The 1986 Samuel C. Harvey lecture: partners in cancer education

I have attempted to highlight the important contributions of a voluntary health organization committed solely to cancer research, education, and patient service. The involvement of many thousands of volunteers has allowed the American Cancer Society to provide the country with a private sector alternative to government programs. Progress in cancer control through changes in lifestyle will not occur simply through the intervention of federal regulations. It will happen through private initiatives in neighborhoods across the country. It is in these communities that volunteers become the spark for the mission of cancer control. The financial contributions of millions of Americans along with their neighbors' enthusiasm and labors enable the American Cancer Society to provide all of us with vital ways to help ourselves, to train health professional leaders, and to unlock the mysteries of cancer through research. The American Cancer Society and the American Association for Cancer Education are truly partners in cancer education.     

The anticipated and unintended consequences of the patient protection and affordable care act on cancer research

Continued research is critical to build upon past improvements in mortality and morbidity from cancer. Provisions in the Patient Protection and Affordable Care Act (PPACA) of 2010 address health research that affect cancer research in many positive and some potentially negative ways. The impact of PPACA on cancer research must be viewed in the context of the federal economic situation and the ongoing reform of the American clinical trial system. Major components of PPACA affect cancer research including requiring insurance coverage of standard care provided as part of clinical trials, establishment and funding of the Patient Centered Outcomes Research Institute focused on comparative effectiveness research, and establishment of the Cures Acceleration Network to foster rapid translation of basic research to the bedside. This article reviews these programs, their strengths, and our concerns regardingtheir potential shortfalls and areas needed to support cancer research on which PPACA is silent.     

Lay patient navigator program implementation for equal access to cancer care and clinical trials: essential steps and initial challenges

BACKGROUND: Disparities in cancer detection, treatment, and outcomes among racial/ethnic minorities and low-income patients are well documented. One way to reduce these disparities is to use patient navigators to address barriers to care. However, little information about optimal characteristics of navigator programs or considerations for those interested in setting up such programs is available. METHODS: The design and implementation of a patient navigator program for underserved cancer patients in an urban, nonacademic community hospital setting is described. The program, which used lay navigators, was conceived as a component of the Urban Latino African American Cancer (ULAAC) Disparities Project in South Los Angeles, a National Cancer Institute (NCI)-sponsored project to improve cancer care and clinical trial access for minority and low-income patients. RESULTS: Careful initial planning, including input from a community advisory committee, was essential to smooth program implementation. Thirty-one volunteers completed navigator training in the program's first year of operation. Of 135 patients offered navigation services, 75 (56%) accepted, and preliminary feedback from patients, navigators, and providers suggests high levels of satisfaction with navigation. Standardized templates used by navigators and staff to record key information are proving helpful for monitoring quality and outcomes (such as effectiveness in addressing specific barriers to care) and continually improving the program. CONCLUSIONS: The ULAAC program represents a viable model for developing lay navigator programs in community hospitals. Preliminary assessments suggest that the program has a positive effect on minority and low-income cancer patients' experience with care and reduces barriers to care. Additional time and research are needed, however, to fully assess the impact on care and outcomes.     

Variations in gastric cancer care

BACKGROUND:

Race is associated with patterns of presentation and survival outcomes of gastric cancer in the United States. However, the impact of race on the receipt of guideline‐recommended care is not well characterized. By using current recommendations, the authors examined the association between race and guideline‐recommended treatments and identified factors that are predictive of variations in gastric cancer care.

METHODS:

By using the National Cancer Database for 1998 through 2005, 106,002 patients with gastric adenocarcinoma were identified. Multivariate analysis techniques were used to examine the association between race, the receipt of guideline‐recommended care, and survival after adjusting for covariates.

RESULTS:

Although African‐American and Hispanic patients were more likely to undergo adequate lymphadenectomy (≥15 lymph nodes) and to receive care at comprehensive cancer centers and high‐volume facilities (for all, P ≤ .001), they were less likely to receive adjuvant multimodality therapy for American Joint Committee on Cancer stage IB through IV, lymph node‐negative (M0) disease. Up to 60% of all patients who underwent gastrectomy failed to receive adequate lymphadenectomy and adjuvant multimodality therapy. The delivery of multimodality therapy varied significantly by stage and lymph node evaluation (P ≤ .001). These findings persisted on our multivariate analyses, indicating that African‐American and Hispanic patients received adequate lymph node evaluation (P ≤ .001), whereas they were associated with receiving no adjuvant multimodality therapy (P ≤ .025).

CONCLUSIONS:

There were significant variations in treatment for gastric cancer among ethnic groups in the United States. It was noteworthy that, although nonwhite race was associated with improved surgical care, gastric cancer care remained suboptimal overall. Cancer programs need to identify procedures to maximize the delivery of adequate gastric cancer care to all patients. Cancer 2010. © 2010 American Cancer Society.     

Setting the stage for universal financial distress screening in routine cancer care

Financial burden from cancer treatment is increasingly being recognized as a threat to optimal access, quality, and outcomes of cancer care for patients. Although research in the area is moving at a fast pace, multiple questions remain unanswered, such as how to practically integrate the assessment and management of financial burden into routine health care delivery for patients with cancer. Although psychological distress screening for patients undergoing cancer treatment now is commonplace, the authors raise the provocative idea of universal screening for financial distress to identify and assist vulnerable groups of patients. Herein, the authors outline the arguments to support screening for financial burden in addition to psychological distress, examining it as an independent patient‐reported outcome for all patients with cancer at various time points during their treatment. The authors describe the proximal and downstream impact of such a strategy and reflect on some challenges and potential solutions to help integrate this concept into routine cancer care delivery. Cancer 2017;123:4092–4096. © 2017 American Cancer Society.     

Evidence-based guidelines for treatment of cervical cancer in Japan: Japan Society of Gynecologic Oncology (JSGO) 2007 edition

Clinical practice guidelines for gynecologic cancers have been published by the National Comprehensive Cancer Network and the National Cancer Institute. Whereas these guidelines form the basis for the standard of care for gynecologic malignancies in the United States, it has proven difficult to institute them in Japan due to differences in patient characteristics, health-care delivery systems, and insurance programs. Therefore, evidence-based guidelines for treating cervical cancer specifically in Japan have been under development. The Guidelines Formulation Committee and Evaluation Committee were independently established within the Committee for Treatment Guidelines for Cervical Cancer. Opinions from within and outside the Japan Society of Gynecologic Oncology (JSGO) were incorporated into the final draft, and the guidelines were published after approval by the JSGO. These guidelines are composed of ten chapters and comprise three algorithms. Each chapter consists of a clinical question, recommendations, background, objectives, explanations, and references. The objective of these guidelines is to clearly delineate the standard of care for cervical cancer treatment in Japan in order to ensure equitable care for all Japanese women diagnosed with cervical cancer.     

Specialization improves outcomes in rectal cancer surgery

Scope of specialtyColorectal surgery encompasses any procedure performed on the colon and/or rectum. This section focuses on rectal surgery, specifically regarding surgery for rectal cancer and its technical complexity and disease complexity that often requires a multidisciplinary team-based approach. The emergence of rectal cancer surgical specialists exhibits improvements in rectal cancer outcomes.Colorectal surgery fellowships are available for general surgeons who desire specialization. Roughly 70 colorectal surgery fellowship programs exist, of which 39 are accredited by the National Accreditation Program for Rectal Cancer (NAPRC).Patient care and quality outcomesThe OSTRiCh (Optimizing the Surgical Treatment of Rectal Cancer) Consortium (OC) and NAPRC developed guidelines for a standardized pathway for rectal cancer care and outline standards for patient care and performance indicators. These efforts focus on the recognition of disparities in rectal cancer outcomes, a system for improvement, delivery of quality care, and optimizing patient results by minimizing morbidity and mortality.Regulatory requirementsIn the United States, Board certification for surgeons performing colorectal surgery is granted by the American Board of Colon and Rectal Surgery (ABCRS). While the United States lags behind its European counterparts in development of rectal cancer quality measures, significant changes have been made to close the gap. Improvement initiatives launched by the OC implemented a myriad of quality metrics for longitudinal outcome tracking; surgical site infection, positive circumferential margin rate, rate of colostomy creation, recurrence rate, to name a few.     

Evaluating the cost‐effectiveness of cancer patient navigation programs: Conceptual and practical issues

Patient navigators—individuals who assist patients through the healthcare system to improve access to and understanding of their health and healthcare—are increasingly used for underserved individuals at risk for or with cancer. Navigation programs can improve access, but it is unclear whether they improve the efficiency and efficacy of cancer diagnostic and therapeutic services at a reasonable cost, such that they would be considered cost‐effective. In the current study, the authors outline a conceptual model for evaluating the cost‐effectiveness of cancer navigation programs. They describe how this model is being applied to the Patient Navigation Research Program, a multicenter study supported by the National Cancer Institute's Center to Reduce Cancer Health Disparities. The Patient Navigation Research Program is testing navigation interventions that aim to reduce time to delivery of quality cancer care (noncancer resolution or cancer diagnosis and treatment) after identification of a screening abnormality. Examples of challenges to evaluating cost‐effectiveness of navigation programs include the heterogeneity of navigation programs, the sometimes distant relation between navigation programs and outcome of interest (eg, improving access to prompt diagnostic resolution and life‐years gained), and accounting for factors in underserved populations that may influence both access to services and outcomes. In this article, the authors discuss several strategies for addressing these barriers. Evaluating the costs and impact of navigation will require some novel methods, but will be critical in recommendations concerning dissemination of navigation programs. Cancer 2009. © 2009 American Cancer Society.     

Population‐based programs for increasing colorectal cancer screening in the United States

Answer questions and earn CME/CNE Screening to detect polyps or cancer at an early stage has been shown to produce better outcomes in colorectal cancer (CRC). Programs with a population‐based approach can reach a large majority of the eligible population and can offer cost‐effective interventions with the potential benefit of maximizing early cancer detection and prevention using a complete follow‐up plan. The purpose of this review was to summarize the key features of population‐based programs to increase CRC screening in the United States. A search was conducted in the SCOPUS, OvidSP, and PubMed databases. The authors selected published reports of population‐based programs that met at least 5 of the 6 International Agency for Research on Cancer (IARC) criteria for cancer prevention and were known to the National Colorectal Cancer Roundtable. Interventions at the level of individual practices were not included in this review. IARC cancer prevention criteria served as a framework to assess the effective processes and elements of a population‐based program. Eight programs were included in this review. Half of the programs met all IARC criteria, and all programs led to improvements in screening rates. The rate of colonoscopy after a positive stool test was heterogeneous among programs. Different population‐based strategies were used to promote these screening programs, including system‐based, provider‐based, patient‐based, and media‐based strategies. Treatment of identified cancer cases was not included explicitly in 4 programs but was offered through routine medical care. Evidence‐based methods for promoting CRC screening at a population level can guide the development of future approaches in health care prevention. The key elements of a successful population‐based approach include adherence to the 6 IARC criteria and 4 additional elements (an identified external funding source, a structured policy for positive fecal occult blood test results and confirmed cancer cases, outreach activities for recruitment and patient education, and an established rescreening process). CA Cancer J Clin 2015. © 2015 American Cancer Society. CA Cancer J Clin 2015;65:496–510 . © 2015 American Cancer Society.     

Improving the quality of care for patients with advanced epithelial ovarian cancer: Program components,implementation barriers,and recommendations

The high lethality of ovarian cancer in the United States and associated complexities of the patient journey across the cancer care continuum warrant an assessment of current practices and barriers to quality care in the United States. The objectives of this study were to identify and assess key components in the provision of high-quality care delivery for patients with ovarian cancer, identify challenges in the implementation of best practices, and develop corresponding quality-related recommendations to guide multidisciplinary ovarian cancer programs and practices. This multiphase ovarian cancer quality-care initiative was guided by a multidisciplinary expert steering committee, including gynecologic oncologists, pathologists, a genetic counselor, a nurse navigator, social workers, and cancer center administrators. Key partnerships were also established. A collaborative approach was adopted to develop comprehensive recommendations by identifying ideal quality-of-care program components in advanced epithelial ovarian cancer management. The core program components included: care coordination and patient education, prevention and screening, diagnosis and initial management, treatment planning, disease surveillance, equity in care, and quality of life. Quality-directed recommendations were developed across 7 core program components, with a focus on ensuring high-quality ovarian cancer care delivery for patients through improved patient education and engagement by addressing unmet medical and supportive care needs. Implementation challenges were described, and key recommendations to overcome barriers were provided. The recommendations emerging from this initiative can serve as a comprehensive resource guide for multidisciplinary cancer practices, providers, and other stakeholders working to provide quality-directed cancer care for patients diagnosed with ovarian cancer and their families.     

Integrating regional and community lung cancer services to improve patient care

Lung cancer is the leading cause of cancer death in Canada. The organization of health care services is central to the delivery of accessible, high-quality medical care and may be one factor that influences patient outcome. An exciting opportunity arose for clinicians to initiate the redesign of lung cancer services provided by three institutions in the Greater Toronto Area. This qualitative report describes the integrated lung cancer network that they developed, the innovation it has facilitated, and the systematic approach being taken to evaluate its impact. Available clinical resources were deployed to restructure services along patient-centred lines and to provide greater access to the specialist lung cancer team. A non-hierarchical clinical network was established that consolidates the lung cancer team. A multi-institutional and multidisciplinary tumour board and comprehensive thoracic oncology clinics are at its core. This innovative organizational paradigm considers all of the available services at each facility and aims to fully integrate specialists across the three institutions, thereby maximizing resource utilization. We believe that this paradigm may have wider applicability. The network is currently working to complete a current program of further service improvements and to objectively assess its impact on patient outcome.     

Critical care of patients with cancer

Answer questions and earn CME/CNE The increasing prevalence of patients living with cancer in conjunction with the rapid progress in cancer therapy will lead to a growing number of patients with cancer who will require intensive care treatment. Fortunately, the development of more effective oncologic therapies, advances in critical care, and improvements in patient selection have led to an increased survival of critically ill patients with cancer. As a consequence, critical care has become an important cornerstone in the continuum of modern cancer care. Although, in many aspects, critical care for patients with cancer does not differ from intensive care for other seriously ill patients, there are several challenging issues that are unique to this patient population and require special knowledge and skills. The optimal management of critically ill patients with cancer necessitates expertise in oncology, critical care, and palliative medicine. Cancer specialists therefore have to be familiar with key principles of intensive care for critically ill patients with cancer. This review provides an overview of the state‐of‐the‐art in the individualized management of critically ill patients with cancer. CA Cancer J Clin 2016;66:496–517. © 2016 American Cancer Society .     

Patient navigation for breast and colorectal cancer in 3 community hospital settings: An economic evaluation

BACKGROUND:

The Ralph Lauren Cancer Center implemented patient navigation programs in sites across the United States building on the model pioneered by Harold P. Freeman, MD. Patient navigation targets medically underserved with the objective of reducing the time interval between an abnormal cancer finding, diagnostic resolution, and treatment initiation. In this study, the authors assessed the incremental cost effectiveness of adding patient navigation to standard cancer care in 3 community hospitals in the United States.

METHODS:

A decision‐analytic model was used to assess the cost effectiveness of a colorectal and breast cancer patient navigation program over the period of 1 year compared with standard care. Data sources included published estimates in the literature and primary costs, aggregate patient demographics, and outcome data from 3 patient navigation programs.

RESULTS:

After 1 year, compared with standard care alone, it was estimated that offering patient navigation with standard care would allow an additional 78 of 959 individuals with an abnormal breast cancer screening and an additional 21 of 411 individuals with abnormal colonoscopies to reach timely diagnostic resolution. Without including medical treatment costs saved, the cost‐effectiveness ratio ranged from $511 to $2080 per breast cancer diagnostic resolution achieved and from $1192 to $9708 per colorectal cancer diagnostic resolution achieved.

CONCLUSIONS:

The current results indicated that implementing breast or colorectal cancer patient navigation in community hospital settings in which low‐income populations are served may be a cost‐effective addition to standard cancer care in the United States. Cancer 2012. © 2012 American Cancer Society.     

Caring for caregivers and patients: Research and clinical priorities for informal cancer caregiving

Informal/family caregivers are a fundamental source of care for cancer patients in the United States, yet the population of caregivers and their tasks, psychosocial needs, and health outcomes are not well understood. Changes in the nature of cancer care and its delivery, along with the growing population of survivors and their caregivers, warrant increased attention to the roles and demands of caregiving. This article reviews current evidence presented at a 2‐day meeting examining the state of the science of informal cancer caregiving that was convened by the National Cancer Institute and the National Institute of Nursing Research. The meeting sought to define who is an informal cancer caregiver, summarize the state of the science in informal cancer caregiving, and describe both the kinds of interventions developed to address caregiving challenges and the various outcomes used to evaluate their impact. This article offers recommendations for moving science forward in 4 areas: 1) improving the estimation of the prevalence and burden of informal cancer caregiving; 2) advancing the development of interventions designed to improve outcomes for cancer patients, caregivers, and patient‐caregiver dyads; 3) generating and testing strategies for integrating caregivers into formal health care settings; and 4) promoting the use of technology to support informal cancer caregivers. Cancer 2016;122:1987–95 . © 2016 American Cancer Society.     

The Harvard Joint Center for Radiation Therapy, 1968-1999: a unique concept and its relationship to the prevailing times in academic medicine

Purpose: Institutional structure, function, and philosophy reflect the organizational needs, and tend to mirror societal values of the times. For many years, the field of radiation oncology had among its major academic centers, an organization that served as a model for collaboration among health care institutions in an effort to serve the common good of its patients, hospitals, professional colleagues, and community. For over three decades, the Joint Center for Radiation Therapy (JCRT) was a leader in developing new organizational approaches for academic and clinical radiation oncology through the philosophy of collaboration in patient care, education, and research.

Methods and Results: In tracing the development and changes in organizational philosophy and structure of the JCRT, one can see the impact on academic oncology and cancer care through the emergence of both radiation and medical oncology as independent subspecialties, the importance of the National Cancer Act of 1971 accompanied by the growth of the NIH research and training programs and, more recently, the effect of the changing attitudes and approaches of hospitals, academicians, practitioners, and policy makers to health care delivery, structures, and cooperation.

Conclusion: Lessons learned from the 31-year history of the JCRT may help provide organizational insight useful in guiding academic oncology and academic medical centers through periods of change.     

Canadian Cancer Centre Response to COVID-19 Pandemic: A National and Provincial Response

Background: COVID-19 has spread rapidly, requiring health delivery systems to undertake dramatic transformations. To evaluate these system changes, we undertook one of the first Canadian health delivery system reviews and the first Canadian cancer centre evaluation of pandemic system modifications. Methods: Questionnaires were distributed to the Canadian Association of Provincial Cancer Agencies (CAPCA) members in order to assess changes to cancer centre services and patient management. Documentation relating to COVID-19 from the CAPCA electronic space was accessed, and all publicly available cancer centre documentation related to COVID-19 was reviewed. Results: Seven provinces completed the questionnaire and had documentation available from the CAPCA electronic space. All screening programs across Canada were suspended. In most provinces surveyed, ≥50% of outpatient appointments were occurring virtually, with <25% using video platforms. Generally, the impact on diagnostic imaging and new patient referrals correlated with the impact of COVID-19. Most provinces had a reduction in operating room availability, with chemotherapy and radiation treatments continuing. Public health modification, including personal protective equipment and screening staff, varied across the country. Conclusion: Canadian cancer centres underwent a rapid and aggressive transformation of services in response to COVID-19, with many similarities and differences across provinces. In part, this response was facilitated by communication under a national association, which in Canada remains unique to cancer. This response may serve to inform changes in other jurisdictions or disease states now and in future waves of the pandemic, as well as a record of changes for future health services and patient outcome research.     

The integration of cancer survivorship training in the curriculum of hematology/oncology fellows and radiation oncology residents

Background

Cancer specialists require an understanding of survivors' needs to insure optimal delivery of care. Training programs currently focus on treatment, while survivorship care focuses on time after treatment. Cancer survivorship training represents an education paradigm shift.

Methods

The Cancer Survivorship Workshop was held at the James P. Wilmot Cancer Center of the University of Rochester in academic year 2011–2012, with six sessions held. Objectives included the following: learning about survivorship from patient, primary care physician, and oncologist perspectives using a curriculum based on survivorship literature; designing treatment summaries (TSs) and survivorship care plans (SCPs) for five malignancies (lung, breast, prostate, colon, and lymphoma); and establishing collaboration between hematology/oncology (HO) and radiation oncology (RO) trainees by working together in teams. Course impact was assessed pre- and post-training using a 13-question survey. Questions were answered using a 10-point scale, with predefined rating for each question.

Results

Statistically significant differences in responses to several survey questions were observed comparing pre- and post-course experience. Improvement was noted in comfort discussing survivorship issues with patients (p?=?0.001), reported knowledge of survivorship care for five types of cancer (p?=?0.002), confidence in ability to explain a SCP (p?=?0.001), and comfort discussing late effects of cancer treatment (p?=?0.001). Five unique sets of TS and SCPs were completed.

Conclusions

This study demonstrates the feasibility of implementing cancer survivorship education into the curriculum of HO and RO training.

Implications for Cancer Survivors

The project was designed with intension to optimize survivor care through enhanced provider training.     

Report of the Japan diabetes society/Japanese cancer association joint committee on diabetes and cancer,Second report

The Japan Diabetes Society/Japanese Cancer Association Joint Committee on Diabetes and Cancer published its first report in July 2013 on the epidemiological assessment of the associations of diabetes with cancer risk/prognosis, the common risk factors for diabetes and cancer, and cancer risk associated with diabetes treatment. The Joint Committee continued its work to assess the role of glycemic control in the development of cancer in patients with diabetes. This review shows that high‐quality evidence examining the association between glycemic control and cancer risk is lacking. In 2014, the Japan Diabetes Society (JDS) and the Japanese Cancer Association (JCA) restarted the JDS/JCA Joint Committee on Diabetes and Cancer, which published the second committee report in Japanese [1]. This is the English version of that report. This article has been jointly published in Diabetology International (doi: 10.1007/s13340‐016‐0257‐z ) and Cancer Science by the Japan Diabetes Society and the Japanese Cancer Association. Members of the JDS/JCA Joint Committee on Diabetes and Cancer. JDS: Mitsuhiko Noda, Kohjiro Ueki, Masato Kasuga, Naoko Tajima, and Ken Ohashi; Editorial collaborators: Atsushi Goto and Hiroshi Noto; JCA: Ryuichi Sakai, Shoichiro Tsugane, Nobuyuki Hamajima, Kazuo Tajima, Kohzoh Imai, and Hitoshi Nakagama.     

Policy statement on multidisciplinary cancer care

BackgroundCancer care is undergoing an important paradigm shift from a disease-focused management to a patient-centred approach, in which increasingly more attention is paid to psychosocial aspects, quality of life, patients’ rights and empowerment and survivorship. In this context, multidisciplinary teams emerge as a practical necessity for optimal coordination among health professionals and clear communication with patients. The European Partnership for Action Against Cancer (EPAAC), an initiative launched by the European Commission in 2009, addressed the multidisciplinary care from a policy perspective in order to define the core elements that all tumour-based multidisciplinary teams (MDTs) should include. To that effect, a working group conference was held in January 2013 within the EPAAC Work Package 7 (on Healthcare) framework.MethodsThe consensus group consisted of high-level representatives from the following European scientific societies, patient associations and stakeholders: European CanCer Organisation (ECCO), European SocieTy for Radiology & Oncology (ESTRO), European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), International Society of Geriatric Oncology (SIOG), European Association for Palliative Care (EAPC), European Oncology Nursing Society (EONS), International Psycho-Oncology Society (IPOS),European Cancer Patient Coalition (ECPC), EuropaColon, Europa Donna - The European Breast Cancer Coalition, Association of European Cancer Leagues (ECL), Organisation of European Cancer Institutes (OECI), EUSOMA - European Society of Breast Cancer Specialists, European Hospital and Healthcare Federation (HOPE) and EPAAC Work Packages 5 (Health promotion and prevention), 7, 8 (Research), 9 (Information systems) and 10 (Cancer plans). A background document with a list of 26 core issues drawn from a systematic review of the literature was used to guide the discussion. Five areas related to MDTs were covered: care objectives, organisation, clinical assessment, patients’ rights and empowerment and policy support. Preliminary drafts of the document were widely circulated for consultation and amendments by the working group before final approval.ResultsThe working group unanimously formulated a Policy Statement on Multidisciplinary Cancer Care to define the core elements that should be implemented by all tumour-based MDTs. This document identifies MDTs as the core component in cancer care organisation and sets down the key elements to guide changes across all European health systems.ConclusionMDTs are an essential instrument of effective cancer care policy, and their continued development crucial to providing patients the care they need and deserve. While implementation must remain in local hands, European health systems can still benefit from having a basis for an effective multidisciplinary model of cooperation. This policy statement is intended to serve as a reference for policymakers and healthcare providers who wish to improve the services currently provided to the cancer patients whose lives and well-being depend on their action.