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Making the Case for Early Palliative Care

Throughout the United States, palliative care (PC) is becoming a more established and integral component of comprehensive cancer care for patients with advanced disease. “Published research has shown that PC is associated with better quality of life and mood, improved symptom control, and more appropriate health resource use,” explains Jennifer S. Temel, MD. “It has also been linked to increased patient and caregiver satisfaction, healthcare savings, and survival.” Clinical guidelines recommend that all patients with metastatic cancer be offered PC services early in the course of the disease. Currently, many cancer centers have some form of PC services, such as inpatient consultative services and acute inpatient units. PC clinics, on the other hand, are scarcer entities. Recent analyses have suggested that integrating PC early in the ambulatory care setting is feasible and can improve patient-reported outcomes as well as several key measures of quality end-of-life care and resource use. Early integration of PC with cancer care improves patients’ understanding of their disease and prognosis, leads to more timely transitions to hospice care, and decreases chemotherapy use near the end of life. Looking Closer at Early Palliative Care According to Dr. Temel, more information about the nature and elements of early PC in ambulatory care is needed. “The integration of PC with standard oncologic care may have a different emphasis and focus than traditional inpatient or consultative PC,” she says. Earlier and longer collaborative relationships between PC clinicians and patients may allow the time and opportunity to face complex issues like treatment decisions and advanced care planning rather than focus mostly on acute symptom management and imminent death. A study...

New Palliative Care Cancer Guidelines

Nearly half of all patients with metastatic cancer have incurable disease, but these individuals can live for years after their initial diagnosis. Palliative care can be used during this period to improve quality of life (QOL) for patients and caregivers. Palliative care emphasizes medically appropriate goal setting, honest communication, and meticulous symptom assessment and control. Despite the documented benefits of using palliative care in standard oncologic care, studies indicate that many patients are not referred to these services until near the end of life. Delaying palliative care reduces opportunities for clinicians to address physical symptoms and the emotional, social, and spiritual needs (see also, The Burden of Pain & Depression in Cancer Patients). Potential Benefits of Early Palliative Care Integration In the March 10, 2012 Journal of Clinical Oncology, the American Society of Clinical Oncology (ASCO) issued a provisional clinical opinion (PCO) on integrating palliative care into standard oncology care. The document was prompted by a growing body of research demonstrating the benefits of this integration early in the care of patients with metastatic cancer. Seven randomized controlled trials have shown that providing early palliative care together with standard oncologic care in patients with advanced cancer can be beneficial. These benefits include: Improved symptoms, QOL, and satisfaction. Reduced caregiver burden. More appropriate referral to and use of hospice. Decreased use of futile intensive care. Furthermore, most of these studies demonstrated improved outcomes at a cost lower than that of standard oncologic care alone. No trials to date have demonstrated harm to patients and caregivers or excessive costs from early involvement of palliative care. Hurdles Ahead for Readily Available Palliative...
Top 10 States Having Hospitals With Palliative Care

Top 10 States Having Hospitals With Palliative Care

On average, our nation gets a “B” for hospital support care, according to a new report released by the Center to Advance Palliative Care. The report surveyed nearly 2,500 U.S. hospitals and graded states on how many of their hospitals provide palliative care—support and coordination of medical service for chronically ill patients and their families. Counting only hospitals with 50 or more beds, R. Sean Morrison, MD, and Diane E. Meier, MD, graded states on the percentage of hospitals that have palliative care teams. States got an “A” for having palliative care teams in 83% or more of their hospitals; a “B” for 61% to 80% of hospitals; a “C” for 42% to 60% of hospitals; a “D” for 28% to 38% of hospitals; and an “F” for 0% to 20% of hospitals. Overall, the report found that 85% of hospitals with more than 300 beds and 63% of hospitals with more than 50 beds have a palliative care team. That gives the nation an overall “B” grade. Among the findings of which states had hospitals that offered the most palliative care: Top 10 States: District of Columbia — 100% of hospitals have palliative care teams Vermont — 100% Nebraska — 93% Maryland — 90% Minnesota — 89% Oregon — 88% Rhode Island — 88% Washington — 83% New Jersey — 80% Ohio — 80% Bottom 10 States: New Mexico — 44% Louisiana — 43% Georgia — 43% Texas — 42% Arkansas — 38% Oklahoma — 30% Alaska — 29% Alabama — 28% Delaware — 20% Mississippi —...
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