After recurrence surveillance recedes: professional accounts of how non-recurrence concerns become service work in cancer survivorship aftercare

ABSTRACT After cancer treatment, suspected recurrence often retains a clear service form through appointments, tests, specialist review and escalation. Other treatment-related concerns, including swallowing, nutrition, bowel, sexual, functional and psychosocial problems, may persist or emerge as scheduled surveillance recedes. We examined how professionals described such concerns becoming easier or harder for services to recognise and act on. We conducted a focused interpretive qualitative analysis of 27 professional interviews with participants working in two London NHS trusts and additional supportive-care services, including third-sector provision outside London. Using the Framework Method, we analysed accounts of service timing, accepted remit, capacity and cross-boundary work. Professional accounts were treated as evidence about service organisation and reported practice, not as proxies for survivor experience. The analysis identified five related findings that converged on three dimensions of organisational placeability: whether a concern remained visible within service attention, whether at least one service accepted it within its remit, and whether a feasible, authorised response could follow. When these dimensions did not align, concerns depended more heavily on self-initiation, local workarounds or discretionary professional brokerage. The study does not estimate unmet need, compare follow-up models or evaluate patient-initiated follow-up. It indicates that a contact route alone is insufficient. Service redesign should also specify which service can take up a concern and what response can follow after recurrence surveillance recedes.