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J Natl Cancer Inst Monogr. 2010;2010(40):31-7. doi: 10.1093/jncimonographs/lgq003.

The coordination of primary and oncology specialty care at the end of life.

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MA, Center for Outcomes Research and Evaluation, Maine Medical Center, 39 Forest Ave., Portland, ME 04101, USA.


The end of life is a time in which both the intensity of cancer patients' needs and the complexity of care increase, heightening the need for effective care coordination between oncology and primary care physicians. However, little is known about the extent to which such coordination occurs or the ways in which it is achieved. We review existing evidence on current practice patterns, patient and physician preferences regarding involvement of oncology and primary care physicians in end-of-life care, and the potential impact of care coordination on the quality of care and health outcomes. Data are lacking on the extent to which end-of-life care is coordinated between oncology and primary care physicians. Patients appear to prefer the continued involvement of both types of physicians, and preliminary evidence suggests that coordinated care improves health outcomes. However, more work needs to be done to corroborate these findings, and many unanswered questions remain.

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