Cancer Care and the Future

Future developments in cancer care will be affected by advances in the clinical control and prevention of the disease. Ongoing genetic and molecular research promises not just more effective treatments for cancer but also less invasive procedures for patients, greater patient autonomy, and improved quality of life. Potential problems may include a compounding of concerns about informed consent for cancer clinical trials and genetic susceptibility testing, as well as more "macro" issues such as the inequitable distribution of cancer care resources in the United States and globally. Also, current trends suggest continued growth in "informal" cancer care resources ranging from online information networks to holistic alternatives to conventional cancer care. Many of these resources have the potential for linking together and empowering cancer patients but also of misinforming them or undermining the oncologist's authority and purpose through the exposure of patients to multiple, conflicting messages. Surveys and other kinds of behavioral research may be needed so that providers of cancer care may better grasp the pluralistic knowledge- and treatment-seeking tendencies of their patients and the way in which they affect physician-authority, treatment adherence, and other key clinical issues.

Finally, demographic trends at the beginning of the twenty-first century strongly suggest that cancer care will be provided amid growing ethnic and cultural diversity in the United States and elsewhere. Already many providers of cancer care feel the impact of this diversity through their daily struggles with language barriers, conflicting expectations, lack of treatment adherence, and other problems. Learning more about patients and their backgrounds provides an important way to address these and other problems. Clearly, however, it is unrealistic to expect caregivers to identify the countless cultural norms and behaviors that may affect their patients' preferences and decisions. An approach tailored to a particular institution's patient demographic is needed, and for this there are handbooks and other tools that may assist a cancer caregiver practicing in any region of the United States. Leading cancer care institutions also increasingly hire professional, culturally astute interpreters who can help oncologists and patients bridge the cultural and linguistic differences that may hinder effective communication and understanding. Conferences and workshops on "cultural competence" and "cultural sensitivity" increasingly are organized for researchers, ethicists, and caregivers to use in response to growing patient heterogeneity.

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