TABLE 4-1 The Provision of Counseling During Adult Cancer-Related Ambulatory Care Visits, United States, 2001–2002a



Annual number of visits (in 1,000s)


Services ordered or provided (% yes)


Mental health or psychotherapy


Diet counseling/education


Exercise counseling/education


Smoking cessation


Smoking cessation for visits made by patients who used tobacco


(9% of visits made by tobacco users)


aAdults were categorized as being aged 25 and older. Visits for non-melanoma skin cancer were excluded. Radiologists were excluded from the sample of office-based physicians. Clinics providing chemotherapy, radiotherapy, physical medicine, and rehabilitation were excluded from the sample of hospital out-patient departments.

SOURCE: Committee staff analyses of the 2001 and 2002 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. See Appendix 4B for details of analyses.

English, issues of health literacy are compounded by issues of basic communication and the specialized vocabulary used to convey health information. In addition, communication barriers may arise that relate to sociocultural differences between survivors and their health care providers (IOM, 2002). These differences may relate to commonly held attitudes, norms, beliefs, and practices for those with certain life experiences (e.g., poverty, membership in a racial or ethnic minority group) or environments (e.g., communities with poor access to health care services).

In summary, there is a limited amount of research regarding cancer survivors’ expectations and experience with their care following primary treatment. Available evidence points to systemic problems in health care delivery that in some cases lead to poor-quality care, such as underuse of post-treatment screening for cancer. When evaluated, problems in survivorship care appear to stem from a lack of coordination between primary care providers and cancer care providers. There is anecdotal evidence of general dissatisfaction with post-treatment care, with cancer survivors reporting too little attention being paid to their many psychosocial concerns, such as depression, fear of recurrence, sexual dysfunction, and financial issues. Why the expectations of cancer survivors are not being met is not clear, but factors that could be at play include a lack of recognition of the value of these aspects of care, the presence of communication barriers, and a lack of delineation of responsibility on the part of providers to address these con-

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