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Palliative, hospice care not used enough for cancer patients, study says

Patients are not being provided either service early or often enough, potentially causing lower quality of life.

By Stephen Feller
Palliative, hospice care not used enough for cancer patients, study says
Despite palliative care being meant to improve quality of life for patients with advanced forms of cancer, and hospice being meant to make patients more comfortable at the end of their lives, neither service is used as often or as well as it should be, according to researchers. Photo by Africa Studio/Shutterstock

STANFORD, Calif., May 27 (UPI) -- Care designed to improve the quality of life for advanced cancer patients, regardless of prognosis or expected length of survival, is not being provided early or often enough, according to new research.

Researchers at Stanford University found palliative and hospice care are not being utilized enough, based on a comparison of veteran health services and Medicare.

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The two types of care are similar, but serve different purposes. Palliative care is meant to improve quality of life and alleviate symptoms of disease, whether or not they are nearing death, while hospice is meant as end-of-life care for patients and social support for their families.

Although hospice is supposed to be recommended when patients have less than six months to live, it is often utilized far less than could be beneficial for patients. Palliative care, on the other hand, is often ignored in areas where patients might make greater gains in health during treatment, or at least will be more comfortable while being treated.

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Researchers were not surprised that the U.S. Veterans Administration has a better track record with either path of care than Medicare because of their stated mission to serve veterans, but they say even the VA could prescribe the services more often.

"Our work indicates palliative care needs to be better integrated into standard oncological care and that there is wide variation in receipt of hospice care," Dr. Risha Gidwani, a health economist and assistant professor of medicine at Stanford University, said in a press release. "The VA is strongly supportive of palliative care and hospice, so it's possible that other non-VA environments are performing even worse with respect to appropriate receipt of hospice and palliative care for cancer patients."

For the study, published in the Journal of Palliative Medicine, the researchers reviewed administrative data for 11,896 veterans over age 65 who died of cancer in 2012 at Medicare, VA or VA-purchased care facilities, comparing the likelihood of palliative care and hospice care.

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Overall, most patients -- 71 percent -- received hospice care, while just 52 percent received palliative care. Only 59 percent of all patients received hospice care for at least their last three days of life, the recommended minimum.

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Overall, patients received hospice care a median of 20 days before death and palliative care a median of 38 days before death, researchers reported, though VA patients first received hospice care a median of 14 days before death, compared with patients in VA-contracted care who entered hospice a median of 28 days before death.

The VA and Medicare have different rules for hospice -- Medicare requires cancer treatment must stop before entering care, while the VA does not -- however nearly 70 percent of VA patients stopped treatment before entering hospice.

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There were also differences between types of cancer. Brain cancer patients were more likely than kidney cancer patients to receive palliative care. Patients older than 85 were also less likely to receive palliative care than those between age 65 and 69, while patients older than 80 were more likely to receive hospice care than younger patients.

"The main lesson learned is we need to improve exposure to palliative care, both in terms of how many patients receive it and when they receive it," Gidwani said, adding that "ideally, there shouldn't be any difference in timing of this care. Patients should receive a service based on their clinical need, not due to health-care system factors."

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