Proceedings of a Workshop
NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by Contract No. 75D30121D11240 (Task Order Nos. 75D30121F00002 and 75D30123F00024) and Contract No. HHSN263201800029I (Task Order Nos. HHSN26300008 and 75N98023F00019) with the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the American Association for Cancer Research; American Cancer Society; American College of Radiology; American Society of Clinical Oncology; Association of American Cancer Institutes; Association of Community Cancer Centers; Flatiron Health; Merck & Co., Inc.; National Comprehensive Cancer Network; National Patient Advocate Foundation; Novartis Oncology; Oncology Nursing Society; Partners in Health; Pfizer Inc.; Sanofi; and Society for Immunotherapy of Cancer. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-71912-4
International Standard Book Number-10: 0-309-71912-7
Digital Object Identifier: https://doi.org/10.17226/27769
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Developing a multidisciplinary and multispecialty workforce for patients with cancer, from diagnosis to survivorship: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27769.
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PLANNING COMMITTEE1
LARISSA NEKHLYUDOV (Co-Chair), Brigham and Women’s Hospital; Dana-Farber Cancer Institute; Harvard Medical School
LAWRENCE N. SHULMAN (Co-Chair), University of Pennsylvania
KAREN BASEN-ENGQUIST, The University of Texas MD Anderson Cancer Center
SMITA BHATIA, University of Alabama, Birmingham
ROBERT CARLSON, National Comprehensive Cancer Network
GWEN DARIEN, National Patient Advocate Foundation
ANITA GUPTA, Johns Hopkins University
CHANITA HUGHES-HALBERT, University of Southern California
RANDY A. JONES, University of Virginia
RANDALL A. OYER, University of Pennsylvania; Penn Medicine Lancaster General Health
SUSAN M. SCHNEIDER, Duke University
ROBERT A. WINN, Virginia Commonwealth University
ROBIN YABROFF, American Cancer Society
Project Staff
ANNA ADLER, Senior Program Assistant (from September 2023)
LORI BENJAMIN BRENIG, Research Associate (until May 2023)
TORRIE BROWN, Program Coordinator
CHIDINMA CHUKWURAH, Senior Program Assistant (until April 2024)
EMMA WICKLAND, Research Associate (from September 2023)
JULIE WILTSHIRE, Senior Finance Business Partner
JENNIFER ZHU, Associate Program Officer
PATRICIA CUFF, Director, Global Forum on Innovation in Health Professional Education
ERIN BALOGH, Co-Director, National Cancer Policy Forum (until June 2024)
LAURENE GRAIG, Senior Program Officer (June–July 2024)
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
FRANCIS AMANKWAH, Co-Director, National Cancer Policy Forum (from July 2024)
SHARYL NASS, Co-Director, National Cancer Policy Forum; Senior Director, Board on Health Care Services
NATIONAL CANCER POLICY FORUM1
ROBERT A. WINN (Chair), Virginia Commonwealth University
PETER C. ADAMSON, Sanofi
JUSTIN E. BEKELMAN, University of Pennsylvania
SMITA BHATIA, The University of Alabama at Birmingham
GIDEON BLUMENTHAL, Merck
CHRIS BOSHOFF, Pfizer Inc.
OTIS W. BRAWLEY, Johns Hopkins University
CHRISTINA CHAPMAN, Baylor College of Medicine; Michael E. DeBakey VA Medical Center
GWEN DARIEN, National Patient Advocate Foundation
CRYSTAL DENLINGER, National Comprehensive Cancer Network
JAMES H. DOROSHOW, National Cancer Institute
S. GAIL ECKHARDT, The University of Texas at Austin
CHRISTOPHER R. FRIESE, University of Michigan
STANTON L. GERSON, Case Western Reserve University
SCARLETT LIN GOMEZ, University of California, San Francisco
JULIE R. GRALOW, American Society of Clinical Oncology
ROY S. HERBST, Yale University; American Association for Cancer Research
HEDVIG HRICAK, Memorial Sloan Kettering Cancer Center
CHANITA HUGHES-HALBERT, University of Southern California
ROY A. JENSEN, University of Kansas; Association of American Cancer Institutes
RANDY A. JONES, University of Virginia
BETH Y. KARLAN, University of California, Los Angeles
SAMIR N. KHLEIF, Georgetown University; Society for Immunotherapy of Cancer
SCOTT M. LIPPMAN, University of California, San Diego
ELENA MARTINEZ, University of California, San Diego
LARISSA NEKHLYUDOV, Brigham and Women’s Hospital; Dana-Farber Cancer Institute; Harvard Medical School
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
RANDALL A. OYER, University of Pennsylvania; Penn Medicine Lancaster General Health; Association of Community Cancer Centers
CLEO A. RYALS, Flatiron Health
RICHARD L. SCHILSKY, ASCO TAPUR Study; University of Chicago
JULIE SCHNEIDER, Oncology Center of Excellence, U.S. Food and Drug Administration
SUSAN M. SCHNEIDER, Duke University
LAWRENCE N. SHULMAN, University of Pennsylvania
HEIDI SMITH, Novartis Pharmaceuticals
KATRINA TRIVERS, Centers for Disease Control and Prevention
ROBIN YABROFF, American Cancer Society
Forum Staff
ANNA ADLER, Senior Program Assistant
TORRIE BROWN, Program Coordinator
CHIDINMA CHUKWURAH, Senior Program Assistant (until April 2024)
EMMA WICKLAND, Research Associate
JULIE WILTSHIRE, Senior Finance Business Partner
JENNIFER ZHU, Associate Program Officer
ERIN BALOGH, Co-Director, National Cancer Policy Forum (until June 2024)
LAURENE GRAIG, Senior Program Officer (June–July 2024)
FRANCIS AMANKWAH, Co-Director, National Cancer Policy Forum (from July 2024)
SHARYL NASS, Co-Director, National Cancer Policy Forum; Senior Director, Board on Health Care Services
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this report:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this proceedings was overseen by PATRICIA GANZ, University of California, Los Angeles. She was responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
We also thank staff member Abigail Allen for reading and providing helpful comments on this manuscript.
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Acknowledgments
The National Cancer Policy Forum is grateful for the support of our many annual sponsors. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Nonfederal sponsors include the American Association for Cancer Research; American Cancer Society; American College of Radiology; American Society of Clinical Oncology; Association of American Cancer Institutes; Association of Community Cancer Centers; Flatiron Health; Merck & Co., Inc.; National Comprehensive Cancer Network; National Patient Advocate Foundation; Novartis Oncology; Oncology Nursing Society; Partners in Health; Pfizer Inc.; Sanofi; and Society for Immunotherapy of Cancer.
The forum wishes to express its gratitude to the expert speakers whose presentations and discussions helped inform efforts to improve equitable access to multispeciality, multidisciplinary care for patients living with and beyond cancer. The forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.
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Contents
IMPROVING MULTIDISCIPLINARY AND MULTISPECIALTY CARE IN THE CANCER CARE CONTINUUM
Common Challenges Facing Cancer Survivors
The Role of Specialty Care and the Need for Coordination
Advancing Multidisciplinary, Multispecialty Care
EDUCATION AND TRAINING OPPORTUNITIES
Interprofessional Collaborative Practice and Interprofessional Education
Project ECHO: Capacity Building for PCPs in Cancer Survivorship Care
ENGAGE: Person-Centered Coordinated Care at the Intersection of Cancer and Mental Health
The Impetus and Challenge of System-Level Interventions to Support Survivorship
Integration of Health Systems for Better Cancer Survivorship Care
Leveraging Data and Technology
Learning from Other Fields of Medicine
System-Level Efforts to Reduce Health Disparities
POLICY, PAYMENT, AND ADVOCACY OPPORTUNITIES
The Human Toll of Policy and Payment Challenges
Closing Gaps in Insurance Coverage for Survivorship Care
Ideas and Efforts to Improve Payment and Service Delivery Models
Policy Options to Facilitate Care Coordination and Navigation
The Power of Perceptions of Value on Patient-, Clinician-, and System-Level Decisions
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Acronyms and Abbreviations
| ACA | Affordable Care Act |
| AI | artificial intelligence |
| APP | advanced practice provider |
| ASCO | American Society of Clinical Oncology |
| CARG | Cancer and Aging Research Group |
| CHC | community health center |
| CHOP | Children’s Hospital of Pennsylvania |
| CMS | Centers for Medicare & Medicaid Services |
| CoC | Commission on Cancer |
| CVD | cardiovascular disease |
| ECANA | Endometrial Cancer Action Network for African Americans |
| ECHO | Extension of Community Health Outcomes |
| EHR | electronic health record |
| EOM | Enhancing Oncology Model |
| ePRO | electronic patient-reported outcome |
| FQHC | federally qualified health center |
| IPCP | interprofessional collaborative practice |
| IPE | interprofessional education |
| ML | machine learning |
| NCCN | National Comprehensive Cancer Network |
| NCI | National Cancer Institute |
| NLP | natural language processing |
| PCP | primary care provider/physician |
| PRO | patient-reported outcome |
| PT | physical therapy/therapist |
| SDOH | social determinants of health |
