The status of quality of life research in oncology is assessed, and priorities for future research with regard to conceptual and theoretical developments, focus and content of research, research designs and practical strategies for research implementation, and transferring information to clinical practice and medical policy decision-making are identified. There is general agreement that quality of life is a subjective and multidimensional construct, yet comprehensive theoretical models have not been developed and applied fully. We recommend that future research be based on conceptual models that explicate the interrelationships among quality of life domains throughout the stages of cancer care. These models, and the longitudinal research that follows from them, should attend specifically to cross-class and cross-cultural issues to avoid overgeneralization from theory and research that are based largely on the views of the majority culture. We encourage the inclusion of this theory-based quality of life assessment as a standard component of clinical trials. Success in this endeavor will require additional standardization of quality of life measures for use across a range of cancer patient populations, including the development of age-specific norms and instruments designed to assess the entire family system.

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The American Cancer Society initiated a major nationwide program to raise public and health professional awareness about the benefits of breast cancer detection, particularly screening mammography. Activities were carried out at the community level and attempted to develop local collaboration and participation. Barriers to use of screening, including cost, quality assurance, physician attitudes and practices, and women's knowledge, were addressed in communities across the United States. Early indications are that the program has made a major impact, contributing to the recent increase in the number of women who have had mammograms, the number of mammograms done in hospitals, the number of physicians who follow Society Guidelines for Mammography 0 (in Illinois, this rose from 15% in 1985 to 46% in 1987), and in the number of early breast cancers being diagnosed. The challenge remains to more broadly integrate breast cancer detection into health practice. The BCDA provides a valuable example to make this goal a reality.