TABLE 4-3 Proportion of Adult Cancer-Related Ambulatory Care Visits for Which Care Was Shared by Other Physicians, by Site of Care, United States, 2001–2002a



Physician Office-Based Visits

Hospital Outpatient Department Visits

Annual number of visits (in 1,000s)




Other physicians share care for problem (%)














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 outpatient 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.

believe that it is their obligation to follow up on their patients and that patients prefer to see them for their cancer-related care, even when that care could be provided by a primary care physician. They may also question the ability of primary care physicians to handle all components of follow-up care (e.g., detection of recurrence) (Steinberg and Rose, 1996). For their part, primary care physicians may not have been informed by care specialists of the important role they have to play in the ongoing care of cancer survivors. A balance between primary care and specialty care is clearly needed, as evidenced by the research of Earle and colleagues cited above (Earle et al., 2003; Earle and Neville, 2004).

Studies of shared cancer follow-up care in the United States are limited. According to national surveys, U.S. physicians report that care is shared by other physicians for nearly half (47 percent) of cancer-related visits (Table 4-3).7 Shared care is reported more often by physicians in hospital outpa-


Information is not available on the nature of the shared care described. For example, physicians reporting that other physicians share care for the problem may be referring to sharing care within their own group practice or sharing care with other physicians outside of their practice.

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