from other, formal sources. As noted in Chapter 1, the American Cancer Society and CancerCare both report that they frequently provide assistance in securing transportation to health-related appointments, supplies needed for health care, medical equipment, wigs, and prosthetics.

The effect on health or health care of providing these material and logistical resources has been the focus of limited research, likely for multiple reasons. First, as noted earlier in the chapter, some of these services have such long-standing and wide acceptance as humane services that there has been little question as to whether they “work.” Transportation, for example, has long been acknowledged as a necessary resource for the receipt of health care, as is evident from its inclusion as a covered service since the inception of the Medicaid program. Moreover, the provision of many of these resources poses less physical risk than a new medication or other clinical treatment, thus attracting less attention as a priority focus for scare research dollars. Some of these services also have been perceived as “human services” rather than “health services” because they are not directly curative or biomedical in intent or origin, and are frequently provided through voluntary human services agencies as opposed to health care providers under third-party reimbursement. In addition, some of these resources may be perceived as “cosmetic” and thus of lower priority than life-saving medical treatments (Healey, 2003). When these services have been examined, the question often has been how to deliver them (often limited in availability) more efficiently and appropriately and how to prioritize their delivery to those in greatest need.

Among the sparse research that has sought to determine the effects on health or health care of providing logistical or material resources, one study documented that when individuals with cancer lacked transportation, treatment was foregone (Guidry et al., 1997). And studies of people with a variety of chronic diseases have found that environmental barriers such as cost and logistical obstacles interfere with the ability to manage their illness (Bayliss et al., 2003; Vincze et al., 2004). The absence of research on other types of support (e.g., use of breast prostheses generally and of different types) has in itself been identified as adversely affecting the quality of life of women after surgery for breast cancer (Healey, 2003).

The committee notes that the absence of research is not evidence of an intervention’s ineffectiveness. Moreover, the frequent provision of many of these services to patients and families by voluntary agencies (detailed in a table presented later in this chapter) indicates that these services likely help patients and their caregivers meet health-related psychosocial needs. The provision of transportation, supplies, and other logistical and material support when needed also can logically be assumed to decrease patient distress and increase the ability of both patients and caregivers to manage illness and its consequences.



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