A recent article titled “Oncology group stresses need for palliative care, not aggressive treatment, at end of life” may represent a shift in thinking among oncologists. The hospice and palliative care world has long observed our medical culture’s aggressive approach to treating as long as possible, often up until the final hours of life. The unnecessary tests and treatments recognized by the medical coalition in this article is a welcome change in thinking. More than anything it may simply encourage physicians, particularly oncologists, to open lines of communication early with their patients regarding the true objective benefits, or lack thereof, of continued treatment. As the article points out, this is particularly needed in late-stage cancer patients. Honest and open communication with patients regarding the truth about their condition and its trajectory is not a sign of a bad doctor, or of giving up hope. It’s a much needed step in improving end-of-life care.
The Philadelphia-based American Board of Internal Medicine Foundation and a coalition of nine medical societies released their top-five recommendations Wednesday for unnecessary tests and treatments that should be reduced to cut costs to the healthcare system.
The recommendations suggests late-stage cancer patients who stand to benefit little from chemotherapy should be taken off anti-cancer drugs and given hospice care at the end of life.
According to the recommendations, as many as ten to 15 percent of cancer patients receive chemotherapy in the last two weeks of life.
Dr. Dave Casarett, head of hospice for the University of Pennsylvania Health System, said the source of the guideline, the American Society of Clinical Oncologists, was surprising to him and represented a shift in thinking.
“It very clearly identifies the elephant in the room,” Casarett said. “This is a phenomenon, this pattern of aggressive treatment up until the very last hours of life, that those of us in the palliative care world see again and again and again, but it’s not something the oncology world has specifically identified in a public way before.”
Casarett said he hopes the recommendation opens lines of communication for doctors and patients to talk about hospice and palliative care without feeling like they are signaling to the other party that they are giving up.
Read the full article here.
What do you think? Is this potential change in thinking needed?