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Ambulatory Cancer Care Providers
National data on ambulatory medical care is available from two large surveys conducted by the National Center for Health Statistics, the National Ambulatory Medical Care Survey (NAMCS), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) (Schappert, 1997). Only nonfederally employed physicians are included in the NAMCS sample and certain specialties are excluded—anesthesiologists, pathologists, and radiologists. Clinics specializing in radiology were excluded from the NHAMCS. Radiologists are important providers of cancer care and their omission limits the interpretation of cancer-specific analyses. Nevertheless, data from these surveys are presented to obtain some insights into the characteristics of adult ambulatory cancer care provided in physician office-based practices and hospital outpatient departments (care provided in hospital emergency rooms was excluded from the following analyses).
Each year, an estimated 19 million adults (age 25 and older) visit physicians' offices and hospital outpatient departments for cancer care.1 These visits represent 3 percent of adult ambulatory care visits. The five physician specialties (excluding radiologists) providing most adult office-based ambulatory cancer care are the following (Table 2.2):
primary care providers,
The predominant physician provider (excluding radiologists) of adult ambulatory cancer care varies by type of cancer (see Table 2.2):
Urologists are the main providers of ambulatory care for adults with prostate cancer (72 percent of visits).
Dermatologists are the main providers of ambulatory care for adults with skin cancer (nonmelanoma) (67 percent of visits).
Oncologists see roughly one-half of adults with cancer of the lung or larynx (46 percent of visits), female breast (45 percent visits), and colorectal cancer (51 percent of visits), and nearly two-thirds of adults seeking care for lymphoma or leukemia (73 percent of visits).
This annual estimate represents the 3-year average (1994-1996) for visits for which the primary reason for the visit was care for malignant neoplasms, International Classification of Diseases (ICD-9) codes 140 to 208. The diagnosis represents the physician's best judgment at the time of the visit and could have been tentative, provisional, or definitive. Excluded from this estimate are cancer-related visits made by individuals without a diagnosis of cancer (e.g., for cancer screening tests).