Personalised Stratified Follow-Up (PSFU) is a vital part of delivering world class cancer services to people whilst addressing the serious challenges of demand and capacity throughout cancer pathways.

The implementation of PSFU pathways provides better care and experience for patients by reducing the amount of time that professionals spend seeing patients who are recovering well post treatment. It also releases professionals’ time to focus on other parts of cancer pathways, such as faster diagnosis and treatment, or those with complex post-treatment needs.

What does implementing PSFU in cancer pathways look like?

It ensures that when a person completes their primary treatment they will be offered:

  • Information about signs and symptoms to look out for, which could suggest their cancer has recurred
  • Rapid re-access to their cancer team, including telephone advice and support, if they are worried about any symptoms, including possible side-effects of treatment
  • Regular surveillance scans or tests (depending on cancer type), with quicker and easier access to results so that any anxiety is kept to a minimum
  • Personalised care and support planning and support for self-management, to help them to improve their health and wellbeing in the long-term. 

What are the benefits of PSFU?

For Patients

  • Access to better care that is personalised, based on individual needs
  • Provides more support for those with complex conditions
  • Help detect/manage cancer-related issues, connect people to suitable services and improves follow up rates
  • Support for self-management includes early detection of symptoms, direct access to healthcare teams, improved understanding and confidence and lifestyle changes to reduce cancer risks
  • Enhanced patient experience by minimising hospital visits and reducing anxiety through timely results

For Professionals

  • Improved continuity of care with better query triage, quicker access to specialists and stronger communications with primary care teams
  • Enhanced knowledge of managing side effects and navigating referral pathways for further support
  • Referral/signposting to services and third sector support
  • For Systems
  • Enhances productivity by optimising professionals time, outpatient capacity and minimising duplicate tests
  • Strengthens care integration and communication
  • Reduces unplanned care demand and increases cost transparency, ensuring resources go to patients with complex needs

For Systems

  • Enhances productivity by optimising professionals time, outpatient capacity and minimising duplicate tests
  • Strengthens care integration and communication
  • Reduces unplanned care demand and increases cost transparency, ensuring resources go to patients with complex needs

We can proudly say due to the determination and support from our clinical teams we have the following PSFU pathways live in the region:

  • Primary breast
  • Metastatic breast
  • Prostate
  • Colorectal
  • Renal
  • Endometrial and ovarian
  • Lung
  • Upper GI
  • Haematology
  • Skin 

“I am extremely enthusiastic about my role and I feel it is a privilege to support patients through this service. Patient feedback on this service or remote surveillance is always positive – patients find it easy to navigate, very accessible and are so relieved and have so much more time freed up by not having to attend in-person follow-ups.”

“I see first hand how cancer care is improving by personalising care to meet the multitude of needs that need to be addressed throughout post-treatment surveillance. Clinical needs and diagnostics now follow an optimal pathway with results being relayed to patients in a more timely manner, reducing the anxieties that can occur. The role of the support worker allows continuity of care and better relationships between acute primary care settings. Patients feel empowered because they know there is a support network that is easily accessed if its ever needed. Education plays a huge part in a patients ability to self manage and through stratified follow up we can deliver a tailor-made educational package to all patients, giving them the means and knowledge to ensure that they are both mentally and physically well. I am incredibly proud of what I do and feel this role is extremely rewarding. It is a privilege to be involved with the future of cancer follow up and personalised care and the improvements being facilitated across our cancer alliance". 

Sustainability

In 2024/2025, CMCA transitioned PSFU transformation projects to sustainably commissioned services for all PSFU tumour sites in the region.

Having a model approach to commissioning and contracting arrangements enabled PSFU becoming business as usual for all cancer sites.

For more information

Are you looking to implement PSFU in your clinical team, reviewing the current PSFU pathway in your trust/team or would just like more information?

Please head to The Cancer Academy, CMCA’s training and educational platform for the cancer care workforce, where you will find lots of PSFU resources created by the Cancer Alliance, including a PSFU generic health and wellbeing workshop video, which you can watch here: Cheshire and Merseyside Personalised Stratified Follow-Up (PSFU) video

To visit The Cancer Academy, click here: Home :: Cheshire & Merseyside Cancer Alliance