Reducing Costs by Better Integration of Palliative Care in Cancer Treatment

We’re up to point 9 on the list – and nearing the end — on Bending the Cost Curve in Cancer Care from the May 26 NEJM. The sug­gestion from Drs. Smith and Hillner is that doctors better inte­grate pal­liative care into usual oncology care.

The authors start this important section well:

We can reduce patients’ fears of aban­donment by means of better-​​integrated pal­liative care. This topic is fraught with mis­un­der­standing given the ref­er­ences to “death panels” during the recent debate con­cerning health care legislation…

Here they’re on target: Some patients think, mis­takenly, that inclusion of pal­liative care in their treatment means their doctors are throwing in the towel. I’ve known some oncol­o­gists who think the same, who per­ceive pal­liative care as a last resort.

The truth is that pal­liative care, which aims to relieve symptoms, can be imple­mented at any point in the treatment of disease.

The authors go on to provide data that cancer patients who receive pal­liative care live just as long, or longer, than those who don’t, and that their medical bills are lower. The issue I have here is their choice of emphasis on a pub­lished study of the Aetna Com­pas­sionate Care Program in which nurses iden­tified patients for pal­liative care by admin­is­trative claims, “thus bypassing the oncol­ogist.” Evi­dently this strategy led to a dou­bling of hospice referrals and other pos­sibly good effects.

Besides that the cited study was authored by employees of an insurance company, which I find unpalatable, the concept of having nurses do the referrals deflects the issue: that oncol­o­gists talk about pal­liative care with their patients, directly. Relying on nurses to carry out these con­ver­sa­tions would, under­standably, con­tribute to a sense of aban­donment, even if the nurses do the job per­fectly. A critical role oncol­o­gists is to com­mu­nicate about treatment care options, part of the cog­nitive work con­sidered in point 8 of this discussion.

But the main idea, that doctors should inte­grate pal­liative care into their cancer patients’ treatment planning, earlier, and as a sup­plement – and not a replacement — for poten­tially curative or tumor-​​shrinking strategies, is right on.

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Related Posts:

• Reducing Cancer Care Costs: Oncol­o­gists Need to Get a Grip on Reality, and Talk about Dying
• Reducing Costs by Holding Back on Chemotherapy for Cancer Patients Who are Frail
• Running 2 Lists That Might Lessen the Costs of Oncology Care
• Reducing Cancer Care Costs by Com­par­ative and Cost-​​Effectiveness Research (CER)
• Low­ering Cancer Care Costs by Lim­iting Chemotherapy in Patients Who Aren’t Responding