Background
Cancer survivorship does not come without cost. There are late and long-term effects cancer survivors experience which can compromise quality of life and increase suffering. Patients who are finishing their treatment ought to receive a survivorship care plan to assist in their coping with the after effect of treatment. The purpose of this work was to create and implement sustainable survivorship care plan approaches in our Canadian health care environment.

Methods
Four jurisdictions were selected through a competitive process to mount survivorship care plan projects. The jurisdictions reflected a broad range of settings for the delivery of care plans and included a community-based agency, a cancer centre, a cancer-centre/community-based consortium (urban/rural), and a national volunteer based organization (on-line). Each designed a unique approach for using a survivorship care plan based on the template draft provided in the call for proposals. Evaluations included patient and staff satisfaction as well as program utilization.

Results
The project illustrated that use of survivorship care plans in Canada was feasible. Survivors reported that the plans helped them in understanding the next steps in their cancer journey. Each jurisdiction reported the following elements were important factors for successful implementation of survivorship care plans: leadership, teamwork and collaboration, tailoring the care plan, education and training, communication and dissemination, and conceptualization of survivorship. Barriers identified included infrastructure support (information technology in particular), process for developing the actual care plan, access to services, and engaging in robust evaluation.

Conclusions
The projects streamlined the transition from treatment to survivorship, and significantly increased the capacity to address this gap in care. It is possible that the community, cancer centre, and on-line approaches could work as complementary systems to bridge gaps for survivors, offering care plan services at various times and places to match needs along the survivorship trajectory.