Need for Palliative Care for Improved Performance at the End of Life

Increased attention is now being afforded to quality of life for patients with advanced-stage disease. CMS recently announced that hospices have been selected to participate in the Medicare Care Choices Model so dually eligible beneficiaries can receive supportive care services provided by a hospice while undergoing curative treatment. Now, an article published in JAMA Oncology underscores the need for these efforts to improve quality of life, especially for cancer patients. The study found that chemotherapy for patients with end-stage cancer was associated with worse quality of life near death while they still retained their ability to perform many life functions.

In a related commentary, Charles D. Blanke, MD, and Erik. K. Fromme, MD, of the Oregon Health & Science University, Portland, write: “These data from Prigerson and associates suggest that equating treatment with hope is inappropriate. Even when oncologists communicate clearly about prognosis and are honest about the limitations of treatment, many patients feel immense pressure to continue treatment. … At this time, it would not be fitting to suggest guidelines must be changed to prohibit chemotherapy for all patients near death without irrefutable data defining who might actually benefit, but if an oncologist suspects the death of a patient in the next six months, the default should be no active treatment,” the author concludes.

The American Journal of Managed Care recently published an entire issue on palliative care, inviting payers, health policy experts, as well as providers of palliative care to address the topic.