Cancer treatment or palliative care, but not both

Veterans Health Administration (VHA) hospitals offer something that Medicare does not offer: in some cases, treatments designed to change the course of a disease can be offered at the same time as palliative care. Researchers in Colorado are now studying the costs, benefits and experience of veterans receiving concomitant treatment and palliative care, as well as the experiences of providers and caregivers. Their conclusions could serve as a basis for wider adoption of this non-standard practice.

"Often, Medicare patients with terminal cancer and their families are faced with a terrible choice: you can continue treatment or receive palliative care, but not both." But the AV has of this unique structure where we can provide anti-cancer treatments designed for the disease. " Now, Medicare is studying the possibility of simultaneous treatment and a hospice, and we said, let's wait for us to do it at AV for a long time! Perhaps our experience could shed light on Medicare's experience, "says Cari Levy, MD, Ph.D., a researcher at the University of Colorado Cancer Center, a professor in the Department of Policy and Research on Medicare. CU Health Care, and geriatrician specializing in palliative care at the former Colorado Veterans Health System Center in Aurora, CO.

Even when the cure for cancer becomes unrealistic, treatments such as radiation therapy and chemotherapy can help alleviate symptoms, for example by alleviating bone pain or reducing tumor burden in some patients. But these treatments have an additional cost for patient care, and Medicare has traditionally allowed the initiation of palliative care only after a patient has decided not to continue treatment.

The simultaneous care cost badysis is currently being revised. Qualitative Analysis of Palliative Care Centers and Community Care Providers Offering Care is published this week in the journal Supportive care in cancer. In this study, researchers interviewed 76 providers at six different sites involved in the simultaneous provision of cancer treatments and palliative care and badyzed interviews on common themes.

One of the themes evoked by VA professionals and hospices was that providing the opportunity to continue treatment while initiating palliative care care often helped patients and their families. to preserve hope while moving to end-of-life care.

"People have this hospice badociation with death, so if you can say, let's continue all those therapies you're getting now and add that great layer of support – a nurse 24/7, a help to the toilet, social worker, etc. This is a way to guide the transition to palliative care without badociation with death, "says Levy.

A second theme was that a dedicated link between VA and palliative care services was helpful in facilitating the flow of information between these two systems.

"Providing VA care and palliative care requires a good relationship between the two." In our study, this liaison was sometimes a social worker and sometimes an oncologist, and thanks to excellent collaboration, simultaneous care was more common. and more effective, "says the first author. Leah Haverhals, Ph.D., a health research specialist with the Department of Veterans Affairs in Aurora, Colorado.

However, the study also found that palliative care providers were often unaware, or even skeptical, of their ability to provide palliative care alongside cancer treatment, such as radiation therapy and chemotherapy through the use of palliative care. AV.

"These kinds of things are really confusing for people, the hospices are wondering if, if the VAs are paying for the treatments, I'm going to get in trouble with Medicare for providing palliative care, the hospices in the community do not want to comply This sometimes led the Hospice to hesitate to provide support while a patient was undergoing treatment for "AV", said Levy.

In addition, the study found that when veterans are referred to palliative care centers provided in the community, many patients continue to want a connection to the medical badistance system.

"I am a palliative care physician in the VA system, and when I refer patients to the hospice, I hear the oncology team and the veterans say, but, but, but … the veterans really want to stay connected to the AV, so even though we refer them to the hospice center of the community, they still want that thread to come back to the VA. do not want to feel cut off from their suppliers, "said Levy.

The researchers point out that the strategy of continuing treatment while starting the hospice is not suitable for all patients. In fact, many patients experience additional symptoms due to cancer treatments such as chemotherapy and radiation therapy. If the treatments do not produce the desired effect, the current model of ending treatment before the beginning of the hospice remains more advantageous. However, based in part on the pioneering work of the VA, Medicare and other insurance companies are beginning to recognize the potential benefits, both physical and psychological, of the competing therapy and palliative care model in the context of incurable diseases, including cancer.

"The hope is that all this informs the Medicare demo and that they can say that you just need to provide good care to people," Levy said. "People want good care that makes them feel good."

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More information:
Leah M. Haverhals et al., The Experience of Providing Palliative Home Care Along with Cancer Treatment in VA, Supportive care in cancer (2018). DOI: 10.1007 / s00520-018-4552-z