internist, but at least we know to call somebody when we get in over our heads. But down the road a piece, you need even more give and take. And long-term, I think there are still reasons to follow people once a year. It is not very often that they will touch base with their oncologist. I hope when people do studies of survivorship care, they will look not only at whether screening tests were getting done, but also whether late relapses are picked up quickly. We also need to consider reassurance of the patient, because many patients just like that sort of connection still with their old oncologist. Which is very important just to reassure them that when their best friend down the block gets a brain mass from a breast cancer 20 years ago, that it is not going to happen to them given their circumstances.

Dr. Benjamin: I agree with your points, particularly, your point that it is not an either/or situation. It is both. And it is this team concept that we oftentimes find in medicine. If someone has a heart attack, I send them to a cardiologist. But they come back. And if a year later they start to have some chest pain and symptoms, I send them back to the cardiologist. The same thing should occur with cancer. When you need them, you need to be able to refer them back, and it should not be either/or, it should be both.

Dr. Woolf: In the interest of time, because we have to break for lunch, let me just make John’s the last question. I am sure the panel will be available afterwards.

Dr. John Ayanian: My question is in follow-up to Regina’s point. And that, as we talk about these models of shared care, I think it is going to be very important to bring the primary care physician organizations to the table in partnership with ASCO. It will not be enough for ASCO to educate its members, the American College of Physicians, the American Academy of Famliy Physicians, and the Society of General Internal Medicine. Essentially the AMA (American Medical Association) is an overarching organization that brings physicians from different disciplines and fields together. I think there is a good model for this in terms of the way the American Heart Association, the American College of Cardiology, and the American College of Physicians have worked together on evidence-based guidelines for patients with heart disease. They together bring both the primary care and specialty care perspective to the table to weigh the evidence as a group to get to what the guidelines should be, and the models of care. So, my question would be what can we do, what will it take to bring the leading organizations of primary care physicians into this process? I think many primary care physicians are just grappling with the needs of cancer survivors in the ways as best they can as individuals. But we haven’t really made this



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