survivorship care consumes a substantial proportion of the typical oncology clinic workday, taking time from patients with new diagnoses and in need of active treatment decisions and monitoring. 2. the burden and complexity of bc survivor care is escalating, and the current model of care is unfit to sustain this growth. 3. bc survivors feel "lost in transition" after they complete the intensive multi-modality treatment as follow-up care can be duplicative and fragmented when multiple teams, rehabilitation specialists, and primary care providers are all co-managing with suboptimal communication and coordination [8].