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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/27769.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Developing a Multidisciplinary and Multispecialty Workforce for Patients with Cancer, from Diagnosis to Survivorship Erin Balogh, Laurene Graig, Anne Johnson, and Sharyl Nass, Rapporteurs National Cancer Policy Forum Board on Health Care Services Global Forum on Innovation in Health Professional Education Board on Global Health Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs 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-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/27769 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2024 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academies of Sciences. All rights reserved. Printed in the United States of America. 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. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

PLANNING COMMITTEE1 LARISSA NEKHLYUDOV (Co-chair), Brigham and Women’s Hospital; Dana-Farber Cancer Institute; Harvard Medical School LAWRENCE 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 JONES, University of Virginia RANDALL OYER, University of Pennsylvania; Penn Medicine Lancaster General Health SUSAN SCHNEIDER, Duke University ROBERT 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 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 SHARYL NASS, Co-Director, National Cancer Policy Forum; Senior Director, Board on Health Care Services 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing s­ peakers. The responsibility for the published Proceedings of a Workshop rests with the workshop ­rapporteurs and the institution. v PREPUBLICATION COPY—Uncorrected Proofs

vi PREPUBLICATION COPY—Uncorrected Proofs

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 round- tables 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. vii PREPUBLICATION COPY—Uncorrected Proofs

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 EMMA WICKLAND, Research Associate JULIE WILTSHIRE, Senior Finance Business Partner JENNIFER ZHU, Associate Program Officer ERIN BALOGH, Co-Director, National Cancer Policy Forum SHARYL NASS, Co-Director, National Cancer Policy Forum; Senior Director, Board on Health Care Services viii PREPUBLICATION COPY—Uncorrected Proofs

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 mak- ing 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: DAVID DOUGHERTY, University of Pennsylvania HILARY Y. MA, MD Anderson Cancer Center WILLIAM PIRL, Harvard Medical School Although the reviewers listed above provided many constructive com- ments 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 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 help- ful comments on this manuscript. ix PREPUBLICATION COPY—Uncorrected Proofs

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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 commit- tee for their work in developing an excellent workshop agenda. xi PREPUBLICATION COPY—Uncorrected Proofs

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Contents ACRONYMS AND ABBREVIATIONS xvii PROCEEDINGS OF A WORKSHOP 1 OVERVIEW 1 IMPROVING MULTIDISCIPLINARY AND MULTISPECIALTY CARE IN THE CANCER CARE CONTINUUM 3 Common Challenges Facing Cancer Survivors, 3 The Role of Specialty Care and the Need for Coordination, 10 Addressing Disparities, 22 Advancing Multidisciplinary, Multispecialty Care, 23 EDUCATION AND TRAINING OPPORTUNITIES 24 Interprofessional Collaborative Practice and Interprofessional Education, 25 The Cancer and Aging Research Group (CARG): An Education and Training Network to Facilitate Multidisciplinary, Multispecialty Expert Care, 28 Project ECHO: Capacity Building for PCPs in Cancer Survivorship Care, 29 ENGAGE: Person-Centered Coordinated Care at the Intersection of Cancer and Mental Health, 30 Supporting Training to Prioritize Access to Care, 30 xiii PREPUBLICATION COPY—Uncorrected Proofs

xiv CONTENTS HEALTH SYSTEM OPPORTUNITIES 31 The Impetus and Challenge of System-Level Interventions to Support Survivorship, 31 Integration of Health Systems for Better Cancer Survivorship Care, 32 Leveraging Data and Technology, 35 Learning from Other Fields of Medicine, 36 System-Level Efforts to Reduce Health Disparities, 36 POLICY, PAYMENT, AND ADVOCACY OPPORTUNITIES 37 The Human Toll of Policy and Payment Challenges, 38 Closing Gaps in Insurance Coverage for Survivorship Care, 39 Ideas and Efforts to Improve Payment and Service Delivery Models, 41 Policy Options to Facilitate Care Coordination and Navigation, 43 Alternative Payment Models, 44 The Power of Perceptions of Value on Patient-, Clinician-, and System-Level Decisions, 44 Facilitating Effective Team-Based Care, 45 The Quest for Equity, 46 CLOSING DISCUSSION 46 REFERENCES 48 APPENDIXES A Statement of Task 59 B Workshop Agenda 61 PREPUBLICATION COPY—Uncorrected Proofs

Boxes and Figures BOXES 1 Observations from Individual Workshop Speakers Regarding the Importance and Challenges of Providing Multispecialty, Multidisciplinary Care for Cancer Survivors, 4 2 Suggestions from Individual Workshop Speakers Regarding Ways to Improve the Provision of Multispecialty, Multidisciplinary Care for Cancer Survivors, 5 3 Experiences Shared by Cancer Survivors, 8 FIGURES 1 U.S. cancer survivors by years from diagnosis, 9 2 Strategies to mitigate inequities and disparities at the intersection of cardiovascular disease and cancer, 14 3 An example risk stratification workflow for cancer survivorship care, 19 4 Conceptual schematic illustrating a multiteam framework for collaborative cancer care, 27 5 Conceptual diagram highlighting areas for which return on investment (ROI) from efforts to improve survivorship care can be assessed across the health system, 33 6 Five-year survival following cancer diagnosis in the United States by socioeconomic status quintile, 38 7 Percentage of adults age 19–64 years without health insurance coverage by state, 40 xv PREPUBLICATION COPY—Uncorrected Proofs

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Acronyms and Abbreviations ACA Affordable Care Act AI artificial intelligence APP advanced practice providers 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 records EOM Enhancing Oncology Model FQHC federally qualified health center IPCP interprofessional collaborative practice IPE interprofessional education ML machine learning xvii PREPUBLICATION COPY—Uncorrected Proofs

xviii ACRONYMS AND ABBREVIATIONS 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 PREPUBLICATION COPY—Uncorrected Proofs

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Patients living with and beyond cancer often require care from a wide range of clinicians as they navigate cancer diagnosis, treatment, and survivorship care. To examine opportunities to improve equitable access to high-quality multispecialty and multidisciplinary expert care for people living with and beyond cancer, the National Academies National Cancer Policy Forum hosted a public workshop in collaboration with the Global Forum on Innovation in Health Professional Education.

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