Palliative Care News

A palliative care consultation team reduced the cost of care for New York Medicaid beneficiaries by $6,000 per patient (Summary here and full article here). The theory is that, by defining people's wishes early on in the hospital stay, you can avoid interventions that they do not want; for example, being ventilated in the ICU. And, as we all know, interventions in the hospital are expensive, so the more you can avoid, the lower the costs. I think these sorts of studies are the findings that invite the "death panel" comparisons, unfortunately. Palliative care still has a ways to go before we all see its value, but I feel like with this study (and others like it) and the recent New England Journal of Medicine article showing lung cancer patients who get palliative care actually live longer than those who do not get palliative care, perhaps the tides are finally changing.

For-profit hospice facilities had more patients diagnosed with conditions associated with lower-skilled needs or that required longer lengths of stay compared with non-profit hospice facilities, researchers have found.

A recent JAMA study suggests that for-profit hospices have fewer cancer patients (and thus more non-cancer patients, like heart disease and dementia) with associated longer lengths of stay, as well as fewer nurse and social worker visits. It's no secret that hospices lose money on very short-stay patients. Cancer patients are more likely to be those short stay patients, when the referral is made late in the course of the disease. Conditions such as dementia can have a less predictable course, and providers are more likely to refer to hospice earlier in the course, making the patient's case more profitable for the hospice agency. This study fundamentally goes against what most hospices I have worked with stand for, but I have not had the occasion to work with a for-profit hospice. My jaw would likely hit the ground if a hospice refused one of my referrals, assuming the patient met the Medicare criteria of having an illness which, under normal circumstances, would be terminal in 6 months or less. This study has raised the possibility that the for-profit hospices are "cherry picking" their cases to keep themselves in the black.

I knew the news wasn't good when I heard Elizabeth Edwards was going home to be with her family after presenting to the hospital with liver failure. The statement also made reference to the fact that no more chemotherapy would be effective and that the cancer had now spread to her liver. She posted a very eloquent statement on her Facebook account just days before she died, stating, "I have found that in the simple act of living with hope, and in the daily effort to have a positive impact in the world, the days I do have are made all the more meaningful and precious" (more of the statement is available here: http://blogs.forbes.com/mikeisaac/2010/12/06/a-look-into-elizabeth-edwards-facebook-post-on-her-worsening-cancer-condition/?boxes=Homepagechannels). How true, how true. I was surprised to hear how quickly she died after beginning palliative care (at least, as far as I can surmise from the medical details available in the press), but this is not unusual for cancer patients in this country. I hope her family continues to benefit from the resources from hospice, even if Elizabeth did not have a lot of time with them. She was a very classy woman who will be missed. Her grace and courage with which she faced breast cancer was not lost on me, a frequent critic of breast cancer research funding. I love what a friend of hers said, "Elizabeth did not want people to say she lost her battle with cancer. The battle was about living a good life and that she won." (from this MSNBC article). Calling a death from cancer a lost battle inevitably sets up the patient as a loser, when really, no matter how you face this illness, nothing could be further from the truth. May she be remembered not for her marriage and its difficulties, but for the inspiring way she lived her life. Rest in peace, Elizabeth.

In the past month, I have been attending on the Leukemia and Lymphoma Service at our hospital. During our rounds, I made a comment to the residents that the leukemia service is the most aggressive palliative care service in the hospital. They looked puzzled until I explained what I meant.

The American Cancer Society named Thomas J. Smith, MD, the recipient of the 2015 Trish Green Quality of Life Award.