of cancer survivors, it is likely that additional health personnel will be needed, particularly nurses with advanced oncology training. Online resources are increasingly available and appear to be an attractive means of reaching multiple provider audiences, but the effectiveness of this and other approaches needs to be assessed. Limited financial support has been available through public and private sectors for survivorship-related education and training.

Recommendation 7: The National Cancer Institute (NCI), professional associations, and voluntary organizations should expand and coordinate their efforts to provide educational opportunities to health care providers to equip them to address the health care and quality of life issues facing cancer survivors.

Efforts are needed to update undergraduate and graduate curricula for those in training and to provide continuing education for practicing providers of survivorship care. Continuing education is needed across many disciplines, but in order to ensure the provision of quality survivorship care, it is especially important to reach (1) medical oncologists, hematologists, urologists, surgeons, and radiation oncologists who initially treat cancer patients; (2) primary care physicians; (3) nurses; and (4) social workers and other providers of psychosocial services.

To augment the supply of nurses who could provide survivorship care, the committee recommends increasing the number of nursing schools that provide graduate training in oncology, providing incentives to nurses who seek certification in oncology, and supporting general efforts to ease the nursing shortage. To ensure access to psychosocial services, continuing education opportunities are needed for social workers and other mental health providers. In addition, efforts are needed to maintain social services in cancer programs. Detailed recommendations on professional education by health care specialty are outlined in Chapter 5.

ADDRESSING EMPLOYMENT-RELATED CONCERNS

Most cancer patients who are working require some kind of accommodation to work throughout treatment, and some experience difficulties at work after treatment. Estimates of the impact of cancer on employment vary. The majority of cancer survivors who worked before their diagnosis return to work following their treatment. However, as many as one in five individuals who work at the time of diagnosis have cancer-related limitations in ability to work 1 to 5 years later. Half of those with limitations are unable to work at all.

All survivors are at risk of experiencing subtle, although not necessarily blatant, employment discrimination. Federal laws enacted in the 1990s



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