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Doctors Urged to Talk Discuss Palliative Care

Soon after diagnosing a patient with advanced cancer, a doctor should begin discussing options for palliative care—the management of symptoms—according to a new policy statement from the American Society of Clinical Oncology (ASCO).  ASCO also released a new, free guide called Advanced Cancer Care Planning for patients to help initiate those conversations.

“Studies show that palliative therapies not only improve patient quality of life, but can even extend life,” said ASCO President George W. Sledge, Jr., MD. In fact, a recent study found that patients with advanced lung cancer who received both chemotherapy and palliative care immediately after diagnosis lived almost three months longer than those receiving chemotherapy alone (N.Engl. J.Med.2010; 363:733-42).

Many people think palliative care means end-of-life care. It’s not the same. Palliative care is a growing specialty focused on symptom control and maintaining quality of life—according to the patient’s goals.  Experts say it should be initiated, along with disease-directed treatments, soon after diagnosis—especially in patients having aggressive disease or severe symptoms or side effects. (Hospice, or end-of-life care, begins when the patient is expected to live less than six months and when disease-directed treatments are discontinued.)

In a special January 24th article in its Journal of Clinical Oncology, ASCO called on physicians to start candid discussions about prognosis, benefits and risks of treatments, and palliative care options soon after initial diagnosis of advanced cancer. Currently this happens with less than 40% of such patients.

Even the best oncology practices have great room for improvement. In an ongoing ASCO study of 5,500 patient records from 600 oncology practices who joined a quality improvement initiative, medical records showed that only 45% of cancer patients were enrolled in hospice before death: Of those, one-third were enrolled in the last week of life. And even in these practices, records from the last visits with the oncology team showed that two of three patients did not receive appropriate management for shortness of breath and 20 % did not receive appropriate pain management. Both are key components of palliative care.

ASCO also called on medical schools to include palliative care training into oncology programs, and on insurers to expand pilot programs that cover palliative care without requiring patients to abandon cancer-focused treatments.

To help patients, ASCO has released a new booklet that clearly explains options for advanced cancer care, with examples of disease-directed treatment, palliative care to manage symptoms and side effects; and hospice care.

Source: American Society of Clinical Oncology, J. of Clinical Oncology, Jan. 24 2011

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