A proposed matrix for organisational changes to improve quality of life in oncology.

Educational and institutional changes are needed to improve the care of dying patients. There are four phases to a cancer control programme, and each phase stresses prevention. The fourth phase of a cancer control programme is concerned with the prevention of suffering, through impeccable management of physical and psychosocial distress. In practice, cancer control is usually addressed primarily as a biological problem, with less emphasis placed on behavioural aspects and the alleviation of suffering. The principles of symptom control and the management of psychosocial issues have been defined by the palliative care movement. However, this body of knowledge tends to be cocooned within palliative care programmes and associated journals and textbooks. As exemplified by recent advances in cancer pain management, symptom control research is a promising area for development. However, the promise is not matched by priority assignment and idea implementation. This article offers proposals for specific changes in the structure of university and cancer programmes, and revision of legislative policies which will enhance the care of patients who depend upon our interest in the fourth phase of cancer control, the prevention and relief of suffering.