especially in outpatient settings (see Chapter 5), and the potential preference on the part of some cancer patients to receiving follow-up care from physicians.

A few academic centers have developed cancer survivorship clinics that concentrate needed expertise to provide follow-up care in one location. Such programs can facilitate the application of a holistic and coordinated approach to medical and psychosocial problems. One potential disadvantage of such clinics is the separation of survivorship care from other routine care and the attendant difficulties of communication and coordination. Selected attributes of the few clinics for survivors of adult cancers are described in Table 4-5.

According to representatives of these clinics, they are labor intensive and the respective roles of physicians and other personnel are not well established. Many of the services available in the clinics are provided by expert oncology nurses and nurse practitioners. A barrier to the dissemination of such clinics is the uncertainty regarding adequate reimbursement for