Introduction

During the past decade, 11 million cases of cancer were diagnosed and 5 million people died from cancer. Approximately one half the patients diagnosed with cancer develop metastatic disease, and more than 70% of all cancer patients develop symptoms from either their primary or metastatic disease (1–4). The decrease in the total number of cancer deaths that occurred between 1996 and 1997 was not sustained; there were 955 more cancer-related deaths in 1998 than in the previous year (5). As the second most common cause of death in the United States, accounting for 23% of all deaths in 1998, cancer is the leading cause of death among women ages 40 to 79 years old. It is estimated that 1,268,000 new cases of cancer will be diagnosed this year, and 553,400 will die of cancer, more than 1500 people a day. Cancer of the lung, prostate, breast, and rectum constitute more than 50% of all cancer deaths.

Palliation represents a large component of cancer treatment and includes the use of therapeutic and supportive care measures. Unlike other aspects of cancer therapy, tumor control and survival are not the endpoints of therapeutic success in palliative care. Quality of life is now recognized as an endpoint which is as important as survival (6,7). The goal of palliative care is to effectively and efficiently relieve symptoms and maintain the maximum quality of life for the duration of the patient's life (2–4,8–13). The effectiveness of palliative therapy can be assessed, in part, by the percentage of patients who experience persistent/recurrent symptoms and the effort required to control these symptoms with a variety of therapeutic modalities (12, 14, 15).