End-of-Life Care

I have come to the conclusion that a successful systematic approach to earlier transitions from disease-directed cancer therapy to end-of-life and palliative care can only come from better communication in the context of more trusting relationships.

Research report from May 2012 ONS Congress interview and poster discussion with Deborah Allen, from Duke University.

Of all the sad pronouncements that oncologists deliver, this may be the one that stings the most. If you were expecting hope from your doctor, how would you react to these words? Would you sit with quiet disbelief, or storm out of the office?

This article addresses some of the most common major challenges in oncologist-patient communication with a nuanced approach to the concepts of autonomy, paternalism, and culture.
• Autonomy Versus Paternalism in Latin America
• The Changing Scenario in Oncologist-Patient Communication
• Dealing With Ethical Dilemmas in Oncological Communication

In this article, prognostic data are summarized and a suggested approach for discussing hospice enrollment with patients is presented.
• Why Oncologists Should Refer Earlier for Hospice Care
• Another Path: Palliative Care From Day-of-Diagnosis

This article highlights the importance of palliative cancer care and the palliative care specialist to patients with incurable cancer. Oncology treatment programs have difficulty assessing and managing the many domains of care required by these patients, making collaboration across disciplines critical.
• The Need for Community-Based Palliative Care for Patients Living With Cancer
• Integration of Palliative Care Into Comprehensive Cancer Care

This article will review the overlap between palliative care and oncology and discuss the available evidence that true integration of palliative and oncology care provides patients with optimal oncology care.
• Moving Beyond 'Best Supportive Care'
• The Oncologist as Primary Palliative Care Provider

Survival for cancer patients in the United States ranks among the highest in the world.[1] Despite the demonstrated success of the US cancer delivery system, government and private payers are forcing changes to the delivery of and payment model for oncology care.

It will likely not come as a surprise to anyone that the cost of cancer care is on the rise, from $104 billion in 2006 to over $173 billion in 2020. The rise in cost is driven by both the increasing cost in therapy (witness the newly approved metastatic melanoma treatment that is $120,000 for a 12-week course of therapy) and the extent of care.

One in four Americans facing end-of-life is a veteran. Because of their traumatic experiences during combat, including experiences with death, veterans with cancer and other serious illnesses can have complex healthcare needs.