ORLANDOAllowing advanced cancer patients to start palliative care without
giving up aggressive treatment substantially increased end-of-life hospice
enrollment in one study and reduced cost of care in another. Both studies were
presented at the 38th Annual Meeting of the American Society of Clinical
Frederick J. Meyers, MD, medical director of the hospice program at the
University of California, Davis, Medical Center, Sacramento, reported that 91%
of patients who received palliative care while enrolled in phase I/II
chemotherapy trials eventually enrolled in hospice (abstract 1440). They also
had higher quality-of-life (QOL) scores on the Functional Assessment of Cancer
Therapy (FACT-G) than control patients who did not receive extra palliative
services. Only 20% of the control group went on to hospice.
John W. Finn, MD, medical director of Hospice of Michigan, a statewide
program based in Detroit, presented a preliminary cost analysis showing a 27%
reduction in Medicare costs for terminally ill patients who received palliative
care in a similar experiment (abstract 1452). These patients also declined less
on QOL measures than a control group of terminal patients who received standard
While data are available for only 55 patients out of 160 enrolled in the
Michigan trial, Dr. Finn suggested the final analysis might show the patients
living longer than their prognoses. Eligible patients had a life expectancy of
less than 6 months, but many are still alive 7 to 8 months later, he said.
No survival differences have been reported in the California trial, but Dr.
Meyers said the patients who received early palliative care were more likely to
finish all their chemotherapy cycles than patients in the control group. A
nurse and a social worker visited the patients at home, addressing symptom
management and offering emotional support while discussing end-of-life issues.
The California study was small, with 44 patients in the palliative care
group and 20 in the control arm. The National Institutes of Health has awarded
a $2.5 million grant for a larger multicenter investigation of the simultaneous
care model. It will be led by Dr. Meyers, who is also director of the West
Coast Center for Palliative Education and Research and chair of internal
medicine at UC Davis.
In the Michigan study, a palliative care nurse coordinated ongoing
treatments and hospice care for the patients. The patients continued to be
treated by participating oncologists at a comprehensive cancer center, two
community-based cancer centers, and private practices. Some patients never
stopped seeking aggressive treatments, Dr. Finn said.