From the Division of Hematology/Oncology, the Massey Cancer Center, and Department of Internal Medicine (Dr Smith), and Legal Medicine and Health Administration (Dr Swisher), the School of Health Administration, Medical College of Virginia at Virginia Commonwealth University, Richmond.
Cancer accounted for more than 23% of all deaths in 1997. Although much
progress has been made in reducing cancer deaths, the inescapable truth is
that most patients with recurrent cancers will die as a result of the malignancy.
This is important for several reasons: (1) two thirds of all cancers are preventable,1 so much of the morbidity and mortality are unnecessary;
(2) the cost of cancer care continues to increase, from $35 billion in 19902 to an estimated $50 billion in 19963;
(3) some physicians and patients are probably not taking advantage of the
progress made in treating metastatic cancer or its symptoms; and (4) far too
many patients are fighting a battle they cannot win, and not taking advantage
of good end-of-life care.
Smith TJ, Swisher K. Telling the Truth About Terminal Cancer. JAMA. 1998;279(21):1746-1748. doi:10.1001/jama.279.21.1746