Critical Report From the Institute of Medicine

If he needed more encouragement than the California verdict,Sen.Wyden (D-Ore) got it a week later when the National CancerPolicy Board at the Institute of Medicine (IOM) released a report that saidphysicians are unprepared to help half or more of the 550,000 people each yearwho experience pain, depression, and breathing difficulties in the days beforetheir death from cancer. 

The report was critical of both the National CancerInstitute (NCI) and Medicare. The former spent only $26 million of its $2.9billion budget in 1999 researching symptom control and palliative care. The IOMreport recommended that the NCI require any health facility seeking to retain orachieve NCI recognition as a Comprehensive Cancer Center to do research onpalliative care and symptom control. The Medicare hospice benefit allowsenrollment of patients only if they are expected to survive 6 months or less,and it does not cover potentially life-prolonging treatment in addition topalliative care—thereby making hospice enrollment tantamount to acceptingdeath. 

Richard Klausner, MD, NCI director, said an implementation group willrecommend ways to make some or all of the changes sought by the report.