Models of Care Toolkit

Connecting unattached patients to the cancer system

An elderly man with a cane is scratching his head. There are puzzle pieces floating around expressing confusion.Health system partners report that the shortage of primary care providers impacts the cancer system’s ability to deliver efficient, equitable care.

New models of care for unattached patients are needed as navigation programs designed to help patients transition in and out of the cancer system reach capacity. Specific models of care for unattached patients may reduce the burden on existing navigation services and ensure continuity of care throughout their cancer journey.

A rapid review conducted by McMaster Health Forum identified two broad and overlapping approaches to supporting all patients who are transitioning into and out of the cancer system and may have specific benefit for unattached patients:

  • Patient navigation approaches in which nurses provide clinical consultation, advocacy, coordination and scheduling, and health monitoring help continuity of care and are particularly beneficial to patients unattached to a primary care provider or team.
  • Multidisciplinary team care models improve communication, care coordination and case management between cancer specialists and primary care providers. For patients without a primary care provider, they reduce the risk of gaps in care.

The rapid review found limited evidence and few programs designed specifically for unattached patients in the cancer system, and no programs to accelerate access to a primary care provider for patients with a suspected or diagnosed cancer.

Are you working in or know of a model of care designed to meet the needs of patients with cancer who are unattached to a primary care provider or team?

Long term solutions to close the primary care attachment gap

A growing number of people in Canada do not have regular access to a primary care provider. Even people who have a primary care provider cannot always get a same or next day appointment when necessary.11,14

Cancer system partners indicate that a lack of access to primary care services has led to an upward trend of cancer diagnoses in emergency departments or when patients are seeking care for unrelated health issues.

Jurisdictions across Canada are implementing solutions to ensure everyone who wants a primary care provider has one, but it will take time.

  • In February 2023, British Columbia introduced a new funding model that compensates doctors for time spent on paperwork to attract and retain family doctors in comprehensive primary care practice.
  • Ontario is removing supervision and assessment barriers for doctors trained and certified in the United States, Australia and Ireland to practice in the province and has a practice ready assessment program specifically for internationally trained family physicians.
  • Many jurisdictions also maintain registries that match doctors and nurse practitioners with unattached patients. Some registries, including Québec, prioritize patients based on urgency, such as a new cancer diagnosis.

Increased funding for nurse practitioners to work in primary care is improving access to primary care services in some jurisdictions, but not all jurisdictions have deployed nurse practitioners in this way.

In 2023 only 5% of all Canadians who reported having a regular primary care provider indicated that their provider is a nurse practitioner.11 Developing policies that allow nurse practitioners to roster patients and bill for services may support attachment in jurisdictions with a shortage of family doctors.

  1. Lavis JN, Hammill AC. Care by sector. In Lavis JN (editor), Ontario’s health system: Key insights for engaged citizens, professionals and policymakers. Hamilton: McMaster Health Forum; 2016, p. 209-69.
  2. Tremblay D, Latreille J, Bilodeau K, et al. Improving the transition from oncology to primary care teams: A case for shared leadership. J Oncol Pract. 2016;12(11):1012-1019.
  3. Tremblay D, Prady C, Bilodeau K, et al. Optimizing clinical and organizational practice in cancer survivor transitions between specialized oncology and primary care teams: a realist evaluation of multiple case studies. BMC Health Serv Res. 2017;17(1).
  4. Meiklejohn JA, Mimery A, Martin JH, et al. The role of the GP in follow-up cancer care: a systematic literature review. J Cancer Surviv. 2016;10(6):990-1011.
  5. Kang J, Park EJ, Lee J. Cancer survivorship in primary care. Korean J Fam Med. 2019;40(6):353-361.
  6. Watson L, Qi S, Delure A, et al. Virtual cancer care during the COVID-19 pandemic in Alberta: Evidence from a mixed methods evaluation and key learnings. JCO Oncol Pract. 2021;17(9):e1354-e1361.
  7. Cancer Quality Council of Ontario. Programmatic Review on the Diagnostic Phase: Environmental Scan.; 2016.
  8. Gorin SS, Haggstrom D, Han PKJ, Fairfield KM, Krebs P, Clauser SB. Cancer care coordination: A systematic review and meta-analysis of over 30 years of empirical studies. Ann Behav Med. 2017;51(4):532-546.
  9. Mittmann N, Beglaryan H, Liu N, et al. Examination of health system resources and costs associated with transitioning cancer survivors to primary care: A propensity-score–matched cohort study. J Oncol Pract. 2018;14(11):e653-e664.
  10. Zhao Y, Brettle A, Qiu L. The effectiveness of shared care in cancer survivors-A systematic review. Int J Integr Care. 2018;18(4):2.
  11. Angus Reid Institute. (2023). Health Care Access Priorities. Angus Reid Institute. Accessed December 4 2023. Available:
  12. Kiran, T. (2023). Our Care National Survey. Our Care. Accessed October 13 2023. Available:
  13. Watson L, Qi S, Delure A, et al. Virtual cancer care during the COVID-19 pandemic in Alberta: Evidence from a mixed methods evaluation and key learnings. JCO Oncol Pract. 2021;17(9):e1354-e1361.
  14. Canadian Residency Matching Service. 2023 CaRMS Matching Results. Accessed December 12 2023. Available:
  15. Canadian Institute for Health Information. Commonwealth Fund survey, 2020. Accessed October 13, 2023. Available:
  16. Jensen, H. Implementation of cancer patient pathways and the association with more timely diagnosis and earlier detection of cancer among incident cancer patients in primary care. PhD dissertation. Aarhus University; 2015
  17. Møller H, Gildea C, Meechan D, Rubin G, Round T, Vedsted P. Use of the English urgent referral pathway for suspected cancer and mortality in patients with cancer: cohort study. BMJ. 2015;351:h5102
  18. Prades J, Espinàs JA, Font R, Argimon JM, Borràs JM. Implementing a Cancer Fast-track Programme between primary and specialised care in Catalonia (Spain): a mixed methods study. Br J Cancer. 2011;105(6):753-759.
  19. Canadian Partnership Against Cancer. Leading Practices to Create a Seamless Patient Experience for the Pre-Diagnosis Phase of Care: An Environmental Scan. 2018. Accessed November 22, 2021.
  20. Walsh J, Young JM, Harrison JD, et al. What is important in cancer care coordination? A qualitative investigation: What is important in care coordination? Eur J Cancer Care (Engl). 2011;20(2):220-227.
  21. Wong WF, LaVeist TA, Sharfstein JM. Achieving health equity by design. JAMA. 2015;313(14):1417-1418.
  22. Lewis RA, Neal RD, Hendry M, et al. Patients’ and healthcare professionals’ views of cancer follow-up: systematic review. Br J Gen Pract. 2009;59(564):e248-59.
  23. Cancer Council Victoria. Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer Draft for National Public Consultation.; 2017. Accessed November 22, 2021.
  24. Jefford M, Koczwara B, Emery J, Thornton-Benko E, Vardy JL. The important role of general practice in the care of cancer survivors. Aust J Gen Pract. 2020;49(5):288-292.