Shruti Tiwari, Oncology Roundtable
A study presented last week at the American Society of Clinical Oncology's (ASCO) annual meeting revealed that early palliative care for individuals diagnosed with metastatic non-small cell lung carcinoma (NSCLC) reduced health care costs during the last month of life by $2,282 when compared to individuals who received standard oncology care.
Past studies have revealed that offering palliative care soon after diagnosis leads to improved quality of life, mood, end-of-life care, and survival, but this study is one of the few that associates palliative care with lower hospital costs and resource use.
Early palliative care for metastatic NSCLC associated with lower costs and hospital resource use
Anne Taylor, Oncology Roundtable
Despite strong patient preferences regarding end-of-life care, oncology care does not always align with patients’ expressed wishes. A 2005 University of Pittsburgh Center for Research on Healthcare survey of over 2,500 Medicare-aged individuals reported that, in the event of a hypothetical terminal illness, 86% of respondents would prefer to die at home; only 9% of respondents would prefer to die in the hospital.
Unfortunately, there is a significant disparity between patients’ end-of-life preferences and the reality of end-of-life care in oncology practice. According to the Dartmouth Atlas Project Report on Quality End-of-Life Care , 29% of Medicare-aged patients who died of cancer died in the hospital.
Place of death often incongruent with patient preferences
My hospital currently offers an inpatient palliative care consult service. At what point does it make sense from a financial standpoint to offer palliative care consults in the outpatient setting?
Given the complexity of the palliative care finances, there is no clear “tipping point” at which it makes sense to offer outpatient palliative care. Rather, individual institutions need to evaluate their circumstances and the extent to which they are willing to invest in a service that is likely to result in financial losses in exchange for improvements in patient care.
When is the right time to pursue outpatient palliative care?