Lack of Palliative, Hospice Care Seen Among Veterans Dying of Cancer

Only half of US veterans who died from cancer received palliative care, while the use of hospice depended upon the care environment, according to a study published in the Journal of Palliative Medicine.

Risha Gidwani, DrPH, health economist at the Veterans Affairs Palo Alto Health Economics Resource Center and consulting assistant professor of medicine at Stanford University School of Medicine, and colleagues studied the care of 11,896 veterans over the age of 65 with cancer who died in 2012, and found that 71% of them received hospice care but only 52% received palliative care. They note that medical societies, including the American Society of Clinical Oncology, recommend that patients with advanced cancer get palliative care soon after diagnosis and hospice care for at least the last 3 days of their life.

Palliative care is meant to alleviate symptoms and improve quality of life, and is appropriate for all patients with serious illness, not only those at the end of life. Hospice care, however, is end-of-life care, which can provide social support for family members, and can be recommended by practitioners only if they believe the patient has fewer than 180 days to live.

The researchers also found that exposure to hospice care differed significantly between patients treated by the Department of Veterans Affairs (VA) and those enrolled in Medicare. Many patients who received palliative care did so late in their disease progression rather than immediately after diagnosis, as recommended. The study found the patients getting VA care were less likely to get hospice care for the minimum recommended 3 days, compared with those in Medicare or other contracted care paid for by the VA. VA patients first received hospice care a median of 14 days before they died, compared with patients in VA-contracted care, who got hospice a median of 28 days before death. The timing of care should not be any different, the authors noted, and patients should get a service based on clinical need, not the health system they’re in.

Medicare and the VA were found to have different policies on using hospice care. VA cancer patients can continue getting curative treatment while in hospice, whereas Medicare patients must stop any chemotherapy or radiation before beginning hospice. There were also differences in the use of hospice and palliative care between cancer types and ages.

“Our work indicates palliative care needs to be better integrated into standard oncological care and that there is wide variation in receipt of hospice care,” the researchers concluded.

The most important takeaway from the study is that we need to improve exposure to palliative care in terms of how many patients receive it and when they receive it, according to Gidwani.