Oncology group stresses need for palliative care, not aggressive treatment, at end of life

The Philadelphia-based American Board of Internal Medicine Foundation and a coalition of nine medical societies released their top-five recommendations Wednesday for unnecessary tests and treatments that should be reduced to cut costs to the healthcare system.

The recommendations suggests late-stage cancer patients who stand to benefit little from chemotherapy should be taken off anti-cancer drugs and given hospice care at the end of life.

According to the recommendations, as many as ten to 15 percent of cancer patients receive chemotherapy in the last two weeks of life.

Fox Chase Cancer Center oncologist Steven Cohen said the reminder to stop treatment when it is unlikely to improve survival outcomes — and when it carries significant side effects — is not surprising. But he hopes it serves as a reminder to doctors to talk about the possibility of eventual hospice care early on in treatment, when the topic is easier to broach.

“Also I think it’s important from the patient perspective, for them to see an official guideline that really says, if you’re not feeling well and doing well, and have been through treatment and are very weak and very ill, more treatment is not going to be helpful,” Cohen said.

Dr. Dave Casarett, head of hospice for the University of Pennsylvania Health System, said the source of the guideline, the American Society of Clinical Oncologists, was surprising to him and represented a shift in thinking.

“It very clearly identifies the elephant in the room,” Casarett said. “This is a phenomenon, this pattern of aggressive treatment up until the very last hours of life, that those of us in the palliative care world see again and again and again, but it’s not something the oncology world has specifically identified in a public way before.”

Casarett said he hopes the recommendation opens lines of communication for doctors and patients to talk about hospice and palliative care without feeling like they are signaling to the other party that they are giving up.

The recommendations also suggest women hold off on getting Pap smears until age 21, and say healthy patients do not need routine cardiac stress tests.