,i #aaeth ,,congress #ast ,session ,h4 ,r4 #hbj ,,in ,,the ,,house ,,of ,,representatives ,february #b1 #bjag,mr4 ,mc,caul 7for himself1 ,ms4 ,speier1 ,mr4 ,butterfield1 and ,mr4 ,kelly of ,pennsylvania7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to maximize discovery1 and accelerate development and availability1 of promising childhood cancer treatments1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,childhood ,cancer ,survivorship1 ,treatment1 ,access1 and ,research ,act of #bjag or the ,childhood ,cancer ,,star ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,findings4 ,title ,i--,,maximizing ,,research ,,through ,,discovery ,subtitle ,a--,caroline ,pryce ,walker ,conquer ,childhood ,cancer ,reauthorization ,act ,sec4 #aja4 ,children's cancer biorepositories and biospecimen research4 ,sec4 #ajb4 ,improving ,childhood ,cancer ,surveillance4 ,subtitle ,b--,pediatric ,expertise at ,,nih ,sec4 #aaa4 ,inclusion of at least one pediatric oncologist on the ,national ,cancer ,advisory ,board4 ,sec4 #aab4 ,sense of ,congress regarding pediatric expertise at the ,national ,cancer ,institute4 ,subtitle ,c--,,nih ,report on ,childhood ,cancer ,activities ,sec4 #aba4 ,reporting on childhood cancer research projects4 ,title ,,ii--,,maximizing ,,delivery3 ,,care1 ,,quality ,,of ,,life1 ,,survivorship1 ,,and ,,caregiver ,,support ,subtitle ,a--,childhood ,cancer ,survivors' ,quality of ,life ,act ,sec4 #bja4 ,cancer survivorship programs4 ,sec4 #bjb4 ,grants to improve care for pediatric cancer survivors4 ,sec4 #bjc4 ,comprehensive long-term follow-up services for pediatric cancer survivors4 ,sec4 #bjd4 ,survivorship demonstration project4 ,subtitle ,b--,coverage and ,payment of ,high ,quality ,care ,sec4 #baa4 ,report by the ,comptroller ,general4 #b4 ,findings ,congress makes the following findings3 7#a7 ,each year in the ,united ,states there are an estimated #ae1ghj children between birth and the age of #ai diagnosed with cancer4 ,approximately #a in #bhe children in the ,united ,states will be diagnosed with cancer before their #bjth birthday4 7#b7 ,in #aifj1 only #d percent of children with cancer survived more than #e years1 but today1 cure rates have increased to over #hj percent for children and adolescents under age #bj4 7#c7 ,while the cure rates for some childhood cancers are now over #hj percent1 the survival rates for many types of cancers in children remain extremely low4 7#d7 ,according to the ,centers for ,disease ,control and ,prevention1 cancer continues to be the leading cause of death by disease in children and adolescents under the age of #ad4 7#e7 ,by #bjbj1 the population of childhood cancers survivors is expected to be #ejj1jjj individuals4 7#f7 ,as many as two-thirds of childhood cancer survivors are likely to experience at least one late effect of treatment1 with as many as one-fourth experiencing a late effect that is serious or life-threatening4 ,common late effects of childhood cancer are neurocognitive1 psychological1 cardiopulmonary1 endocrine1 and musculoskeletal effects1 secondary malignancies1 and early death4 7#g7 ,as a result of disparities in the delivery of cancer care1 minority1 low-income1 and other medically underserved children are more likely to be diagnosed with late stage disease1 experience poorer treatment outcomes1 have shorter survival time with less quality of life1 and experience a substantially greater likelihood of cancer death4 7#h7 ,collection of biospecimens1 along with clinical and outcome data1 on children and adolescents with cancer in the ,united ,states is necessary to improve childhood and adolescent cancer treatments and cures4 ,currently biospecimens1 and clinical and outcome data1 are collected for less than half of children in the ,united ,states with cancer4 7#i7 ,the late effects of cancer treatment may change as therapies evolve1 which means that the monitoring and care of cancer survivors may need to be modified on a routine basis4 7#aj7 ,despite the intense stress caused by childhood cancer1 there is a lack of standardized and coordinated psychosocial care for the children and their families1 from the date of diagnosis through treatment and survivorship4 7#aa7 ,the ,national ,academy of ,medicine1 in its report on cancer survivorship entitled ,childhood ,cancer ,survivorship3 ,improving ,care and ,quality of ,life1 states that an organized system of care and a method of care for pediatric cancer survivors is needed4 7#ab7 ,focused and well-designed research and pilot health delivery programs can answer questions about the optimal ways to provide health care1 follow-up monitoring services1 and survivorship care to those diagnosed with childhood cancer and contribute to improvements in the quality of care and quality of life of those individuals through adulthood4 7#ac7 ,the ,national ,institutes of ,health1 including the ,national ,cancer ,institute1 invest approximately half of their annual appropriations to support basic research that serves as the foundation for translational and clinical research for all diseases and conditions1 with the potential to lead to breakthroughs for children with cancer4 ,virtually all progress against cancer--in both children and adults--has been founded in basic research1 often in areas not directly related to the disease4 7#ad7 ,the ,national ,cancer ,institute supports a number of key research programs specifically to advance childhood cancer care1 including precision medicine clinical trials for children with cancer1 the ,children's ,oncology ,group 7part of the ,national ,clinical ,trials ,network of the ,national ,cancer ,institute71 the ,pediatric ,preclinical ,testing ,consortium1 the ,pediatric ,brain ,tumor ,consortium1 the ,childhood ,cancer ,survivor ,study1 the ,therapeutically ,applicable ,research to ,generate ,effective ,treatments program and related pediatric cancer genomics research 7including the ,pediatric ,,match ,precision ,medicine trial71 and the ,pediatric ,oncology ,branch 7part of the intramural program of the ,national ,cancer ,institute1 whose mission is to develop new treatments for pediatric cancer74 ,i ,,maximizing ,,research ,,through ,,discovery ,a ,caroline ,pryce ,walker ,conquer ,childhood ,cancer ,reauthorization ,act #aja4 ,children's cancer biorepositories and biospecimen research ,section #dag;,e of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;a-#aa7 is amended-- 7#a7 by striking subsection 7a7 and inserting the following3 7a7 ,children's cancer biorepositories 7#a7 ,award ,the ,secretary1 acting through the ,director of ,,nih1 may make awards to an entity or entities described in paragraph 7#d7 to build upon existing initiatives to collect biospecimens and clinical and demographic information with a goal of collection for the vast majority of all children1 adolescents1 and young adults with selected cancer subtypes 7and their recurrences7 for which current treatments are least effective1 through one or more biospecimen research efforts designed to achieve a better understanding of the cause of such cancers 7and their recurrences7 and the effects of treatments for such cancers4 7#b7 ,use of funds ,amounts received under an award under paragraph 7#a7 may be used to carry out the following3 7,a7 ,acquire1 preserve1 and store high-quality1 donated biospecimens and associated clinical and demographic information on children1 adolescents1 and young adults diagnosed with cancer in the ,united ,states1 focusing on children and adolescents enrolled in clinical trials for whom current treatments are least effective4 ,activities under this subparagraph may include storage of biospecimens and associated clinical and demographic data at biorepositories supported by the ,national ,cancer ,institute1 such as the ,children's ,oncology ,group ,biorepository and the ,pediatric ,cooperative ,human ,tissue ,network as well as through biorepositories established as appropriate to support the scientific needs of future research efforts4 7,b7 ,make such information publicly available1 including the repositories described in subparagraph 7,a74 7,c7 ,maintain a secure searchable database on stored biospecimens and associated clinical and demographic data from children1 adolescents1 and young adults with cancer for the conduct of research by scientists and qualified health care professionals4 7,d7 ,establish procedures for evaluating applications for access to such biospecimens and clinical and demographic data from researchers and other qualified health care professionals4 7,e7 ,make available and distribute biospecimens and clinical and demographic data from children1 adolescents1 and young adults with cancer to researchers and qualified health care professionals for peer-reviewed research at a minimal cost4 7#c7 ,no requirement ,no child1 adolescent1 or young adult with cancer shall be required under this subsection to contribute a specimen to a biorepository or share clinical or demographic data4 7#d7 ,application2 considerations 7,a7 ,application ,to be eligible to receive an award under paragraph 7#a7 an entity shall submit an application to the ,secretary at such a time1 in such manner1 and containing such information as the ,secretary may reasonably require4 7,b7 ,considerations ,in evaluating the applications in subparagraph 7,a71 the ,secretary shall consider the existing infrastructure of the entity that would allow for the timely capture of biospecimens and related clinical and demographic information for children1 adolescents1 and young adults with cancer4 7#e7 ,privacy protections2 consent 7,a7 ,in general ,the ,secretary may not make an award under paragraph 7#a7 to an entity unless the ,secretary ensures that such entity-- 7i7 collects biospecimens and associated clinical and demographic information from children and adolescents with appropriate permission from parents or legal guardians in accordance with ,federal and ,state law2 and 7ii7 adheres to strict confidentiality to protect the identity and privacy of patients in accordance with ,federal and ,state law4 7,b7 ,consent ,the ,secretary shall establish an appropriate process for achieving consent from the patient1 parent1 or legal guardian4 7#f7 ,single point of access2 standard data2 guidelines and oversight 7,a7 ,single point of access ,the ,secretary shall ensure that each biorepository supported under paragraph 7#a7 has electronically searchable data for use by researchers and other qualified health care professionals in the manner and to the extent defined by the ,secretary4 7,b7 ,standard data ,the ,secretary shall require all recipients of an award under paragraph 7#a7 to make available a standard dataset for the purposes of subparagraph 7,a7 in a standard electronic format that enables researchers and qualified health care professionals to search4 7,c7 ,guidelines and oversight ,the ,secretary shall develop and disseminate appropriate guidelines for the development and maintenance of the biorepositories supported under this subsection1 including appropriate oversight4 7#g7 ,coordination ,the ,secretary shall ensure that clinical and demographic information collected in accordance with this subsection is collected in coordination with the information collected under section #cii;,e-#a4 7#h7 ,prohibition on use of funds ,funds made available to carry out this subsection shall not be used to acquire1 preserve1 or maintain a biospecimen collected from a patient if such activity is already covered by funds available from the ,national ,cancer ,institute for such purpose4 7#i7 ,report ,not later than #d years after the date of enactment of the ,childhood ,cancer ,survivorship1 ,treatment1 ,access1 and ,research ,act of #bjag1 the ,secretary shall submit to ,congress a report on-- 7,a7 the number of biospecimens and corresponding clinical demographic data collected through the biospecimen research efforts supported under paragraph 7#a72 7,b7 the number of biospecimens and corresponding clinical demographic data requested for use by researchers2 7,c7 any barriers to the collection of biospecimens and corresponding clinical demographic data2 7,d7 any barriers experienced by researchers or health care professionals in accessing the biospecimens and corresponding clinical demographic data necessary for use in research2 and 7,e7 any recommendations with respect to improving the biospecimen and biorepository research efforts under this subsection4 7#aj7 ,definitions ,for purposes of this subsection3 7,a7 ,award ,the term award includes a grant1 contract1 cooperative agreement1 or other transaction determined by the ,secretary4 7,b7 ,biospecimen ,the term biospecimen includes-- 7i7 solid tumor tissue or bone marrow2 7ii7 normal or control tissue2 7iii7 blood and plasma2 7iv7 ,,dna and ,,rna extractions2 7v7 familial ,,dna2 and 7vi7 any other sample required by the ,secretary4 7,c7 ,clinical and demographic information ,the term clinical and demographic information includes-- 7i7 date of diagnosis2 7ii7 age at diagnosis2 7iii7 the patient's gender1 race1 ethnicity1 and environmental exposures2 7iv7 extent of disease at enrollment2 7v7 site of metastases2 7vi7 location of primary tumor coded2 7vii7 histologic diagnosis2 7viii7 tumor marker data when available2 7ix7 treatment and outcome data2 7x7 information related to specimen quality2 and 7xi7 any other information required by the ,secretary4 2 and 7#b7 in subsection 7d7-- 7,a7 by striking and section #cii;,e-#a and inserting and sections #cag,u1 #cii;,e-#a1 #dag;,h1 and #dag;,h-#a2 7,b7 by striking #bjji through #bjac and inserting #bjah through #bjbb2 and 7,c7 by striking such purpose and inserting such purposes4 #ajb4 ,improving ,childhood ,cancer ,surveillance ,section #cii;,e-#a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;e-#c;a7 is amended-- 7#a7 by redesignating subsection 7b7 as subsection 7d72 and 7#b7 by striking subsection 7a7 and inserting the following3 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may make awards to ,state cancer registries to enhance and expand infrastructure to track the epidemiology of cancer in children1 adolescents1 and young adults4 ,such registries may be updated to include each occurrence of such cancers within a period of time designated by the ,secretary4 7b7 ,activities ,the grants described in subsection 7a7 may be used for-- 7#a7 identifying1 recruiting1 and training all potential sources for reporting childhood1 adolescent1 and young adult cancer cases2 7#b7 developing procedures to implement early inclusion of childhood1 adolescent1 and young adult cancer cases on ,state cancer registries through the use of electronic reporting2 7#c7 purchasing infrastructure to support the early inclusion of childhood1 adolescent1 and young adult cancer cases on such registries2 7#d7 submitting deidentified data to the ,centers for ,disease ,control and ,prevention for inclusion in a national database of childhood1 adolescent1 and young adult cancers2 and 7#e7 tracking the late effects of childhood1 adolescent1 and young adult cancers4 7c7 ,coordination ,the ,secretary shall ensure that information collected through ,state cancer registries under this section is collected in coordination with clinical and demographic information collected under section #dag;,e7a71 as appropriate4 4 ,b ,pediatric ,expertise at ,,nih #aaa4 ,inclusion of at least one pediatric oncologist on the ,national ,cancer ,advisory ,board ,clause 7iii7 of section #djf7;h77#b77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhd;a7h77#b77;,a77 is amended to read as follows3 7iii7 of the members appointed to the ,board-- 7,i7 not less than #e members shall be individuals knowledgeable in environmental carcinogenesis 7including carcinogenesis involving occupational and dietary factors72 and 7,,ii7 not less than one member shall be an individual knowledgeable in pediatric oncology2 4 #aab4 ,sense of ,congress regarding pediatric expertise at the ,national ,cancer ,institute ,it is the sense of ,congress that the ,director of the ,national ,cancer ,institute should ensure that all applicable study sections1 committees1 advisory groups1 and panels at the ,national ,cancer ,institute include one or more qualified pediatric oncologists1 as appropriate4 ,c ,,nih ,report on ,childhood ,cancer ,activities #aba4 ,reporting on childhood cancer research projects ,section #dji;,d7c77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhd;h7c77#c77 is amended by-- 7#a7 striking public on and inserting 8public on-- 7,a7 2 7#b7 striking the period at the end and inserting 2 and2 and 7#c7 inserting at the end the following3 7,b7 childhood cancer research projects conducted or supported by the ,national ,institutes of ,health4 4 ,,ii ,,maximizing ,,delivery3 ,,care1 ,,quality ,,of ,,life1 ,,survivorship1 ,,and ,,caregiver ,,support ,a ,childhood ,cancer ,survivors' ,quality of ,life ,act #bja4 ,cancer survivorship programs 7a7 ,cancer survivorship programs ,the ,public ,health ,service ,act is amended by inserting after section #cii,n of such ,act 7#db ,u4,s4,c4 #bhj;g-#b7 the following3 #cii,n-#a4 ,pilot programs to explore model systems of care for pediatric cancer survivors 7a7 ,in general ,not later than #a year after the date of enactment of the ,childhood ,cancer ,survivorship1 ,treatment1 ,access1 and ,research ,act of #bjag1 the ,secretary may make awards to eligible entities to establish pilot programs to develop1 study1 or evaluate model systems for monitoring and caring for childhood cancer survivors throughout their lifespan1 including evaluation of shared care and medical home and clinic based models for transition to adult care4 7b7 ,eligible entities ,in this section1 the term eligible entity means-- 7#a7 a medical school2 7#b7 a children's hospital2 7#c7 a cancer center2 7#d7 a community-based medical facility2 or 7#e7 any other entity with significant experience and expertise in treating survivors of childhood cancers4 7c7 ,use of funds ,the ,secretary may make an award under this section to an eligible entity only if the entity agrees-- 7#a7 to use the award to establish a pilot program to develop1 study1 or evaluate one or more model systems for monitoring and caring for cancer survivors2 and 7#b7 in developing1 studying1 and evaluating such systems1 to give special emphasis to-- 7,a7 design of protocols for different models of follow-up care1 monitoring1 and other survivorship programs 7including peer support and mentoring programs72 7,b7 development of various models for providing multidisciplinary care2 7,c7 dissemination of information and the provision of training to health care providers about how to provide linguistically and culturally competent follow-up care and monitoring to cancer survivors and their families2 7,d7 development of psychosocial interventions and support programs to improve the quality of life of cancer survivors and their families2 7,e7 design of systems for the effective transfer of treatment information and care summaries from cancer care providers to other health care providers 7including risk factors and a plan for recommended follow-up care72 7,f7 dissemination of the information and programs described in subparagraphs 7,a7 through 7,e7 to other health care providers 7including primary care physicians and internists7 and to cancer survivors and their families1 where appropriate2 and 7,g7 development of initiatives that promote the coordination and effective transition of care between cancer care providers1 primary care physicians1 and mental health professionals4 #cii,n-#b4 ,workforce development collaborative on medical and psychosocial care for childhood cancer survivors 7a7 ,in general ,the ,secretary shall1 not later than #a year after the date of enactment of the ,childhood ,cancer ,survivorship1 ,treatment1 ,access1 and ,research ,act of #bjag1 convene a ,workforce ,development ,collaborative on ,medical and ,psychosocial ,care for ,pediatric ,cancer ,survivors 7referred to in this section as the ,collaborative74 ,the ,collaborative shall be a cross-specialty1 multidisciplinary group composed of educators1 consumer and family advocates1 and providers of psychosocial and biomedical health services4 7b7 ,goals and reports ,the ,collaborative shall submit to the ,secretary a report establishing a plan to meet the following objectives for medical and psychosocial care workforce development3 7#a7 ,identifying1 refining1 and broadly disseminating to health care educators information about workforce competencies1 models1 and curricula relevant to providing medical and psychosocial services to persons surviving pediatric cancers4 7#b7 ,adapting curricula for continuing education of the existing workforce using efficient workplace-based learning approaches4 7#c7 ,developing the skills of faculty and other trainers in teaching psychosocial health care using evidence-based teaching strategies4 7#d7 ,strengthening the emphasis on psychosocial health care in educational accreditation standards and professional licensing and certification exams by recommending revisions to the relevant oversight organizations4 7#e7 ,evaluating the effectiveness of patient navigators in pediatric cancer survivorship care4 7#f7 ,evaluating the effectiveness of peer support programs in the psychosocial care of pediatric cancer patients and survivors4 4 7b7 ,technical amendment 7#a7 ,in general ,section #c of the ,hematological ,cancer ,research ,investment and ,education ,act of #bjjb 7,public ,law #ajg-agb2 #aaf ,stat4 #eda7 is amended by striking section #dai;,c and inserting section #dag;,c4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall take effect as if included in section #c of the ,hematological ,cancer ,research ,investment and ,education ,act of #bjjb 7,public ,law #ajg-agb2 #aaf ,stat4 #eda74 #bjb4 ,grants to improve care for pediatric cancer survivors 7a7 ,in general ,section #dag;,e of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;a-#aa71 as amended by section #aja1 is further amended-- 7#a7 in the section heading1 by striking research and awareness and inserting research1 awareness1 and survivorship2 and 7#b7 by striking subsection 7b7 and inserting the following3 7b7 ,improving care for pediatric cancer survivors 7#a7 ,research on causes of health disparities in pediatric cancer survivorship 7,a7 ,research awards ,the ,director of ,,nih1 in coordination with ongoing research activities1 may conduct or support pediatric cancer survivorship research including in any of the following areas3 7i7 ,needs and outcomes of pediatric cancer survivors within minority or other medically underserved populations4 7ii7 ,health disparities in pediatric cancer survivorship outcomes within minority or other medically underserved populations4 7iii7 ,barriers that pediatric cancer survivors within minority or other medically underserved populations face in receiving follow-up care4 7iv7 ,familial1 socioeconomic1 and other environmental factors and the impact of such factors on treatment outcomes and survivorship4 7,b7 ,balanced approach ,in conducting or supporting research under subparagraph 7,a77i7 on pediatric cancer survivors within minority or other medically underserved populations1 the ,director of ,,nih shall ensure that such research addresses both the physical and the psychological needs of such survivors1 as appropriate4 7#b7 ,research on late effects and follow-up care for pediatric cancer survivors ,the ,director of ,,nih1 in coordination with ongoing research activities1 may conduct or support research on follow-up care for pediatric cancer survivors1 including in any of the following areas3 7,a7 ,the development of indicators used for long-term patient tracking and analysis of the late effects of cancer treatment for pediatric cancer survivors4 7,b7 ,the identification of risk factors associated with the late effects of cancer treatment4 7,c7 ,the identification of predictors of adverse neurocognitive and psychosocial outcomes4 7,d7 ,the identification of the molecular underpinnings of long-term complications4 7,e7 ,the development of risk prediction models to identify those at highest risk of long-term complications4 7,f7 ,initiatives to protect cancer survivors from the late effects of cancer treatment1 by developing targeted interventions to reduce the burden of morbidity borne by cancer survivors4 7,g7 ,transitions in care for pediatric cancer survivors4 7,h7 ,training of professionals to provide linguistically and culturally competent follow-up care to pediatric cancer survivors4 7,i7 ,different models of follow-up care4 7,j7 ,examining the cost-effectiveness of the different models of follow-up care4 4 #bjc4 ,comprehensive long-term follow-up services for pediatric cancer survivors ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by inserting after section #cag,t the following3 #cag,u4 ,standards for comprehensive long-term care for pediatric cancer survivors through the lifespan ,the ,secretary may establish a task force to develop and test standards1 outcomes1 and metrics for high-quality childhood cancer survivorship care in consultation with a full spectrum of representation of experts in late effects of disease and treatment of childhood cancers1 including-- 7#a7 oncologists who treat children and adolescents2 7#b7 oncologists who treat adults2 7#c7 primary care providers engaged in survivorship care2 7#d7 survivors of childhood cancer2 7#e7 parents of children who have been diagnosed with and treated for cancer and parents of long-term survivors2 7#f7 professionals who are engaged in the development of clinical practice guidelines2 7#g7 nurses and social workers2 7#h7 mental health professionals2 7#i7 allied health professionals1 including physical therapists and occupational therapists2 7#aj7 experts in health care quality measurement and improvement2 and 7#aa7 others1 as the ,secretary determines appropriate4 4 #bjd4 ,survivorship demonstration project 7a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 may carry out a demonstration project over a #c-year period1 designed to improve the quality and efficiency of care provided to childhood cancer survivors throughout their lifespan1 through improved care coordination as survivors transitions to adult care4 7b7 ,selection of demonstration sites 7#a7 ,maximum number of sites ,the maximum number of sites at which the demonstration project under subsection 7a7 is carried out may not exceed #aj4 7#b7 ,diversity of sites ,in selecting entities to participate in the demonstration project1 the ,secretary may1 to the extent practicable1 include in such selection-- 7,a7 small-1 medium-1 and large-sized sites2 and 7,b7 sites located in different geographic areas4 7c7 ,activities under demonstration project ,the activities conducted under the demonstration project under subsection 7a7 may1 in addition to any other activity specified by the ,secretary1 include activities that seek to develop different models of care coordination1 including transitions of care1 follow-up care1 monitoring1 and other survivorship related programs that utilize a multidisciplinary1 team based approach to care1 including any of the following activities3 7#a7 ,coordination of care and transitions of care between cancer care providers1 primary care physicians1 mental health professionals and any other relevant providers4 7#b7 ,dissemination of information to1 and training of1 health care providers about linguistically and culturally competent follow-up care specific to cancer survivors4 7#c7 ,development of monitoring programs for cancer survivors and their families4 7#d7 ,incorporation of peer support and mentoring programs to improve the quality of life of cancer survivors4 7#e7 ,designing systems and models for the effective transfer of treatment information and care summaries from cancer care providers to other health care providers 7including risk factors and a care plan74 7#f7 ,evaluation of functional status and incorporation of specific functional needs into the care planning process4 7#g7 ,dissemination of the information on activities and programs conducted under this section to other health care providers 7including primary care physicians7 and to cancer survivors and their families1 where appropriate4 7#h7 ,other items determined by the ,secretary4 7d7 ,measures ,the ,secretary may use the following measures to assess the performance of each site3 7#a7 ,patient care and patient_/family satisfaction measures4 7#b7 ,resource utilization measures4 7#c7 ,adult survivorship measures1 as appropriate4 7e7 ,,gao ,report ,the ,comptroller ,general of the ,united ,states shall submit a report to ,congress evaluating the success of the demonstration project4 ,such report shall include an assessment of the impact of the project upon the quality and cost-efficiency of services furnished to individuals under this title1 including an assessment of the satisfaction of such individuals with respect to such services that were furnished under such project4 ,such report shall include recommendations regarding the possible expansion of the demonstration project4 ,b ,coverage and ,payment of ,high ,quality ,care #baa4 ,report by the ,comptroller ,general 7a7 ,in general ,the ,comptroller ,general of the ,united ,states shall conduct a review and submit recommendations to ,congress on existing barriers to obtaining and paying for adequate medical care for survivors of childhood cancer4 7b7 ,considerations ,in carrying out the review and formulating recommendations under subsection 7a71 the ,comptroller ,general shall-- 7#a7 identify existing barriers to the availability of complete and coordinated survivorship care for survivors of childhood cancer and to the availability of expert pediatric palliative care1 including consideration of-- 7,a7 understanding and education among patients1 health care providers1 regulators1 and third-party payors2 7,b7 adequacy of payment codes to cover necessary survivorship services2 7,c7 access to necessary medical and other services for such survivors1 including the services described in subsection 7c72 and 7,d7 lack of pediatric palliative care across all stages of illness and hospice services for patients approaching the end of life2 and 7#b7 make recommendations to provide improved access and payment plans for childhood cancer survivorship programs and palliative care1 including psychosocial services and coverage of such services4 7c7 ,services described ,the services described in this subsection are the following3 7#a7 ,coordinated multidisciplinary long-term follow-up care with access to appropriate pediatric subspecialists and adult subspecialists with specific expertise in survivorship1 including subspecialists with expertise in oncology1 radiation oncology1 surgery1 cardiology1 psychiatry or psychology1 endocrinology1 pulmonology1 nephrology1 dermatology1 gynecology1 and urology4 7#b7 ,appropriate organ function testing 7particularly screening for potential problems at much younger ages than usually indicated in the general population7 and treatment1 including-- 7,a7 neuropsychological testing and mental health services2 7,b7 fertility testing and treatment2 7,c7 evaluation and treatment for endocrine disorders including growth hormone and testosterone replacement2 7,d7 diagnostic imaging to screen for late effects of treatment 7including subsequent cancers71 such as mammograms and magnetic resonance imaging testing to screen for possible breast cancer2 7,e7 screening for cardiac problems1 such as echocardiograms2 7,f7 screening for osteoporosis with bone densitometry1 including duel x-ray absorptiometry and monitoring #be-;hydroxyvitamin ,d levels2 7,g7 dental coverage and necessary dental implants2 7,h7 hearing aids and other prosthetic devices2 and 7,i7 screening for lung problems1 such as pulmonary function testing4