Improving Palliative Care for Cancer: Summary and Recommendations

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National Academies Press, Jun 19, 2001 - Medical - 64 pages
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It is innately human to comfort and provide care to those suffering from cancer, particularly those close to death. Yet what seems self-evident at an individual, personal level has, by and large, not guided policy at the level of institutions in this country. There is no argument that palliative care should be integrated into cancer care from diagnosis to death. But significant barriers-attitudinal, behavioral, economic, educational, and legal-still limit access to care for a large proportion of those dying from cancer, and in spite of tremendous scientific opportunities for medical progress against all the major symptoms associated with cancer and cancer death, public research institutions have not responded. In accepting a single-minded focus on research toward cure, we have inadvertently devalued the critical need to care for and support patients with advanced disease, and their families.
This report builds on and takes forward an agenda set out by the 1997 IOM report Approaching Death: Improving Care at the End of Life, which came at a time when leaders in palliative care and related fields had already begun to air issues surrounding care of the dying. That report identified significant gaps in knowledge about care at the end of life and the need for serious attention from biomedical, social science, and health services researchers. Most importantly, it recognized that the impediments to good care could be identified and potentially remedied. The report itself catalyzed further public involvement in specific initiatives-mostly pilot and demonstration projects and programs funded by the nonprofit foundation community, which are now coming to fruition.

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Contents

Section 1
1
Section 2
38
Section 3
43
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About the author (2001)

Kathleen M. Foley, M.D., is an attending neurologist at Memorial Sloan-Kettering Cancer Center and a professor of neurology, neuroscience, and clinical pharmacology at Weill Medical College of Cornell University in Ithaca, New York.

Anthony Back, M.D., is an associate professor at the University of Washington and an affiliate member at the Fred Hutchinson Cancer Research Center in Seattle.

Eduardo Bruera, M.D., is a professor of medicine and the F. T. McGraw Chair in the Treatment of Cancer at The University of Texas M. D. Anderson Cancer Center in Houston.

Nessa Coyle, Ph.D., F.A.A.N., is the director of the Supportive Care Program of the Pain and Palliative Care Service, department of neurology, at Memorial Sloan-Kettering Cancer Center in New York.

Matthew J. Loscalzo, M.S.W., is the director of patient and family support services at the Rebecca and John Moore University of California San Diego Cancer Center and is on staff at the UCSD Medical School.

John L. Shuster Jr., M.D., is a research physician at the Tuscaloosa Veterans Administration Medical Center and teaches at the University of Alabama.

Bonnie Teschendorf, Ph.D., is the director of quality of life science at the American Cancer Society in Atlanta.

Jamie H. Von Roenn, M.D., is a professor of medicine at Northwestern University's Feinberg School of Medicine and is in the hematology/oncology division at the Robert H. Lurie Comprehensive Cancer Center in Chicago.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

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