consideration of cost and may be useful, but as physicians, we do not like to hear about them. Pressures to reduce cost may limit the overuse of unnecessary services and free up resources to counter underuse of necessary services.

Dr. Susan Weiner: I am from the Children’s Cause for Cancer Advocacy. I was involved in the first survivorship report on childhood cancer. I would like to first congratulate everybody who worked on this report. It is an absolutely fabulous companion piece to the childhood cancer survivors report that the IOM produced about a year and a half ago. My question has to do with issues related to hand offs and transitions. Survivors of childhood cancer have problems that are more dramatic perhaps than those of adults. They develop and change, they grow, and they become adults, and they end up in clinicians’ practices. My question is for Dr. Ayanian, but also for the panel generally. I would like to know whether you would be willing to address the question of transition to adult care for childhood cancer survivors either in one of the breakout sessions or in whatever follow-up activities there are?

Dr. Ayanian: It is a great point that you raise, and something that I face in my clinical practice at Brigham Women’s Hospital across the street from Children’s Hospital of Boston. It is not infrequent that we care for survivors of childhood chronic disease, including cancer or other conditions such as sickle cell anemia or severe asthma, who then need to transition to adult care sometime in their late teens or early twenties. Because of their chronic condition, sometimes these adolescents and young adults end up with their pediatric providers into their late twenties and early thirties. It is certainly a topic that we need to pay more attention to. In areas of the country where pediatricians and internists are accustomed to working closely together, often in major academic centers, where children’s hospitals and adult hospitals are side by side, these centers should be leading the way in studying and developing new care models to ensure there is continuity of care. These young adults are a special group of patients who are particularly at risk of getting lost in transition and we need to pay more attention to them. From a professional standpoint, we have a growing number of people who are jointly trained in pediatrics and medicine, and many of them are starting to address questions just like the one you raised about how care should be transitioned for patients with childhood cancers who survive into adulthood.

Dr. Greenfield: Let’s have one more response, and then we’re going to have to close.

Dr. Winn: This issue came up during our committee’s deliberation. Who, for example, should follow childhood Hodgkin’s disease? Steve Woolf is



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