centers offered group support programs (Presberg and Levenson, 1993; Coluzzi et al., 1995; Gruman and Convissor, 1995). A recent survey on genetics services at NCI clinical and comprehensive cancer centers indicates that that most centers provide such services for evaluation of familial cancer (82 percent) (Epplein et al., 2005).
Most people with cancer are treated in community hospitals close to their homes. In an effort to assure the quality of cancer care throughout the nation, the American College of Surgeons in 1922 established a Commission on Cancer (CoC) that sets standards for quality multidisciplinary cancer care, surveys hospitals to assess compliance with those standards, collects data from approved hospitals to measure treatment patterns and outcomes, and uses the data to improve cancer care outcomes at the national and local levels (Personal communication, K. Phair, Cancer Liaison Program Administrator, CoC, November 9, 2004).10 As of 2003, there were more than 1,400 CoC-approved cancer programs in the United States and Puerto Rico, representing nearly 25 percent of all hospitals (CoC, 2003). More than 70 percent of all newly diagnosed cancer patients are treated in CoC-approved cancer programs, either as an inpatient or when visiting an outpatient hospital-based practice or clinic. Some of the CoC standards pertain to services of potential benefit to cancer survivors (Box 4-3).
CoC staff provided information to the committee on the supportive care services offered at CoC-approved facilities in the previous year. The information provided is self-reported by the institutions on a web-based application, which is updated twice a year (Personal communication, K. Phair, Cancer Liaison Program Administrator, CoC, November 9, 2004). Cancer centers submit detailed information on their programs in advance of their onsite survey. A service was considered to be present if it was provided at the facility, in a staff physician’s office, or by referral. At least some level of supportive care was available through the reporting sites, for example, psychology and mental health providers were available in 88 percent of programs, a pain management service was available in 92 percent of programs, and lymphedema rehabilitation services were available in 77 percent of programs (Table 4-9).