The 2026 primary care oncology toolkit: An evolving shared-care framework for the implementation of prospective survivorship evidence.

Abstract

11076 Background: As cancer survivorship transitions into a chronic disease model, a significant "implementation gap" exists between landmark 2025 clinical data and frontline primary care. Survivors face a 2.39-fold higher risk of cardiovascular mortality, yet standardized protocols for PCP-led surveillance remain in development. This review identifies an evolving "Shared-Care Framework" designed to integrate prospective 2025 evidence into the internal medicine setting, anticipating a shift toward decentralized, longitudinal survivorship care. Methods: A narrative synthesis was performed to develop a pilot-ready framework for primary care. We analyzed practice-changing evidence published between January 2025 and January 2026, including the Barac Risk Model, the Bhalraam et al. SGLT2i meta-analysis , and emerging cervical screening strategies. Findings were synthesized into thematic surveillance blocks to identify opportunities for prospective guideline-concordant implementation. Results: Synthesis of recent landmark data identified several opportunities for prospective adoption in the internal medicine setting. The framework evaluates evolving cardio-metabolic surveillance strategies, including the integration of the Barac Model (2025) for 10-year heart failure (HF) risk prediction and the proactive use of SGLT2 inhibitors, which have demonstrated a 51% reduction in HF hospitalizations among survivors. Furthermore, the review identifies prospective clinical blocks for PCP-led surveillance of stable survivors, emphasizing proactive bone health monitoring for patients on aromatase inhibitors and metabolic screening for those on androgen deprivation therapy (ADT). This includes the potential adoption of low-dose oxybutynin as a new standard for managing ADT-induced hot flashes. Finally, the framework addresses health equity paradigms by evaluating the transition to in-office HPV self-sampling and automated EMR alerts for age 45 colorectal screening to mitigate the rising incidence of early-onset disease. Conclusions: This evolving shared-care framework offers a scalable model for the future of survivorship. By aligning primary care protocols with prospective 2025 landmark data, clinicians can optimize long-term coordination and address health disparities ahead of formal guideline updates.