Introduction

Advanced cancer brings intense psychosocial distress to both patient and family. No area of a patient's and family's life is untouched by cancer, and unmet needs in any area of life become magnified as the disease progresses. Family members or designated caretakers are an essential part of the care team, and they affect the quality of care the patient receives. Consequently, attention to family issues arising from the patient's diagnosis is part of the patient's treatment. The family's distress is the patient's distress and meeting nonmedical needs and addressing family concerns will relieve tensions that affect the patient's physical symptoms. As family members or other nonmedical caretakers provide more technologically complex care for longer periods of critical illness, the medical team must be mindful of the burden carried by these partners in care.

This chapter provides indicators for medical providers' ongoing evaluation of the well-being of patient and family. These indicators are based on information provided by patients concerning their needs and on issues delineated by medical practice as important to patients and their families. By knowing objective indicators, medical providers can reassess psychosocial components of treatment plans and implement services to address nonmedical and subjective problems that may be exacerbating the patient's suffering.

Needs identified by patients

The concerns of patients with advanced-stage cancer are typically more psychosocial than medical. Even a medically oriented need like symptom management has emotional and social components that require intervention, not only for the patient but for the family and nonmedical caretakers.