Too often, cancer patients and their families must choose between traditional hospice limited to palliative care and active treatment of their disease. Fortunately, the Veterans Health Administration (VA) has taken a lead in offering both hospice/palliative care and cancer therapy concurrently in the United States (US). This is a major step in what has been demonstrated in clinical trials to improve quality of life for cancer patients, and, potentially a longer life as well.
Traditionally, when entering hospice, a patient transitioned to a new paradigm – new medical goals, new medical team, perhaps new surroundings. The intent was to provide comfort, symptom relief, and mental relief, both psychologically and spiritually. The US medical establishment has lagged behind the United Kingdom (UK) for the past two decades in merging palliative care into the full range of cancer care.
Palliative care in the US was recognized for its financial benefits initially. Through this model, resources were used more effectively and there were fewer readmissions – both highly prized in the Diagnosis Related Groups reimbursement model, which sets payments and penalizes hospitals for readmissions. But creating a system where patients must choose either hospice or treatment has significant drawbacks. People on the palliative care of hospice no longer had access to treatments that could possibly give them better quality of life, or even extend their lives. Those patients who chose treatments, but not hospice, were denied the extra support and management of symptoms that palliative care offers.
In the 2015 Quality of Death Index, the US came in 9th place behind the UK, the Netherlands, Germany, Taiwan, Belgium, Ireland, New Zealand, and Australia. However, the Centers for Medicate and Medicaid Services (CMS) is currently piloting a new program for Medicare beneficiaries that could change that standing. Patients in the program can receive both palliative and anticancer therapies through any of 140 Medicare-certified hospices enrolled for a period of five years. Patients must fit certain criteria to participate.
Hurdles remain before the US can move up the ladder to providing the best care in the world to its citizens, but with the VA leading the way, and the CMS providing a pilot program for comprehensive care, the US can move up a needed rung on that ladder.
