Cancer Patients Need Better Care for Symptoms
Cancer often brings with it a host of distressing symptoms including pain, labored breathing, anxiety, and depression. And the treatments can produce side effects equally difficult to cope with, such as nausea, fatigue, and confusion.
Providing adequate relief from such distress, however, is not the norm among health care providers, says a new report from the National Research Council and Institute of Medicine's National Cancer Policy Board. Improvements in palliative care -- the management of symptoms and side effects -- have not kept pace with the medical advances that have extended the lives of cancer patients. Where the willingness and means exist to provide adequate pain control or compassionate care, insurance regulations, lack of coverage, or both often make it difficult or impossible to do so.
Nine million Americans -- 3 percent of the population -- are now living with cancer as a chronic illness. For many of these individuals, lack of treatment or undertreatment of their symptoms vastly diminishes the quality of their day-to-day lives.
In its report, the board explains why this situation exists and what might be done about it. A single-minded focus on cure, compounded by society's ambivalence toward death and dying, has resulted in relatively little attention being paid to palliative cancer care. Of its $2.9 billion budget in 1999, the National Cancer Institute -- the federal government's leader in cancer research and training -- spent less than 1 percent on research and training related to palliative and end-of-life care.
"While our health care specialists labor toward curing the many different kinds of cancer, nothing would have a greater impact on the daily lives of cancer patients and their families than good symptom control and supportive therapy," said board member Kathleen Foley.
The National Cancer Institute must step up its commitment to research and training on palliative care and serve as a model for others, the report says. Meanwhile, public and private insurers must re-examine their coverage of palliative care services. In particular, the federal Centers for Medicare and Medicaid Services should fund projects to devise better ways to deliver and reimburse this care when and where cancer patients need it -- whether at home or in a hospital or hospice setting. And just as important, information on palliative care and related options must be made readily available to patients and families. -- Saira Moini
Improving Palliative Care for Cancer: Summary and Recommendations. National Cancer Policy Board, Institute of Medicine and National Research Council (2001, 78 pp.; ISBN 0-309-07563-7; available from National Academy Press, tel. 1-800-624-6242; $18.00 plus $4.50 shipping for single copies).
The study was led by Kathleen M. Foley, neurologist and pain specialist, Memorial Sloan-Kettering Cancer Center, and director, Project on Death in America, New York City. It was funded by the National Cancer Institute, the Centers for Disease Control and Prevention, the American Cancer Society, American Society of Clinical Oncology, Abbott Laboratories, Amgen Inc., and Aventis.