paid attention to factors beyond their direct medical care, such as sources of support for dealing with the illness (USA Today et al., 2006). A number of studies also have shown that physicians substantially underestimate oncology patients’ psychosocial distress (Fallowfield et al., 2001; Keller et al., 2004; Merckaert et al., 2005). Indeed, oncologists themselves report frequent failure to attend to the psychosocial needs of their patients. In a national survey of members of the American Society of Clinical Oncology, a third of respondents reported that they did not routinely screen their patients for distress. Of the 65 percent that did do so, methods used were often untested or unreliable. In a survey of members of an alliance of 20 of the world’s leading cancer centers, only 8 reported screening for distress in at least some of their patients, and only 3 routinely screened all of their patients for psychosocial health needs (Jacobsen and Ransom, 2007).

A number of factors can interfere with clinicians’ addressing psychosocial health needs. These include the way in which clinical practices are designed, the education and training of the health care workforce, shortages and maldistribution of health personnel, and the nature of the payment and policy environment in which health care is delivered. Because of this, improving the delivery of psychosocial health services requires a multipronged approach.


In this context, the National Institutes of Health asked the IOM to empanel a committee to conduct a study of the delivery of the diverse psychosocial services needed by cancer patients and their families in community settings. The committee was tasked with producing a report describing barriers to access to psychosocial services and ways in which these services can best be provided, analyzing the capacity of the current mental health and cancer treatment system to deliver such care, delineating the associated resource and training requirements, and offering recommendations and an action plan for overcoming the identified barriers. The committee interpreted “community care” to refer to all sites of cancer care except inpatient settings.

This study builds on and complements several prior reports on cancer care. First, two recent reports address quality of care for cancer survivors. From Cancer Patient to Cancer Survivor: Lost in Transition (IOM and NRC, 2006) well articulates how high-quality care (including psychosocial health care) should be delivered after patients complete their cancer treatment. Childhood Cancer Survivorship: Improving Care and Quality of Life (IOM and NRC, 2003) similarly addresses survivorship for childhood cancer. The recommendations made in the present report complement and can be implemented consistent with the vision and recommendations put forth in those reports. Second, two other recent reports address palliative care:

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