reducing its burden on cancer survivors and the healthcare system.

Indexed as

Cancer SurvivorsCritical PathwaysFearHealth PersonnelNeoplasm Recurrence, LocalNeoplasmsAdultAustraliaDelphi TechniqueFemaleHumansMaleMiddle AgedResearch PersonnelCancer survivorshipClinical pathwayFear of cancer recurrenceOncologyScreeningStepped care

Identifiers

PMID39375279
PMCPMC12988909

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.