The American Society of Clinical Oncology and other medical societies, recommend that patients with advanced cancer receive palliative care directly after diagnosis and call in hospice care for at least the last 3 days of their life. However, shown by a new study there are major gaps between these recommendations and real-life practice.
Risha Gidwani, DrPH is a health economist at Veterans Affairs Palo Alto Health Economics Resource Center and a consulting assistant professor of medicine at the Stanford University School of Medicine who, along with her colleagues, examined care received by all veterans over the age of 65 diagnosed with cancer and had died in 2012. There were a total of 11,896 individuals.
Hospice care was provided to 71% of veterans but ony 52% received palliative care. The exposure to hospice care differed between patients treated by the U.S. Department of Veterans Affairs and those who enrolled in Medicare. The palliative care received for many patients was obtained late in their disease’s progression instead of immediately following their diagnosis, as was recommended by ASCO. There will be an online article of the study in the Journal of Palliative Medicine. Gidwani is the lead author of the study and the senior author is Vincent Mor, PhD, who is a professor of health services, policy and practice at Brown University.
The Difference In Palliative Care And Hospice
The palliative care and hospice are two very different services. Palliative care is intended to alleviate symptoms and improve quality of life for patients with serious illness and not just those who are at the end of life. Hospice care is end-of-life care (fewer than 180 days to live) that also provides support for family members. Hospice patients are not usually able to receive any treatment to try to extend their life due to insurance rules.
Palliative, Hospice Care Lacking
Patients receiving VA care were less likely to receive hospice care for the minimum recommended 3 days compared with those in Medicare or in other contracted care paid for by VA. There shouldn’t be any difference in timing of this care and the patient should receive a service based on their clinical need, not due to health-care system factors. Also, VA cancer patients can continue receiving curative treatment while in hospice care, but Medicare patients must stop any chemotherapy or radiation before beginning hospice. It was also found that patients older than 85 were less likely to receive palliative care than those between the ages of 65 and 69.
Palliative Care Needs To Be Better Integrated
Their study indicates that palliative care needs to be better integrated into standard oncological care and that there is wide variation in receipt of hospice care. A positive finding of the study found that 85.6% of veterans had some exposure to hospital care or palliative care in the 180 days before death. This is a higher percentage than seen in the community. The study’s findings on palliative care are worrisome. Early palliative care can increase both longevity and quality of life, so why are some referred so late? Some doctors apparently say they are unsure about the prognosis and that’s why the patient is referred late, but we know that earlier referrals are better.
Do not be afraid to ask specific questions concerning hospice and palliative care if you are responsible for a loved one’s care.
Search out as much as possible about the facilities available in your area and choose one that you feel comfortable with and believe they will give the best possible care to your loved one. Many of us have gone through this with parents or other loved ones, and feeling secure about your choice for their care may relieve one of your biggest worries and leave you with one less thing to deal with.
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