Discussant of the abstract by Rao et al, Oreofe Olukemi Odejide, MD, MPH, a medical oncologist at Dana-Farber Cancer Institute, Boston, underscored the issues associated with intense health-care utilization near the end of life. “Several studies have shown that intense health-care utilization negatively impacts patients, with resultant high physical distress, poor psychological well-being with increased anxiety and depression, and overall poor quality of life,” said Dr. Odejide. “The negative effects of intense health-care utilization also impact caregivers, who are at risk for increased depression, complicated grief, poor quality of life, and lower satisfaction with care.”
Early Palliative Care: Proven Intervention
In contrast, said Dr. Odejide, the benefits of early palliative care and hospice use are well documented. Multiple randomized controlled trials, mostly among patients with solid tumors, have demonstrated that integrated palliative care reduces symptom burden, improves quality of life, and also results in high-quality end-of-life care, she added. These benefits have also been seen for patients who enroll in hospice in a timely fashion.
Despite the fact that multiple sources of evidence have demonstrated the benefits of early palliative care, it remains underutilized among patients with cancer, said Dr. Odejide. “Although we see overall rates of hospice enrollment increasing, it’s largely explained by late hospice enrollment in the last 3 days or the last week of life,” Dr. Odejide noted. “We need to figure out a way to drive the uptake of this proven intervention. At the same, we must ensure that improvements in end-of-life care are not limited to a subset of patients with cancer but include patients with hematologic malignancies as well.” ■
DISCLOSURE: Dr. Odejide reported no conflicts of interest.
The use of billed palliative care services among Medicare beneficiaries with hematologic malignancies has risen dramatically in recent years, but most encounters still occur within days of death, according to research presented at the 2019 Supportive Care in Oncology Symposium.1 The analysis of...