Follow-Up Care

Patients often report that the months and years after cancer treatment are tougher than the treatment itself. More and more, the cancer system is looking to Family Physicians and Nurse Practitioners and their teams to care for patients in this follow-up and rehabilitative phase of care. This website is here to give you the tools and supports you need. The goals of survivorship care are

Some say that cancer has an "acute phase" and a "chronic phase" of care. With our expertise in chronic disease management and balancing our patients' co-morbidities, primary care is well equipped to coordinate and respond to the needs of cancer patients in this "chronic phase."

"The Moving Forward After Cancer Treatment" Program at CancerCare Manitoba is working to support follow up care and help patients and providers transition to follow up care at the end of curative systemic/radiation therapy by developing standardized care plans and implementing transition appointments.

A transitional appointment (TA) is provided by the patient's usual oncology providers and includes screening for distress, appropriate referrals, and provision of a personalized, written treatment summary and care plan to the patient, with copies to the primary care provider and surgeon.

Transition appointments have currently been rolled out for colorectal, breast, lymphoma and gynecological (ovarian, fallopian tube, and peritoneal) patients. Work is underway with other patient groups. The care plans and patient education materials are available here online by clicking on the tab on the left called "Cancer Specific Follow-Up Care Resources". General follow up care resources for your patients are available here online by clicking on the tab on the left called "General Follow-Up Care Resources".

Stay tuned for updates on this work by checking this website regularly.

You can refer your patients to for more information.

If you have questions about this program or about a specific part of the developed care plans, please contact us at