In the United States survival from cancer is steadily improving. Most care is delivered in outpatient physician offices or clinics. When cure is not possible, oncologists direct their efforts to symptom palliation when cure is not possible. Care is also rising in cost. In all of these aspects of care delivery –- potentially curative therapies, the outpatient setting, and of symptom palliation — it is not clear that neither all patients benefit nor that care is uniformly delivered.