Cancer accounted for more than 23% of all deaths in 1997. Although much progress has been made in reducing cancer deaths, the inescapable truth is that most patients with recurrent cancers will die as a result of the malignancy. This is important for several reasons: (1) two thirds of all cancers are preventable,1 so much of the morbidity and mortality are unnecessary; (2) the cost of cancer care continues to increase, from $35 billion in 19902 to an estimated $50 billion in 19963; (3) some physicians and patients are probably not taking advantage of the progress made in treating metastatic cancer or its symptoms; and (4) far too many patients are fighting a battle they cannot win, and not taking advantage of good end-of-life care.