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A STRONGER CANCER CENTERS PROGRAM A report of a committee of the INSTITUTE OF MEDICINE Division of Health Care Services National Academy Press Washington, D.C. 1989

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identifying issues of medical care, research, and education. This study was supported by the National Institutes of Health, U.S. Department of Health and Human Services, through Contract No. N01-OD- 9-2104. 2101 Constitution Ave., N.W. Washington, D.C. 20418 (202) 334-3300 Publication TOM-89-03

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INSTITUTE OF MEDICINE Division of Health Care Services Committee to Study the Cancer Centers Program of the National Cancer Institute CHARLES C. SPRAGUE,* (Chairman), President Emeritus, University of Texas Health Science Center at Dallas IVAN L. BENNETT, JR.,* Professor, New York University Medical School, New York GERARD N. BURROW, Vice Chancellor for Health Sciences and Dean of the School of Medicine, University of California at San Diego, Ida JoBa MARY E. CHARI SON, Associate Professor of Medicine and Director, Clinical Epidemiology Unit, Cornell University Medical College, New York RICHARD A. COOPER, Executive Vice President and Dean of the Medical College of Wisconsin, Milwaukee ROBERT W. DAY, Director, Fred Hutchinson Cancer Research Center, Seattle M. ALFRED HAYNES,* Director, Drew/Meharry/Morehouse Consortium Cancer Center, Los Angeles JEAN E. JOHNSON,* Professor and Associate Director for Nursing Oncology, University of Rochester Cancer Center, Rochester ARNOLD KALUZNY, Professor, School of Public Health, and Research Associate, Health Services Research Center, University of North Carolina at Chapel Hill ALBERT H. OWENS, JR., Director, Johns Hopkins Oncology Center, Johns Hopkins Hospital, Baltimore BENNO C. SCHMIDT,* Managing Partner, I. H. Whitney & Co., New York ROBERT E. SPALLONE, Administrator, Basic Science and Laboratory Operations, Fox Chase Cancer Center, Philadelphia NATALIE DAVIS SPINGARN, Health and Social Policy Writer and Consultant, Washington, D.C. JONATHAN W. UHR, Chairman, Department of Microbiology, University of Texas Health Science Center at Dallas *Member, Institute of Medicine .

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IOM Staff KARL D. YORDY, Director, Division of Health Care Services MICHAEL G. H. MCGEARY, Study Director CARLOTTA CRAIG MOLITOR, Research Associate DEBORAH FULCHER, Administrative Secretary ROBERT A. WALKINGTON, Consultant LINDA R. LIPSON, Consultant 1V