In 2006, a total 2,243,953 patients in Italy were reported to survive after a cancer diagnosis. It is increasingly difficult to respond to the needs of this growing population and to follow these patients in the established care institutions due to a lack of time and health care personnel.
We thank Drs. Shin and Park for having described to us their model of survivorship care that has been examined over the past 2 years in Korea. We believe that their proposal is good because it creates a greater integration and sharing of survivors' pathways of care between oncologists and primary care physicians (PCPs) within cancer survivor clinics (CSCs).
However, as suggested by the authors, no single model fits every situation. For example, in Italy, their model is difficult to achieve because of the role PCPs currently play and the training they usually experience.
PCPs follow a large number of patients with various pathologies (cancer patients are a minority), with limited time available for their consultations. PCPs usually treat patients with chronic and metabolic diseases whereas they usually lack the skills and time to recognize the long-term side effects of cancer and/or cancer treatment and psychological disturbances among cancer survivors as well as to provide screening examinations for cancer recurrence and secondary primary tumors or screening programs for cancer survivors' relatives.
Conversely, the majority of patients appear to be reluctant to abandon their oncologists and/or the hospitals in which they have been treated.
Our idea is therefore to establish, in major cancer centers, CSCs in which health care specialists are dedicated to and operate full time in the care of cancer survivors. We believe that the training of cancer survivor specialists should result from a clinical experience in oncology/hematology departments, the in-depth knowledge of cancer treatments and their long-term side effects, and a familiarity with cancer-related psychological dysfunction and the issues of social/employment reintegration after cancer care. Moreover, psychologists should be part of these teams.
Finally, CSCs should not replace oncologists and PCPs but rather should play a role in consultation and coordination among the different specialties involved in survivorship care.