The burden of illnesses and disabilities in the United States and the world is closely related to social, psychological, and behavioral aspects of the way of life of the population. (IOM, 1982:49–50)
Health and disease are determined by dynamic interactions among biological, psychological, behavioral, and social factors. (IOM, 2001:16)
Because health … is a function of psychological and social variables, many events or interventions traditionally considered irrelevant actually are quite important for the health status of individuals and populations. (IOM, 2001:27)
In previous reports the Institute of Medicine (IOM) has issued strong findings about the important role of psychological/behavioral and social factors in health and recommended more attention to these factors in the design and delivery of health care (IOM, 1982, 2001, 2006). In 2005, the IOM was asked once again to examine the contributions of these psychosocial factors to health and how best to address them—in this case in the context of cancer, which encompasses some of the nation’s most serious and burdensome illnesses.
One in ten American households today has a family member who has been diagnosed with or treated for cancer1 within the past 5 years (USA Today et al., 2006), and 41 percent of Americans can expect to be diagnosed with cancer at some point in their lifetime (Ries et al., 2007). More than ten and a half million people in the United States live with a past or current diagnosis of cancer (Ries et al., 2007).
Early detection and improved treatments for many different types of cancer have changed our understanding of this group of illnesses from that of a single disease that was often uniformly fatal in a matter of weeks or months to that of a variety of diseases—some of which are curable, all of which are treatable, and for many of which long-term disease-free survival is possible. In the past two decades, the 5-year survival rate for the 15 most common cancers has increased from 43 to 64 percent for men and from 57 to 64 percent for women (Jemal et al., 2004).
Nonetheless, the diseases that make up cancer represent both acute life-threatening illnesses and serious chronic conditions. Their treatment is