issues related to a particular oncologic intervention (e.g., surgery, radiotherapy, adjuvant therapy).

Evidence-based guidelines would provide specific information on how to manage the complex issues facing survivors of adult cancers. Assessment tools and screening instruments for common late effects are also needed to help identify cancer survivors who have, or who are at high risk for, late effects and who may need extra surveillance or interventions.

Recommendation 3: Health care providers should use systematically developed evidence-based clinical practice guidelines, assessment tools, and screening instruments to help identify and manage late effects of cancer and its treatment. Existing guidelines should be refined and new evidence-based guidelines should be developed through public- and private-sector efforts.

Cancer survivors represent a very large at-risk population, and without evidence-based clinical practice guidelines, health care providers will vary widely in their practices, leading to inefficiencies in care delivery. Evidence suggests that some tests are being overused in the context of routine surveillance care after cancer treatment (Elston Lafata et al., 2005). The critical need for more rational, consistent, and efficient cancer follow-up practices has been widely recognized (Johnson and Virgo, 1997; Schwartz et al., 2000). As a nation, we have not invested in the research on cancer survivors on which such clinical practice guidelines would be based. Without high-quality evidence on the benefits, harms, and relative cost-effectiveness of follow-up strategies, cancer survivors face the health and financial hazards of overuse, underuse, and misuse of resources. The adoption of evidence-based guidelines has the potential to reduce this variation, improve patient outcomes, and reduce health care costs. Health services research is needed to evaluate the impact of such guidelines in the context of survivorship care.

The most comprehensive CPGs included in the committee’s review were created under the auspices of regional or national health policy organizations (e.g., Australia; British Columbia, Canada; Scotland). Similar support from appropriate bodies in the United States would facilitate guideline development. Public and private support of studies to generate evidence for guideline development is needed. The Centers for Medicare and Medicaid Services is the primary payor of care for cancer survivors and therefore have a stake in developing clinical practice guidelines. The Agency for Healthcare Research and Quality maintains a National Guideline Clearinghouse and supports Evidence-Based Practice Centers that review relevant scientific literature on clinical, behavioral, organizational, and financial topics to produce evidence reports and technology assessments (AHRQ, 2004a,b). Such reviews can form the foundation of evidence-based guidelines. Profes-



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