to care: Who should I see? What tests should I have? How can I manage my cancer- and treatment-related symptoms? What services are available to help me and my family cope? Half of all men and one-third of women in the United States will develop cancer in their lifetime, so these are questions many of us will face. Today, 1 in 30 Americans has a history of cancer, and among those 65 and older, the figure is 1 in 7. A new paradigm of survivorship is emerging that addresses the needs of this group and the issues that face society in providing for them—for us, in the greater sense. This Institute of Medicine (IOM) report explores this new territory and offers a plan for moving ahead.

The committee’s report focuses on adult survivors of cancer during the phase of care that follows primary treatment and (1) examines the medical and psychosocial consequences of cancer and its treatment; (2) defines quality care for cancer survivors and strategies to achieve it; (3) explores social and economic hardships facing cancer survivors related to, for example, problems in insurance coverage and employment discrimination, and proposes policies to ameliorate such problems; and (4) describes how we can improve what we know about the quality of care and quality of life for cancer survivors and their families.

This study could hardly be better timed to ensure both public and policy attention. The committee’s report builds on a significant body of work. In particular, the President’s Cancer Panel concluded a series of public meetings and in June 2004 released its report, Living Beyond Cancer, with policy recommendations for consideration (President’s Cancer Panel, 2004). In addition, in April 2004 the Centers for Disease Control and Prevention (CDC) and the Lance Armstrong Foundation released A National Action Plan for Cancer Survivorship to advance public health strategies (CDC and LAF, 2004). Cancer has recently overtaken heart disease as the leading cause of death in the United States among those under age 85 (Jemal et al., 2005), and the public views cancer as the most important health problem facing the nation (Blendon et al., 2001). Consumer advocacy organizations have long been interested in improving the care provided to cancer patients and survivors (NCCS, 1996).

ORIGINS OF THE STUDY

The idea to embark on a major study of cancer survivorship within the National Academies originated with the National Cancer Policy Board (NCPB). The NCPB was established in 1997 in the IOM and the National Research Council’s Division of Earth and Life Studies at the request of the National Cancer Institute (NCI), the National Institutes of Health, and the President’s Cancer Panel. The NCPB identified emerging policy issues in the nation’s effort to combat cancer, and prepared reports that address those



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