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Recommendation 1: NCI should designate certain cancer centers, as well as some community cancer centers, as centers of excellence in symptom control and palliative care for both adults and children. The centers will deliver the best available care, as well as carrying out research, training, and treatment aimed at developing portable model programs that can be adopted by other cancer centers and hospitals. Activities should include, but not be limited to, the following:

  • formal testing and evaluation of new and existing practice guidelines for palliative and end-of-life care;

  • pilot testing “quality indicators” for assessing end-of-life care at the level of the patient and the institution;

  • incorporating the best palliative care into NCI-sponsored clinical trials;

  • innovating in the delivery of palliative and end-of-life care, including collaboration with local hospice organizations;

  • disseminating information about how to improve end-of-life care to other cancer centers and hospitals through a variety of media;

  • uncovering the determinants of disparities in access to care by minority populations that should be served by the center and developing specific programs and initiatives to increase access; these might include educational activities for health care provid

  • providing clinical and research training fellowships in medical and surgical oncology in end-of-life care for adult and pediatric patients; and

  • creating faculty development programs in oncology, nursing, and social work; and

  • providing in-service training for local hospice staff in new palliative care techniques.

Recommendation 2: NCI should add the requirement of research in palliative care and symptom control for recognition as a “Comprehensive Cancer Center.”

Practices and policies that govern payment for palliative care (in both public and private sectors) hinder delivery of the most appropriate mix of services for patients who could benefit from palliative care during the course of their illness and treatments.

Recommendation 3: The Health Care Financing Administration (HCFA) should fund demonstration projects for service delivery and reimbursement that integrate palliative care and potentially life-prolonging treatments throughout the course of disease.



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