Can You Get Chemo In Hospice

A terrible choice: Cancer treatment or hospice care, but not both — Cari Levy, M.D., Ph.D., and colleagues explore the experience of concurrent treatments and hospice during end-of-life care for cancer. Credit: Academy of Colorado Cancer Center

Veterans Health Administration (VHA) hospitals offer something Medicare does non: In some cases, treatments meant to alter the course of a disease can be offered along with hospice care. At present Colorado researchers are looking into the costs, benefits, and experiences of veterans receiving concurrent treatment and hospice care, and experiences of the providers and staff delivering this care. Their findings may provide the footing for wider adoption of this nonstandard exercise.

"Often, Medicare patients with terminal cancer and their families are given a terrible option: You can continue treatments or have hospice care, merely not both. But the VA has this unique structure where we can provide cancer therapies that are designed to be affliction-modifying while also referring patients for hospice intendance in the community. Now Medicare is exploring the possibility of concurrent handling and hospice, and we said, wait we've been doing this in the VA for a long time! Perchance our experience can inform Medicare's experiment," says Cari Levy, Physician, Ph.D., investigator at the University of Colorado Cancer Center, professor in the CU School of Medicine Department of Wellness Care Policy and Research, and geriatrician specializing in hospice and palliative care at the Veterans Diplomacy Eastern Colorado Health Care System, in Aurora, CO.

Even once curing a cancer becomes unrealistic, treatments like radiation and chemotherapy may help to ease symptoms, for example by lessening bone pain or reducing tumor burden in some patients. But these treatments add together price to a patient'due south intendance, and Medicare has traditionally only allowed the initiation of hospice care after a patient decides against farther treatment.

The cost analysis of concurrent care is currently under review. The qualitative analysis of community hospice and VHA providers offer intendance is published this week in the periodical Supportive Care in Cancer. For the current study, researchers interviewed 76 providers at half dozen unlike sites involved in offering concurrent cancer therapy/hospice and analyzed interviews for mutual themes.

One theme expressed by VA and hospice professionals was that offer the pick to go along therapy while also initiating hospice intendance ofttimes helped patients and their families preserve hope while transitioning into stop-of-life intendance.

"People accept this association of hospice with death. If you can say let'southward continue all these therapies you're receiving at present and add together this wonderful layer of support—a 24/7 nurse, aid for bathing, social worker, etc. - that sounds great. This is a way to shepherd the transition to hospice care without the association with death," says Levy.

A second theme was that a dedicated liaison between VA and hospice intendance was useful to facilitate the menstruum of information between these two systems.

"Providing care at the VA and through hospice requires a honed relationship betwixt the two. In our report, sometimes that liaison was a social worker and sometimes an oncologist. With nifty collaboration, concurrent care was more common and more successful," says first writer Leah Haverhals, Ph.D., health research specialist at the Department of Veterans Affairs in Aurora, Colorado.

However, the study too found that hospice care providers were oftentimes unaware or even skeptical of their ability to provide hospice concurrent with cancer handling such equally radiation and chemotherapy through the VA.

"This stuff is actually disruptive to people. Hospices wondered, if the VA pays for treatments, am I going to get into problem with Medicare for providing palliative care? The hospices in the community don't desire to be noncompliant with Medicare guidelines. Sometimes this led to the hospice hesitating to provide their back up while a patient was on VA treatment," says Levy.

Additionally, the written report found that when veterans are referred to hospice provided in the community, many patients keep to desire a connection with the VA system.

"I'm a palliative care dr. in the VA organization, and when I refer patients to hospice, I hear the oncology squad and veterans maxim, but, but, but... Veterans really do desire to stay connected to the VA, so even if we refer them to hospice in the community, they still want that thread back to the VA. Veterans don't desire to feel cutting off from their providers," says Levy.

The researchers betoken out that the strategy of continuing therapy while starting hospice isn't appropriate for all patients. Many patients, in fact, experience boosted symptoms due to cancer treatments similar chemotherapy and radiations, and if therapies are not having the intended event, there remains more benefit in the current model of ending treatment earlier starting hospice. However, based in office on pioneering work at the VA, Medicare and other insurance providers are starting to recognize the potential do good, both physically and psychologically, to the model of concurrent therapy and hospice in the context of incurable diseases including cancer.

"The hope is that all of this informs the Medicare demo and that they tin say you but demand to provide skilful intendance to people," says Levy. "People want expert care that makes them experience good."

More information: Leah M. Haverhals et al, The experience of providing hospice care concurrent with cancer treatment in the VA, Supportive Care in Cancer (2018). DOI: 10.1007/s00520-018-4552-z

Citation: A terrible choice: Cancer treatment or hospice care, but non both (2018, November 28) retrieved 21 September 2022 from https://medicalxpress.com/news/2018-11-terrible-choice-cancer-treatment-hospice.html

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