The National Cancer Policy Board (NCPB) recognized that excellent palliative care is possible but is not being delivered to a large number of those living with and dying from cancer. In its 1999 report Ensuring Quality Cancer Care, one of the Board’s recommendations was:

Ensure quality of care at the end of life, in particular, the management of cancer-related pain and timely referral to palliative and hospice care.

The current report delves into and expands on that mandate, addressing not only what can be done for people now nearing the end of life, but also setting a course for the development of better treatments and better ways of delivering and paying for them. This report also takes forward the agenda outlined in an influential 1997 IOM report Approaching Death: Improving Care at the End of Life, the first comprehensive, evidence-based, national report on these issues, which stimulated widespread interest and progress in some aspects of care for the dying. With the 1997 and 1999 reports as backdrop, the current effort focuses on specific areas in which the Board believes action still has to be catalyzed.

To accomplish this, eight papers were commissioned, which comprise Part II of this report. This chapter summarizes the current state of affairs, drawing on those papers and other sources, and ends with a set of broad-based recommendations supported by the evidence supplied in the commissioned papers. The papers themselves should be consulted for many more suggestions of specific activities and actions to be considered. The titles and authors are as follows:

  • Chapter 2: Reliable, High-Quality, Efficient End-of-Life Care for Cancer Patients: Economic Issues and Barriers, Joanne Lynn and Ann O’Mara

  • Chapter 3: Quality of Life and Quality Indicators for End-of-Life Cancer Care: Hope for the Best, Yet Prepare for the Worst, Joan M.Teno

  • Chapter 4: The Current State of Patient and Family Information About End-of-Life Care, Aaron S.Kesselheim

  • Chapter 5: Palliative Care for African Americans and Other Vul nerable Populations: Access and Quality Issues, Richard Payne

  • Chapter 6: End-of-Life Care: Special Issues in Pediatric Oncology, Joanne M.Hilden, Bruce P.Himelstein, David R.Freyer, Sarah Friebert, and Javier R.Kane

  • Chapter 7: Clinical Practice Guidelines for the Management of Psychosocial and Physical Symptoms of Cancer, Jimmie C.Holland and Lisa Chertkov

  • Chapter 8: Cross-Cutting Research Issues: A Research Agenda for Reducing Distress of Patients with Cancer, Charles S.Cleeland

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