ASCO’s QOPI (Quality Oncology Practice Initiative) analysis recently found that less than half of all cancer patients are enrolled in hospice care before their death and of those who are enrolled, one-third are not enrolled until the last week of their lives. In response to this and other QOPI findings, ASCO published a new policy and guidelines this week, intended to encourage physicians to initiate open dialogue about palliative care and treatment with patients as soon as they are identified as having incurable cancer.
The authors state, “There is a need to change the paradigm for advanced cancer care to include an earlier and more thorough assessment of patients’ options, goals, and preferences, and to tailor the care that we deliver to these individual needs throughout the continuum of care.”
The authors, led by Jeffrey Peppercorn at Duke, state that anticancer therapy should be considered only when it is deemed likely to result in significant clinical benefit, and that the priority throughout the course of the disease should be placed on “enhancing patients’ quality of life.” To this end, the authors cite evidence from a recent randomized trial showing that early palliative care results in improved quality of life and survival when compared with standard disease treatment.
Another important point made in the new policy statement is that now, less than 3% of adult patients with cancer are enrolled in clinical trials, yet willingness to participate is estimated at roughly 50%. The authors state that patients should be encouraged to enroll in clinical trials earlier in their disease, rather than at such a late stage that the expectation of benefit is unrealistic.
Peppercorn and his colleagues cite the following as potential barriers to providing personalized treatment in incurable disease: awareness of the importance of this issue among doctors; a lack of guidelines for discontinuing therapy; the fact that our current reimbursement system favors immediate intervention rather than prolonged discussion between caregiver and patient; and the barriers that prevent incurable cases from participating in clinical trials.
They posit that the steps needed to provide successful personalized treatment include raising awareness of the issue in general by emphasizing individualized care in medical education and training; prioritizing compensation of oncologists for open discussion of options throughout healthcare reform process; empowering patients; and continuing basic research in advanced cancer care.
The statement was published Monday, January 24th in the Journal of Clinical Oncology; you can read the full-text here: http://jco.ascopubs.org/content/early/2011/01/24/JCO.2010.33.1744.full.pdf+html.