Objective: This review explored psychosocial interventions targeting adult cancer survivors’ reintegration following active cancer treatment. This included the types of interventions tested and the tools used to measure reintegration. Introduction: Cancer survivors face lingering health issues following the completion of cancer treatment. Many cancer survivors still experience unmet psychosocial care needs despite receiving follow-up care. Further, many survivorship interventions do not specifically address outcomes important to survivors. A number of primary studies have identified reintegration as an outcome important to cancer survivors. Reintegration is a concept that focuses on returning to normal activities, routines, and social roles after cancer treatment; however, it is emerging and Inclusion criteria: Studies involving adult cancer survivors (18 years or older at diagnosis) of any cancer type or stage were included in this review. Studies with psychosocial interventions targeted at reintegrating the person into daily life after cancer treatment were included. Interventions addressing clinical depression or anxiety, and interventions treating solely physical needs that were largely medically focused were excluded. Methods: A literature search was conducted in MEDLINE (Ovid), CINAHL (EBSCOhost), and Embase. Gray literature was searched using ProQuest Dissertations and Theses (ProQuest). Reference lists of included studies were searched. Studies were screened at the title/abstract and full-text levels, and 2 independent reviewers extracted data. Manuscripts in languages other than English were excluded due to feasibility (eg, cost, time of translations). Findings were summarized narratively and reported in tabular and diagrammatic format. Results: The 3-step search strategy yielded 5617 citations. After duplicates were removed, the remaining 4378 citations were screened at the title and abstract level, then the remaining 306 citations were evaluated at the full-text level by 2 independent reviewers. Forty studies were included that evaluated psychosocial interventions among adult cancer survivors trying to reintegrate after active cancer treatment (qualitative n=23, mixed methods n=8, quantitative n=8, systematic review n=1). Included articles spanned 10 different countries/regions. Over half of all included articles (n=25) focused primarily on breast cancer survivors. Many studies (n=17) were conducted in primary care or community-based settings. The most common types of interventions were peer-support groups (n=14), follow-up education and support (n=14), exercise programs (n=6), and multidisciplinary/multicomponent programs (n=6). While the majority of included studies characterized the outcome qualitatively, 9 quantitative tools were also employed. Conclusions: This review identified 6 types of interventions to reintegrate survivors back into their daily lives following cancer treatment. An important thread across intervention types was a focus on personalization in the form of problem/goal identification. Given the number of qualitative studies, future research could include a qualitative systematic review and meta-aggregation. Quantitative tools may not be as effective for evaluating reintegration. More primary studies, including mixed methods studies, utilizing consistent measurement tools are required. Furthermore, this work provides a basis for future research to continue examining the complexity of implementing such interventions to successfully achieve reintegration. To do so, primary studies evaluating interventions from an implementation science and complex systems perspective would be useful. Review registration: Open Science Framework https://osf.io/r6bmx

Prostate cancer is a common and life-altering condition among Canadian men, yet little is known about how follow-up care is provided to those who have completed treatment. Despite improving survival rates, survivors experience ongoing needs and are often not provided with support to manage them. This study sought to investigate the post-treatment experiences and needs of prostate cancer survivors and to determine if and how these needs are being met. Using a qualitative description design, prostate cancer survivors who had completed treatment took part in semi-structured interviews. The interviews were recorded and analyzed thematically. The participants experienced varying levels of satisfaction with their follow-up care. While primary care providers played significant roles, continuity of care and specialist involvement varied. Most participants felt unprepared to manage the long-term effects of their cancer due to a lack of information and resources from their healthcare providers. Instead, participants turned to their peers for support. Ongoing physical and psychosocial needs went unmet and had significant impacts on their daily lives. Participants felt that support for these issues should be automatically integrated into their follow-up care. In summary, this study revealed the importance of integrated, patient-centered follow-up care for prostate cancer in Atlantic Canada.

Background: Virtual follow-up (VFU) has the potential to enhance cancer survivorship care. However, a greater understanding is needed of how VFU can be optimized. Objective: This study aims to examine how, for whom, and in what contexts VFU works for cancer survivorship care. Methods: We conducted a realist evaluation of VFU among patients with breast cancer and prostate cancer at an urban cancer center during the COVID-19 pandemic. Realist evaluations examine how underlying causal processes of an intervention (mechanisms) in specific circumstances (contexts) interact to produce results (outcomes). Semistructured interviews were conducted with a purposive sample of patients ≤5 years after diagnosis. Interviews were audio-recorded and analyzed using a realist logic of analysis. Results: Participants (N=24; n=12, 50% with breast cancer and n=12, 50% with prostate cancer) had an average age of 59.6 (SD 10.7) years. Most participants (20/24, 83%) were satisfied with VFU and wanted VFU options to continue after the COVID-19 pandemic. However, VFU impacted patient perceptions of the quality of their care, particularly in terms of its effectiveness and patient centeredness. Whether VFU worked well for patients depended on patient factors (eg, needs, psychosocial well-being, and technological competence), care provider factors (eg, socioemotional behaviors and technological competence), and virtual care system factors (eg, modality, functionality, usability, virtual process of care, and communication workflows). Key mechanisms that interacted with contexts to produce positive outcomes (eg, satisfaction) were visual cues, effective and empathetic communication, and a trusting relationship with their provider. Conclusions: Patients value VFU; however, VFU is not working as well as it could for patients. To optimize VFU, it is critical to consider contexts and mechanisms that impact patient perceptions of the patient centeredness and effectiveness of their care. Offering patients the choice of in-person, telephone, or video visits when possible, coupled with streamlined access to in-person care when required, is important. Prioritizing and addressing patient needs; enhancing physician virtual socioemotional behaviors and technology competency; and enhancing VFU functionality, usability, and processes of care and communication workflows will improve patient perceptions of the patient centeredness and effectiveness of virtual care.

Advancements in targeted therapies and immunotherapies have improved survival for individuals with metastatic non-small-cell lung cancer (mNSCLC), creating a growing population of Canadians living long-term with the disease. These individuals face ongoing physical, emotional, and practical challenges, yet existing supportive care services are often designed for patients receiving curative intent treatment and may not adequately address the challenges of those undergoing continuous treatment. To explore these experiences and inform the development of supports tailored to their needs, eight participants with mNSCLC completed one-on-one virtual interviews. They described limited support for managing side effects and psychosocial concerns despite general satisfaction with oncology care. Fatigue and cognitive challenges impacted daily functioning, and emotional challenges (e.g., fear of progression, stigma, and difficulty finding meaning) impacted quality of life. Financial burden, including unexpected costs and loss of income, further affected their well-being. Existing supports, such as exercise programs, were viewed positively but were often difficult to access, were offered only short-term, and required patients to find them independently. Recommendations included improved coordination and communication across the healthcare system, alongside tailored interventions such as navigation services, resource directories, health promotion supports, and expanded peer support. Overall, people living long term with mNSCLC face distinct challenges and unmet supportive care needs, highlighting the importance of integrating supportive services into routine oncology care.

Background: Online support groups (OSGs) offer a convenient way for patients with cancer and survivors of cancer to obtain information and support. However, not all OSGs are helpful, and in some cases, they may increase distress. Overall, there is a lack of clear evidence on the effects of OSGs, along with how and why they work. Objective: This study examined how, for whom, and in what contexts OSGs work for patients with cancer and survivors of cancer. Methods: A realist review of the evidence on cancer OSGs was conducted (12 databases, inception to February 15, 2025). We followed Pawson’s steps and the RAMESES (Realist and Meta-Narrative Evidence Syntheses: Evolving Standards) quality standards for realist reviews. The Mixed-Methods Appraisal Tool was used to assess the quality of the evidence. Using a realist logic of analysis, we generated a narrative summary of the findings, context-mechanism-outcome configurations, and a program theory (eg, conceptual framework) to explain how cancer OSGs work. Additionally, we developed evidence-based recommendations for optimizing the effectiveness of OSGs. Results: Of 16,659 papers identified, 168 were included. The evidence was organized into 3 categories, 10 concepts, and 57 context-mechanism-outcome configurations. Cancer OSGs can support patients by providing informational, emotional, appraisal, and altruistic support. This can lead to changes in distress, isolation, empowerment, and self-esteem, through negative and positive appraisals as well as coping efforts. These outcomes, however, depend on user attitudes about OSGs (ie, trustworthy, useful, culturally safe, and easy-to-use), how well the OSG fits their needs (ie, health need, sociodemographic or clinical characteristics, and coping style), and perceptions of control (ie, availability, anonymity, privacy, and autonomy). If an OSG was a good fit for a user’s needs, whether they experienced positive outcomes depended on features of the communication technology (ie, modality, response time, and visual social cues), group composition and dynamics (ie, norms, moderation, safety, cohesion, and belonging), and the nature and content of interactions (ie, emotional expression, cognitive processing, and empathetic responses). These factors trigger underlying mechanisms such as feeling understood, accepted, cared for, valued, reassured, informed, and confident, which result in positive outcomes. Conclusions: OSGs can address supportive care needs and improve psychosocial well-being for patients with cancer and survivors of cancer. However, outcomes depend on specific contexts and mechanisms that impact how well OSGs meet patients’ needs. To optimize effectiveness of OSGs, we recommend (1) helping to assess fit and address specific needs; (2) demonstrating trustworthiness; (3) enhancing anonymity and control, and protecting privacy; (4) enhancing ease-of-use; (5) supporting connection and belonging; (6) encouraging activity; (7) enhancing the nature of content shared to boost therapeutic effects; and (8) monitoring and adjusting design and management strategies.

BACKGROUND Online support groups (OSGs) are often a convenient way for many patients with cancer and cancer survivors to obtain information and support. However, not all OSGs are helpful, and in some cases, they may increase distress. Overall, there is a lack of clear evidence on the effects of OSGs, along with how and why they work. OBJECTIVE This study examined how, for whom, and in what contexts OSGs work for patients with cancer and cancer survivors. METHODS A realist review of the evidence on cancer OSGs was conducted (12 databases, inception to 01/10/2025). Realist reviews examine how underlying causal processes of an intervention (mechanisms) in specific circumstances (contexts) interact to produce results (outcomes). A program theory (e.g. conceptual framework) was developed to explain how cancer OSGs work. RESULTS Of 16,659 articles identified, 168 were included. Cancer OSGs can be an effective tool for providing emotional, informational, validatory, and altruistic support. This can lead to changes in distress, isolation, empowerment, and self-esteem, through negative and positive appraisals as well as coping efforts. These outcomes, however, depend on user attitudes about OSGs, how well the OSG fits their needs, and perceptions of control (i.e., availability, privacy, anonymity). If an OSG was a good fit for a user’s needs (e.g., relevant and relatable), whether they experienced positive outcomes or not depended on features of the communication technology (i.e., response time, visual cues), group dynamics (i.e., norms, moderation, connectedness), and content (i.e., emotional expression, cognitive processing). CONCLUSIONS OSGs can address supportive care needs and improve psychosocial wellbeing for patients with cancer and cancer survivors. However, outcomes depend on specific contexts and mechanisms that impact how well OSGs meet patients’ needs. To optimize effectiveness of OSGs, we recommend (1) helping to assess fit and address specific needs; (2) demonstrating trustworthiness; (3) enhancing anonymity and control, and protecting privacy; (4) enhancing ease of use; (5) supporting connection and belonging; (6) encouraging activity; (7) enhancing the nature of content shared to boost therapeutic effects; and (8) monitoring and adjusting design and management strategies to enhance effectiveness. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2021-053916