One of the most important things patients and their families cite when it comes to end-of-life care is the desire to be home and with their family. To many in the U.S., this means hospice care and, therefore, the end of active cancer treatment. Now, researchers point to a model adopted by the U.S. Veteran’s Administration where hospice and active cancer care are given concurrently.
Hospice is designed to improve the quality of a patient’s last days by offering comfort and dignity, and often allows the patients to remain in their own home surrounded by their loved ones. Today, once hospice is established in the U.S. active cancer care is ended and the patient receives palliative care that is intended to control pain and relieve symptoms.
According to Drs. Jeanie M. Youngwerth and D. Ross Camidge from the University of Colorado, the U.S. trails behind many other countries when it comes to providing quality medical care for patients with terminal conditions. But, straying from the norm, the VA does not limit “curative” therapies while a veteran is receiving hospice care.
“Consequently, in theory, the VA would permit life-prolonging measures, such as chemotherapy, to be administered while a patient simultaneously receives hospice services,” said the doctors.
For veterans, this is good news since this population makes up one-third of those who suffer from mesothelioma, a terminal cancer caused by past asbestos exposure. Approximately 3,000 Americans are diagnosed with mesothelioma each year. Asbestos was used as insulation in military buildings and ships. It was also used as an insulator around heat and cooling systems, in Navy vessels and in the gaskets placed inside airplane engines and large machinery.
For other mesothelioma patients, the option for concurrent care is still being assessed. The doctors point out that several clinical trials found “
early initiation of palliative/hospice care with active anticancer therapy, so called “concurrent care,” improves quality and, potentially, quantity of life for patients with advanced cancer.” In addition, they note, that a 2010 study found that “patients with advanced lung cancer did better in terms of both quality and quantity of life when they received palliative care integrated with standard anticancer care as opposed to receiving anticancer care alone.”
Other government agencies hope to join the VA in their treatment model. Centers for Medicare & Medicaid Services, through the Medicare Care Choices Model, is piloting a program for Medicare beneficiaries to receive palliative care services from certain hospice providers while concurrently receiving anticancer therapies provided by their oncology providers, according to the doctors.
Other medical professionals agree with the need for concurrent care for critically ill patients. In a 2012 presentation at the annual meeting of the American Academy of Hospice and Palliative Medicine, Dr. Diane E. Meier, director of the Center to Advance Palliative Care and professor of geriatrics and internal medicine at Mount Sinai School of Medicine, stressed that now is the time to educate physicians as well as the general public that palliative care is “actually about relieving the pain, symptoms, and stress of serious illness in patients of any age and at any stage of disease, and that palliative care can be delivered alongside curative or life-prolonging therapies.”