Overview In the United States, a total of 1,479,350 new cancer cases and 562,340 deaths from cancer were estimated to occur in 2009. 1 All patients experience some level of distress associated with the diagnosis and treatment of cancer at all stages of the disease. Surveys have found that 20% to 40% of patients with newly diagnosed and recurrent cancer show a significant level of distress. 2 However, fewer than 10% are actually identified and referred for psychosocial help. 3 Many cancer patients who are in need of psychosocial care are not able to get the help they need due to the under recognition of patient's psychological needs by the primary oncology team and lack of knowledge of community resources. The need is particularly acute in community oncology practices that have few to no psychosocial resources, and cancer care is often provided in short visits. 4 For many centuries, patients were not told their diagnosis of cancer because of the stigma attached to the disease. Since the 1970s, this situation has changed and patients are well aware of their diagnosis and treatment options. However, patients are reluctant to reveal emotional problems to the oncologist. The words psychological, psychiatric, and emotional are as stigmatizing as cancer. Psychological issues remain stigmatized even in the context of coping with cancer. Consequently, patients often do not tell their physicians about their distress and physicians do not inquire about the psychological concerns of their patients. Recognition of patients' distress has become more difficult as cancer care has shifted to the...
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