useful action item for the next 2 to 3 years would be to conduct some demonstration projects, evaluate them, publicize the results, and then move toward standardizing the practice. It may be the case that the imperative for care planning will be established nationally in the next two to three years, but it is also likely that local initiatives will be needed to motivate change at the national level. As demonstrations are proceeding, business models must be developed to sustain survivorship care planning.

Dr. Demark-Wahnefried suggested that for states to take an active role, CDC will have to encourage demonstration projects on survivorship. Dr. Pollack said that while CDC is very interested in this area, they have no dedicated funds for survivorship projects.

Dr. Byers pointed out that CDC does not have the resources for 98 percent of the items that are in cancer plans. This is why diversification is necessary. Dedicated tobacco tax revenues, the private sector, and nongovernmental organizations can be mobilized to support the implementation of these plans.

Dr. William Kraybill identified another potential partner in state or regional cancer control, the American College of Surgeons’ Commission on Cancer (ACS-COC). Most large and small cancer programs around the country are organized in a multidisciplinary fashion and abide by a set of standards promulgated by the ACS-COC. They are partially funded by the American Cancer Society and are likely to be enthusiastic about moving survivorship forward. Dr. Byers agreed and suggested that the combination of the American Cancer Society, the ACS-COC, and the state tumor registries represent a potentially powerful triad that has not been fully taken advantage of.

Dr. James Talcott characterized survivorship as crosscutting and mentioned organizational barriers that make it difficult to cut across disease entities. Academic medicine is often organized by disease, and often, one must duplicate effort for breast cancer, prostate cancer, lymphoma, and every other oncology subspecialty. It is sometimes hard to engage in activities that cut across diagnoses. There are almost no opportunities for researchers to work with other investigators who are doing the same thing “one disease over.”

Finally, Dr. Byers discussed how the traditional public health role of surveillance could be enhanced to further survivorship care planning. Perhaps methods could be devised to routinely monitor outcomes of confusion, anxiety, fatigue, dissatisfaction with care, and poor quality care. Survivorship-related quality-of-care measures could include those related to poor transitions in care or underuse of tamoxifen among women with breast cancer who were prescribed the medication. Cancer registries could be monitoring outcomes after cancer apart from death and (in some) recurrence. Demonstration projects on enhanced cancer registration to capture



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