• characterize the psychosocial consequences of a diagnosis of breast cancer,

  • evaluate the effectiveness of services to alleviate psychosocial distress,

  • assess the status of psychosocial interventions in the context of contemporary breast cancer care,

  • assess the status of professional education and training and applied clinical and health services research, and

  • propose policies to improve the quality of care and quality of life for women with breast cancer and their families.1

Individuals with cancer may have cancer-specific concerns, such as fear of cancer recurrence, and generalized symptoms such as worry, trouble sleeping, fatigue, and anxiety about going to the doctor. Underlying mental illness may also be exacerbated by the experience of being diagnosed with cancer or living with the disease. To capture the broad range of concerns of individuals with cancer, the Board, in this report, has relied on the definition of “psychosocial distress” from the National Comprehensive Cancer Network. “We have defined ‘distress’ as it applies to cancer, as follows. Distress is an unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with the ability to cope with cancer treatment. It extends along a continuum, from common normal feelings of vulnerability, sadness, and fears to problems that are disabling, such as true depression, anxiety, panic, and feeling isolated or in a spiritual crisis” (NCCN, 1999:114).


The National Cancer Policy Board (the Board) was established in March 1997 at the Institute of Medicine (IOM) and National Research Council with core support from the NCI and CDC to address issues that arise in the prevention, control, diagnosis, treatment, and palliation of cancer. The 20-member board includes health-care consumers, providers, and investigators in several disciplines (see membership roster). This report is one of three reports that comprise a Board initiative to address issues of concern for cancer survivors, with an emphasis on what happens following the primary treatment of cancer. The first report in that series, Childhood Cancer Survi-


Excluded from this review are the small number of men with breast cancer and healthy women who are at high-risk for breast cancer because of their genetic makeup or family history. The Board recognizes that each of these groups have unique health and psychosocial needs, but elected not to cover them in this report. The Board hopes in future reports to examine issues related to genetic testing and cancer.

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