The good news made headlines nationwide: Deaths from several kinds of cancer have declined

significantly in recent years. But the news has to be bittersweet for many cancer patients and their families. Every year, more than 500,000 people in the United States still die of cancer. In fact, more than half of all patients diagnosed with cancer will die of their disease within a few years. And while it's true survival is longer today than in the past, the quality of life for these patients is often greatly diminished. Cancer—many of the treatments used to fight it—causes pain, nausea, fatigue, and anxiety that routinely go undertreated or untreated.

In the nation's single-minded focus on curing cancer, we have inadvertently devalued the critical need for palliative care, which focuses on alleviating physical and psychological symptoms over the course of the disease. Nothing would have a greater impact on the daily lives of cancer patients and their families than good symptom control and supportive therapy. Yet the National Cancer Institute (NCI), the federal government's leader in cancer research and training, spent less than I percent of its 1999 budget on any aspect of research or training in palliative care.

The nation needs to get serious about reducing needless suffering. NCI should commit to and fund research aimed at improving symptom control and palliative care. NCI also could designate "centers of excellence" among the cancer centers it recognizes. To get that designation, centers would deliver innovative, top-quality palliative care to all segments of the populations the centers serve; train professionals in medicine, nursing, psychology, social work, and other disciplines to provide palliative dare; and conduct research.

Insurance coverage for palliative and hospice care also contributes to the problem by forcing people to choose between active treatment or hospice care. This "either/or" approach does not readily allow these two types of essential care to be integrated. The Medicare hospice benefit is designed specifically for people in the final stages of illness and allows enrollment only if patients are expected to survive six months or less. The benefit excludes patients from seeking both palliative care and potentially life-extending treatment.

That makes hospice enrollment an obvious deterrent for many patients. And hospices, which may have the most skilled practitioners and the most experience in administering palliative care, cannot offer their services to people who could really benefit but still are pursuing active treatment.

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 not guided policy at the level of institutions in this country. Death is inevitable, but severe suffering is not. To offer hope for a long life of the highest possible quality and to deliver the best quality cancer care from diagnosis to death, our public institutions need to move toward policies that value and promote palliative care.

Palliative care is concerned with improving patients'

A．survival rates

B．quality of life

C．lifespans.

D．options for health insurance providers