Based on the evidence presented in Chapters 3 and 4 and the additional evidence presented in this chapter on the feasibility of providing psychosocial health services in accordance with the standard recommended in Chapter 4, the committee makes the following recommendations.

Recommendation: Health care providers. All cancer care providers should ensure that every cancer patient within their practice receives care that meets the standard for psychosocial health care. The National Cancer Institute should help cancer care providers implement the standard of care by maintaining an up-to-date directory of psychosocial services available at no cost to individuals/families with cancer.

In making this recommendation, the committee appreciates that patients diagnosed with cancer are treated for their illness by many different types of providers—some specializing in oncology and others, such as primary care physicians and general surgeons, who have a patient population that is more heterogeneous with respect to diagnosis. Patients with cancer may make up a minority of patients seen by the latter clinicians. The committee believes that all providers should implement the above recommendation, but appreciates that those whose practices are not devoted to oncology may have other strategies, standards, and expectations placed on them by experts in the care of patients with other diseases. While the committee believes that the standard of psychosocial health care has applicability to all chronic diseases (as illustrated by the breadth of clinical conditions addressed by the models of care reviewed in Table 4-1 in Chapter 4), it calls upon oncology practices to lead the way in implementing this standard of care and providing cancer care “for the whole patient.”

In making this recommendation, the committee also appreciates that there is not currently as ample a supply of psychosocial services as is necessary to meet all the needs of all patients, and some problems (such as a lack of health insurance and poverty) can be addressed only in a small way. Nevertheless, the committee urges all involved in the delivery of cancer care not to allow the perfect to be the enemy of the good. The inability to solve all psychosocial problems permanently should not preclude attempts to remedy as many as possible—a stance akin to treating cancer even when a successful outcome is not assured. Patient education and advocacy organizations can play a key role in bringing this about.

Recommendation: Patient and family education. Patient education and advocacy organizations should educate patients with cancer and their family caregivers to expect, and request when necessary, cancer

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