• The Current State of Patient and Family Information About End-of-Life Care Issues

  • Improving Access to and Quality of Palliative and End-of-Life Care: Issues in the African-American Community and Other Vulnerable Populations

  • Special Issues in Pediatiric Oncology: End-of-Life Care

  • Clinical Practice Guidelines for the Management of Psychosocial and Physical Symptoms of Cancer

  • Cross-Cutting Research Issues: A Research Agenda for Reducing Distress of Patients with Cancer

  • Professional Education in Palliative and End-of-Life Care for Physicians, Nurses, and Social Workers

CONCLUSIONS AND RECOMMENDATIONS

People with cancer suffer from an array of symptoms at all stages of the disease (and its treatment), though these are most frequent and severe in advanced stages. Much of the suffering could be alleviated if currently available symptom control measures were used more widely. For symptoms not amenable to relief by current measures, new approaches could be developed and tested, if even modest research resources were made available. Both the use of current interventions and the development of new ones are hindered by the barriers discussed earlier (and in the chapters that follow). The National Cancer Policy Board’s recommendations are intended to break down or lower the barriers to excellent palliative care for people with cancer today, and those who will develop cancer in years to come. The recommendations describe a series of initiatives directed largely—though not exclusively—at the federal government, which should be playing a more powerful role than it does currently.

The conclusions and recommendations are not laid out in parallel to the barriers. They have been consolidated as “packages” for particular organizations and entities, and some address more than one barrier. Recommendation 1, in particular, which focuses on the role of National Cancer Institute (NCI)-designated cancer centers, contains elements that address all the barriers.

NCI-designated cancer centers should play a central role as agents of national policy in advancing palliative care research and clinical practice, with initiatives that address many of the barriers identified in this report.

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



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