All patients with advanced cancer should receive palliative care soon after diagnosis, according to the American Society of Clinical Oncology, but only about half of veterans who died with cancer in 2012 received it, according to a new study. In addition, the researchers found that the likelihood a patient received hospice care was affected by his or her care provider — either the U.S. Department of Veteran Affairs or Medicare — rather than their need. What gives?
First, a quick primer: Palliative care aims to alleviate pain and suffering. It's useful for patients with severe diseases — whether or not they are dying. Hospice care is end-of-life care. It can include social and emotional support for the patient and family members.
Risha Gidwani, DrPH, a health economist at VA Palo Alto Health Economics Resource Center and a consulting assistant professor of medicine at Stanford, and a team examined care received by veterans over the age of 65 who died with cancer in 2012, a total of 11,896 individuals. Their research appears today in the Journal of Palliative Medicine.
They didn't figure out why such a big gap persists between the recommendations and real-life. But they did discern some practices in need of improvement. Gidwani reflected on the results in a press release:
Our work indicates palliative care needs to be better integrated into standard oncological care and that there is wide variation in receipt of hospice care. The VA is strongly supportive of palliative care and hospice, so it’s possible that other non-VA environments are performing even worse with respect to appropriate receipt of hospice and palliative care for cancer patients.
VJ Periyakoil, MD, who directs the Stanford Palliative Care Education and Training Program and was not involved in the study, found some of the findings worrisome:
We know that early palliative care increases both longevity and quality of life. It is really puzzling as to why patients are referred so late despite compelling data to do otherwise. Some doctors may say that they are unsure about the prognosis and that is why they refer patients late. However, that argument does not hold water as earlier referrals are better, and at worst we would be guilty of referring a patient a little earlier in the trajectory.
Previously: The most important letter you may ever write, Identifying disparities in palliative care among cancer and non-cancer patients and Popular author writes about the "circle of caring for a dying person"
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