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Despite evidence-based research demonstrating the high prevalence rates of emotional distress, medical systems continue to focus their attention on biomedical aspects of treatment leaving a significant gap in patient care. This paper reflects on values and policy and suggests that we are unlikely to change health care systems unless we routinely address comprehensive aspects of the patient's experience. If we do not measure indicators of emotional distress, we risk not responding to this significant aspect of the cancer experience. The key message to health care providers here is: what we measure is what we act upon.