Innovations in health care for cancer survivors: let's learn from the past.

New approaches to improve the health and wellbeing of cancer survivors in all stages of survival are on the rise. But there is so much more to do. There is a rich past in the development of integrative clinical services and health services research, particularly related to chronic illness that can inform these new efforts. For example, since the early 1980s, many practitioners and researchers have been involved in the development of multidisciplinary programs, clinics, centers, and integrated primary care efforts to address complex multiply determined problems in chronic illness. They have much to teach us. While we do not yet know the optimal mix, operational details, and cost impact of services needed to maximize long-term outcomes in cancer survivors, lessons from the past with other chronic illnesses can help inform us. We do not have to repeat many of the errors encountered by these earlier efforts. Clearly, it is important that we develop new ways to manage and prevent the long term and late health and behavioral problems of cancer survivors [1]. Yet, these development efforts need to be cognizant of challenges experienced in providing comprehensive care to those with other chronic illness (e.g., cardiovascular disease, arthritis, recurrent and chronic pain disorders, and diabetes) [2, 3]. My point is simple. Let’s learn from the successes and failures of these previous efforts. This should help us move forward at a faster rate with fewer mistakes as various groups develop and implement effective, practical, and economically feasible approaches for cancer survivors. As I speak to oncologists, internists, nurse clinicians, behavioral health specialists, insurance, or health care administrators, I hear many of the concerns I used to hear when a group of us developed a multidisciplinary pain treatment center at the University of Rochester Medical Center in the early 1980s and a multidisciplinary rehabilitation center for injured workers in the 1990s. Comments from provider colleagues included, “I can handle all these problems within my existing practice, I don’t see any need to refer out unless there is really something major that I really can’t manage” and “I think the idea of working alongside others as a team is great, but I really need to make certain my productivity stays up and this might impact it given the extra time it takes.” We also heard such concerns as, “An integrated report after evaluation... who will really read it?” “Who is going to pull the report together and how much time will that take?” or “Can all these services be reimbursed or how will they be paid for?” In meetings with many insurance carriers we heard such comments as, “Sounds great, but I’m not covering all these different services...it’s not necessary,” “Where are the clinical guidelines that warrant this? Where is the evidence?” or “The services are too experimental at this point.” These are valid points that all need to be attended to. Some other comments I have heard recently regarding cancer survivorship services that sound all too familiar are: “We schedule the team in our new cancer survivor clinic and patients tell us all this attention really isn’t necessary and then they don’t come back,” or a hospital administrator recently told me, “While it is clear that we have the clinical staff to do this, and the business plan specifies proposed resources, I wonder what is really needed (e.g., extent of space, scheduling, billing, collections, marketing) and for how long?” “Will it ever be profitable and when do we really think it will breakeven?” “What do different models of the business plan look like?” Another perspective I have J Cancer Surviv (2007) 1:177–178 DOI 10.1007/s11764-007-0028-8