Integrating palliative care earlier in the disease process can improve quality of life and possibly survival for patients with advanced cancer, but its value is widely misunderstood, according to a recent review by palliative care experts in the New England Journal of Medicine.
Most palliative care currently is provided at end-of-life due to its perceived association with hospice care, said the article, co-authored by experts from Harvard Medical School, Massachusetts General Hospital, the American Cancer Society, and Johns Hopkins University. But whereas hospice care provides comfort for patients in the last stages of an incurable disease, palliative care focuses on relieving symptoms and can be provided in concert with curative treatment at any stage in a serious illness.
“Debates over ‘death panels,’ physician-assisted suicide, and reimbursement for advance care planning have made policymakers reluctant to devote resources to initiatives perceived to be associated with ‘death and dying’,” the authors wrote. “The practice and policy behind palliative care must be considered independently from end-of-life care. Palliative care should no longer be reserved exclusively for those who have exhausted options for life-prolonging therapies.”
Palliative care makes sense for seriously ill patients from clinical, economic, and political standpoints, according to the article. For example, several studies have shown that patients who receive palliative care consultations early in their disease process report better symptom control, lower rates of depression, and a better understanding of their prognosis and treatment goals compared with control groups.
Cost savings also accrue from palliative care, the authors said. Hospitals with specialty palliative care services have reduced lengths of stay, decreased admissions to intensive care, and lowered lab and pharmacy expenses while outpatient services have been estimated to reduce overall treatment costs by up to 33% per patient.
Despite palliative care’s potential to improve health and lower cost, legislators have been slow to support it, the authors said. The key to change is reframing the discussion to emphasize how palliative care can improve quality of life at any stage of illness without decreasing survival. They recommended the following potential solutions:
Financial incentives: Hospitals and insurers should provide practice and payment incentives for clinicians, such as Medicare reimbursement for physicians to counsel patients throughout their illness and integrate palliative care services into routine practice. Health care systems should be encouraged to adopt coordinated care programs that combine palliative services with disease-centered treatment.
Education reform: Medical schools and residency programs should train physicians in managing symptoms, providing psychosocial support, and discussing prognosis and treatment preferences with seriously ill patients. More funding is needed for fellowship programs in palliative care.
Hospital-based palliative care teams: All hospitals should have access to integrated palliative care services over the next decade. Major cancer centers and the American Hospital Association have taken steps to increase the prevalence of palliative care but services are still lacking in many states, especially in small, for-profit, and public hospitals.