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From Cancer Patient to Cancer Survivor: Lost in Transition
Research Programs (CDMRP) to administer these funds. Between FY 1992 and 2004, $1.65 billion has been appropriated by Congress to DoD for research on breast cancer (DoD, 2004a). In addition, $10.3 million has been generated in sales of the U.S. Postal Service’s first-class stamp (Pub. L. No. 105–41, Stamp Out Breast Cancer Act [H.R. 1585]). Since 1997, Congress has appropriated money to fund peer-reviewed research for prostate cancer ($565 million appropriated to date), ovarian cancer ($81 million), and chronic myelogenous leukemia ($13.5 million). The CDMRP attempts to identify gaps in funding and provide award opportunities that will enhance program research objectives without duplicating existing funding opportunities. A number of funded research projects are related to cancer survivorship, including those focused on quality of life and symptom management (DoD, 2004b). Training grants are available through CDMRP and have include those related to psycho-oncology.
Agency for Healthcare Research and Quality
AHRQ has published evidence reports on the management of cancer symptoms (i.e., pain, depression, and fatigue) and the effectiveness of behavioral interventions to modify physical activity behaviors in cancer patients and survivors (AHRQ, 2002b, 2004a). Additional syntheses related to survivorship may be forthcoming because cancer is among the 10 top conditions affecting Medicare beneficiaries and therefore, the subject of a new AHRQ initiative. State-of-the art information about the effectiveness of interventions for these conditions will be developed, including reviews of prescription drugs. Funding for the initiative was authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Systematic reviews and syntheses of the scientific literature will focus on the evidence of outcomes, comparative clinical effectiveness, and appropriateness of health care items such as pharmaceuticals and health care services, including the manner in which they are organized, managed, and delivered (AHRQ, 2004b).
Two large research networks supported by AHRQ could provide opportunities for survivorship research. The Primary Care Practice-based Research Networks (PBRNs) provide opportunities to examine care within primary care settings. Together, the 19 PBRNs provide access to more than 5,000 primary care providers and nearly 7 million patients across the United States (AHRQ, 2001). Among the research that has been conducted within PBRNs is a study of the coordination between referring physicians and specialists (Forrest et al., 2000). The Integrated Delivery System Research Network (IDSRN) is a model of field-based research that links researchers with large health care systems to conduct research (AHRQ, 2002a). As a group, the IDSRN provides health services in a wide variety of organiza-