A study from The University of Texas M. D. Anderson Cancer Center reports that cancer centers in the United States provide patients and their families with palliative care, though the depth, range and integration of programs and services widely vary.
The study was published in the March 17 edition of the Journal of the American Medical Association.
Despite the many advances in cancer research, palliative care -- the medical specialty focused on relieving debilitating symptoms or disease or treatment complications, caring for the dying and providing psychosocial care for the patient and family -- continues to play a vital role in the continuum of cancer care, according to the study.
"We know that palliative care is most effective when incorporated early in oncology care," said David Hui, M.D., a fellow in M. D. Anderson's Department of Palliative Care and Symptom Management and lead author of the study. "We've recently seen a positive movement among a number of institutions and oncology and patient advocacy organizations pushing for increased palliative care services and early incorporation of such care, but we wanted to better understand how services and programs were structured and what barriers there might be to developing a more consistent approach."
What Hui and the research team from M. D. Anderson and the National Cancer Institute (NCI) found was that NCI-designated cancer centers are significantly more likely to have a comprehensive palliative care program than non NCI-designated centers, though most responding cancer center executives supported stronger integration and enhanced resources.
The questionnaire, which was sent to executives and program leaders at the 71 NCI-designated cancer centers and 71 non-NCI cancer centers, revealed that 98 percent of NCI cancer centers had a palliative care program compared to 78 percent of non-NCI cancer centers.
Hui also said that the survey showed tremendous support for palliative care services and integration from executives and program leaders from both groups, but executives noted that third-party reimbursement for such services and limited resources were barriers to delivering more and better care. They also found that research programs, palliative care fellowships and mandatory rotations for oncology fellows were uncommon.
More specifically, the survey showed that 92 percent of NCI-designated centers had at least one palliative care physician compared to 74 percent of non-NCI designated centers. As for inpatient palliative care consultation teams, 92 percent of NCI centers had such a team compared with 56 percent of non-NCI centers. Of NCI-designated centers, 59 percent had outpatient palliative care clinics while 22 percent of non-NCI centers offered services through such a clinic. Only 23 percent of cancer centers had dedicated acute care beds while 37 percent of centers had an in-house hospice.
"This study shows great progress over the last few years with centers seeing the benefit of palliative care, as heterogeneous as it is," said Hui. "Now that there is a better idea of what the obstacles are for centers, the field can work to make improvements."
Hui said that one indication of limited access and integration of services is the time that it took the centers to refer patients to palliative care. The study found that the median duration from referral to death was seven days for inpatient consultation teams, seven days for palliative care units and 90 days for outpatient clinics.
"Our study showed that patients and their families were being referred to palliative care often too late in their journeys when the full value of palliative care may not be realized. Much more work remains to be done to improve the quality of care for our patients," he said.
The study was funded in part through the National Cancer Institute. Members of the research team included Ahmed Elsayem, M.D.; Maxine De La Cruz, M.D.; Donna S. Zhukovsky, M.D.; Shanna Palla; Avery Evans; Nada Fadul, M.D.; J. Lynn Palmer, Ph.D. and Eduardo Bruera, M.D., all of M. D. Anderson; and Ann Berger, M.D. from the National Cancer Institute.
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