Unnecessary palpitations over palliative care

January 17, 2014

The New England Journal of Medicine (NEJM) said it best when it declared in its December 13, 2013, issue that “palliative care suffers from an identity problem.”

Indeed it does. In my last blog post, I wrote about pain and addiction, and quoted my palliative care doctor. Some readers took that to mean that I am at the end of the road, so to speak, since I am calling for palliative care. 

No, I’m not! (At least I hope I’m not.)

While it is true that the palliative care movement grew out of hospice care, there are substantial differences. 

The goal of palliative care is to provide relief from painful symptoms and from the side effects of serious diseases, such as cancer. Palliative care also addresses the emotional, social, spiritual and other issues that come up. It may be administered at the time of diagnosis, as in my case, or it may be employed throughout the treatment phase, during followup, and at the end of life.

Hospice care begins when it is clear that the patient is not going to survive the illness and treatment has stopped. 

Don’t feel bad if you didn’t know that. Even many health care professionals believe palliative care is synonymous with end-of-life care, according to the NEJM.

“For palliative care to be used appropriately, clinicians, patients, and the general public must understand the fundamental differences between palliative care and hospice care,”  the article said. 

A field-tested definition developed by the Center to Advance Palliative Care and the American Cancer Society reads: “Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment.”

When I received my stage 4 lung cancer diagnosis, my doctors brought the palliative care team in right away and explained that outcomes — especially quality of life — are almost always better when it is included. It turns out I too had also equated palliative care with hospice care.

Several clinical trials have shown the benefits of early specialty palliative care in patients with advanced cancer.

For example, the NEJM notes that patients with metastatic lung cancer who receive outpatient palliative care from the time of diagnosis and throughout the course of their illness report better quality of life and lower rates of depression than do controls.

There are also cost savings attributed to palliative care, which happens to be one of the fastest-growing sub-specialities in medicine.     

The NEJM cited one study that estimated inpatient palliative care consultations are associated with more than $2,500 in net cost savings per patient hospital admission. Similarly, outpatient palliative care services have been estimated to reduce overall treatment costs for seriously ill patients by up to one-third. Early use of palliative care achieves these savings by decreasing the need for acute care services, leading to fewer hospital admissions and emergency department visits, it says.

Patients who gain access earlier to specialty palliative care have better clinical outcomes at potentially lower costs — compelling reasons for providers, policymakers, and the general public to get the message.

Follow me on Twitter   @DLSherman

One comment

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I really like the way you explained this. I, for one, did not realize that this is used for serious illnesses from the get-go. It makes sense really. Feel good!

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