was provided by 1,036 clinics in 224 hospitals (overall response rate, 74 percent). In 2002, information on 35,586 patient visits was provided by 1,041 clinics in 224 hospitals (overall response rate, 75 percent). For each participating outpatient department clinic, a random sample of visits was obtained during a 4-week period. Excluded from the sampling frame of the hospital outpatient departments are clinics providing chemotherapy, radiation therapy, infusion therapy, physical medicine, and rehabilitation because, in these settings, much of the care is provided by nonphysician providers (e.g., oncology nurses, radiation technicians, physical therapists). The purpose of the surveys is to capture physician-patient encounters.
Investigators in Europe, Canada, and Australia have evaluated delivery system issues, often in an effort to improve national health programs. Much of the work of relevance to the delivery of cancer survivorship care comes from the United Kingdom, where cancer care is being reorganized and the results of restructuring efforts are being evaluated through clinical audits (Tattersall and Thomas, 1999). Here, traditional disciplinary divisions of medicine, surgery, obstetrics, and gynecology are being replaced by disease-and organ-based multidisciplinary groupings. The goals of the reorganization are to facilitate improvements in quality, reduce geographic disparities in outcomes of treatment, and provide better coordinated care.
As part of a major effort to gauge cancer patients’ experience with cancer within the British National Health System, a nationwide survey was conducted in 2000 (Airey et al., 2002). The survey covered access to care, diagnosis, first treatment, hospital care, and outpatient care.17 Some aspects of follow-up care were assessed as part of this survey:
19 percent of cancer patients reported that doctors and nurses did not spend enough time, or spent no time at all, telling them what would happen when they left the hospital after their first treatment.
26 percent of patients were not given written or printed information about what they should or shouldn’t do following their discharge.
36 percent of cancer patients were not told about a support or self-help group.