PALM SPRINGS, Calif--The United Kingdom, not unlike the United
States, is undergoing a period of radical change in the organization
of cancer services, the status of the medical professionals delivering
those services, and the climate for conducting clinical research,
Ann Cull, PhD, said at the American Society for Psychiatric Oncology/AIDS
Such changes are creating a crisis for psychosocial oncology,
but may also open up new opportunities, as the need for psychosocial
services and research to help control cost becomes apparent, she
The National Health Service, the UK's central socialized medicine
delivery system, is being gradually dismantled, Dr. Cull said,
and replaced by local health trust organizations.
With the intent of establishing primary care physicians as the
principal providers of services to cancer patients, the government
is setting up "cancer units" in district hospitals designed
to manage patients with common cancers under the direction of
Larger designated cancer centers will be responsible for handling
the full range of cancer diagnoses, as well as providing specialist
and consultant services, said Dr. Cull, a clinical psychologist
and researcher at the Western General Hospital, a regional cancer
center in Edinburgh.
Although the rationale behind the development of this new structure
for cancer care delivery appears to be directed toward improving
standards of care, she said, members of the oncology community
worry that these changes will lead to a "leveling down"
"In the area of psychosocial oncology, where the provision
of services is somewhat patchy even in the cancer centers, there
is concern about how these smaller cancer units will be able to
provide comprehensive care," she commented.