There are more than 13.7 million cancer survivors in the United States today, and more than 1.5 million people will be newly diagnosed this year. In recent years there have been substantial advances in cancer treatments, resulting in increased life expectancy. While certainly desirable, the dynamic has changed and more and more people are now living with cancer as a chronic disease. All of these individuals face a variety of complex decisions related to their care that include screening, treatment choices, and the financial challenges of cancer care. However, less than a third of all people with cancer receive adequate counseling and support. A 2008 Institute of Medicine (USA) committee noted that: “Remarkable advances in biomedical care for cancer have not been accompanied by results in providing high-quality care for the psychological and social effects of cancer. Numerous cancer survivors and their caregivers report that health care providers did not understand their psychosocial needs, failed to recognize and adequately address depression and other stress symptoms, were not aware of or did not refer them to available resources, and generally did not consider psychosocial support. be an integral part of quality cancer care.” (Institute of Medicine 2008) In recent years, since the Institute of Medicine's (IOM) landmark report: Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, awareness of the value of psychosocial support has grown. Numerous other professional and standard-setting organizations have recognized the importance of and mandated social and emotional care as part of their quality recommendations and/or measures, including Patient-Center Outcomes Research Institute (PCORI): 2012 Yields. .... .middle of document......the questionable savings for our healthcare system hidden under stories of "good deaths" have provided arguments too compelling for politicians to ignore. The lessons here are clear and obvious: it is possible to offer patient-centered services and cost-effective care to patients and their families that is clinically appropriate and ethically responsible. Given the prevalence of cancer, applying some of the same considerations to integrate psychosocial interventions into cancer support settings can produce positive outcomes for patients, their families, and the healthcare system. Strategies may include greater emphasis on training and program planning, modifying reimbursement and financing strategies, and adding greater specificity in standards for accreditation of cancer centers. If we do not, we will continue to face the ethical implications of the culture of exclusivity in supportive cancer care.