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End-of-life care extends beyond physical treatments to include supportive psychological, spiritual, and emotional care, and the goals of care shift from the quantity of life to the quality of life and symptom relief.
Providers of Cancer Care
It is common for cancer patients to see a number of specialist providers during the course of cancer care. Interdisciplinary care refers to the reliance on health care and other providers with a range of backgrounds and expertise. An interdisciplinary cancer care team might include an oncology nurse, pathologist, radiation oncologist, medical oncologist, surgeon, nutritionist, social worker, occupational therapist, pastoral counselor, hospice volunteer, and pain management team made up of physicians, nurses, and pharmacists. Individuals being cared for in a cancer center may have the most direct access to the full range of cancer care providers. In other settings—for example, rural areas—a community-based primary care provider may become the local member of a geographically dispersed team and, through communication, serve as a link between these providers and patients.
A wide range of physicians can be involved in cancer care, from pathologists, radiologists, surgeons, and medical oncologists, to specialists in pain management. It is difficult to obtain a precise count, but there are roughly 10,000 cancer physician specialists according to information from medical boards, the American Medical Association's (AMA's) annual survey of physicians, and the American Society of Clinical Oncology (ASCO).
Specialty medical boards are private, voluntary, nonprofit organizations founded to conduct examinations and issue certificates of qualifications. As of 1997, four medical specialty boards had certified nearly 10,000 cancer specialists:
The American Board of Internal Medicine had certified 6,550 medical oncologists.
The American Board of Radiology had certified 1,468 radiation oncologists.
The American Board of Pediatrics had certified 1,348 pediatric hematology oncologists.
The American Board of Obstetrics and Gynecology had certified 568 gynecologic oncologists.
Many practicing "oncologists" are not board certified as such. For example, among physicians identifying themselves as radiation oncologists on the AMA survey, as many as one-quarter were not certified by the American Board on Radiology (AMA, 1997). The reasons experienced oncologists might not be board certified include age (board certification is relatively recent) and primary involvement in research activities rather than patient care. Board certification is used as a quality indicator for physicians, but subspecialty certification is not always available for cancer specialists (e.g., there is no board certification for surgical oncology).
According to the AMA, in 1996 there were an estimated 6,731 self-identified medical oncology specialists representing 1 percent of the U.S. physician workforce. Nearly all of these oncologists (87 percent) were involved in patient care, and of these, more than three-quarters (77 percent) were in office-based practices. An estimated 8 percent of oncologists were primarily clinical researchers (AMA, 1998).
As of 1997, about 9,000 U.S.-based physicians belonged to the American Society of Clinical Oncology, the largest professional society dedicated to clinical oncology issues (Linda Mock, American Society of Clinical Oncology, personal communication to Mafia Hewitt, March 1998).