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 Oncology (ASCO).
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 care.
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.