loop in the early stages of cancer care. The cancer survivorship care plan as well as the clinical guidelines could really help primary care physicians treat their cancer patients a lot better. When available, they will be great tools.

During our discussion, members of the audience talked about case management and how the burden of the decision regarding management is often handled by the family. Family members may be put in that position, but this gatekeeper role may, or may not, be appropriate. Sometimes patient loyalty steps in. A patient may feel guilty for going to get another opinion, or going to another physician. And we need to keep these responses in mind when we are building any kind of model.

We also discussed communication issues and the need for both professional education and training and guidelines to improve knowledge of survivorship amongst physicians. Ultimately, we need relevant care available at the time people need it, and when they need it.

The shared care model was discussed and I would like to say that in family medicine particularly, and most of primary care, we have used that model for a long time, but we just haven’t called it shared care. When I have a patient that has a heart attack, I send him to a cardiologist. He is not the cardiologist’s patient, and I do not lose my patient. We both treat that patient. If the patient subsequently has chest pain or has other symptoms in a year, I send the patient back to the cardiologist. So, the shared care model exists, we just need to use it a lot more. And in the research arena, we really should be looking at the intersection of primary care and oncology care.

In summary, as oncologists and as primary care physicians we have to provide better care and support for our patients. Oncologists can not do it alone, and primary care physicians can not do it alone. And we owe it to our patients to improve communications and our care.

Dr. Greenfield: Thank you, Regina. And thank you again for leaving your busy practice to join us today. Dr. Ganz, will you discuss your first breakout session on testing models of survivorship care?


Moderator: Patricia Ganz, University of California, Los Angeles

During our session, Steven Woolf discussed the shared care model, and Regina Benjamin did a very nice job covering that topic, so I will not spend more time on that. We had presentations from Linda Jacobs, who is the director of the Living Well After Cancer Program at the University of Pennsylvania Abramson Cancer Center. This program was established about five years ago so it is the oldest contemporary cancer survivor clinic. Several different strategies for incorporating survivorship care into patient

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