Physicians struggling to initiate difficult conversations with advanced-stage cancer patients about their wishes for end-of-life care now have help in the form of a new guide from the American Society of Clinical Oncology (ASCO).
According to the ASCO, the best time to have frank discussions about all treatment options available--including palliative and hospice care--with patients diagnosed with incurable disease is early in the treatment process. In practice, however, these conversations occur with just 40 percent of patients, most often during a patient's final days or weeks of life.
And while research has also shown that most patients want to die at home, ASCO's Quality Oncology Practice Initiative data show that only 45 percent of cancer patients are enrolled in hospice care before death. Of those enrolled, one-third were enrolled in the last week of life. The analysis also found that many patients did not receive appropriate management of their pain or shortness of breath in their last two medical visits, even though palliative care has been shown to prolong life for terminal cancer patients.
ASCO's policy statement, published Tuesday in ASCO's Journal of Clinical Oncology, outlines essential elements of care for patients with advanced cancer and identifies barriers that currently prevent advance cancer care planning conversations between physicians and patients.
Chief among the recommendations is that "quality of life should be an explicit priority throughout the course of advanced cancer care." As part of this message, the society calls on insurers to not only provide direct reimbursement for advanced cancer care planning discussions, but to expand programs that maximize palliative care without requiring patients to abandon cancer-focused treatment.
"While improving survival is the oncologist's primary goal, helping individuals live their final days in comfort and dignity is one of the most important responsibilities of our profession," said ASCO president, Dr. George W. Sledge, Jr., in a statement.
Copies of the ASCO's new guidebook are now available at Cancer.Net, with further clinical guidance for oncologists expected to be released later this year.