Breaking News
December 13, 2018 - Research findings could lead to new targets for cancer-fighting therapeutics
December 13, 2018 - Butantan Institute signs collaboration agreement with MSD to develop dengue vaccines
December 13, 2018 - Study explores how patients want to discuss symptoms with doctors
December 13, 2018 - RUDN medics first to gather scattered data on hepatitis morbidity in Somalia
December 13, 2018 - Age and gender disparities found in use of bed nets to prevent malaria in sub-Saharan Africa
December 13, 2018 - Caffeine therapy benefits developing brains of premature babies
December 13, 2018 - New review focuses on electrospinning techniques used in musculoskeletal tissue engineering
December 13, 2018 - A new division focused on human immune system
December 13, 2018 - Zogenix Announces Positive Phase 3 Trial Results on the Efficacy and Safety of Fintepla (ZX008) in Dravet Syndrome
December 13, 2018 - BCR ABL Genetic Test: MedlinePlus Lab Test Information
December 13, 2018 - Caffeinated beverages during pregnancy linked to lower birth weight babies
December 13, 2018 - Stanford Medicine Health Trends Report examines opportunity to democratize health care
December 13, 2018 - Obsessive-compulsive disorder may protect individuals from obesity
December 13, 2018 - Scientists investigate how a painful event is processed in the brain
December 13, 2018 - Genetic study reveals new insights into underlying causes of moderate-to-severe asthma
December 13, 2018 - Vitamin C supplementation for pregnant smokers may reduce harm to infants’ lungs
December 13, 2018 - New study reveals yin-yang personality of dopamine
December 13, 2018 - Children with high levels of callous traits show widespread differences in brain structure
December 13, 2018 - Long-term Benefit of Steroid Injections for Knee Osteoarthritis Challenged
December 13, 2018 - Adding new channels to the brain remote control
December 13, 2018 - In the Spotlight: A different side of neuroscience
December 13, 2018 - Medical Marvels: Using immunotherapy for melanoma that spread to the brain
December 13, 2018 - Puzzles do not keep dementia away finds study
December 13, 2018 - New mouse model shows potential for rapid identification of promising muscular dystrophy therapies
December 13, 2018 - Study reveals urban and rural differences in prenatal exposure to essential and toxic elements
December 13, 2018 - New collaborative partnership in quest of novel antibiotics
December 13, 2018 - Single tau molecule holds clues to help diagnose neurodegeneration in its earliest stages
December 13, 2018 - AHA Scientific Statement: Low Risk of Side Effects for Statins
December 13, 2018 - What Is Acute Flaccid Myelitis?
December 13, 2018 - How bereaved people control their thoughts without knowing it
December 13, 2018 - Health care democratization underway, according to 2nd annual Stanford Medicine Health Trends Report | News Center
December 13, 2018 - Going Beyond a Single Color
December 13, 2018 - London-based startup launches ‘thedrug.store’ aiming to clean up CBD industry
December 13, 2018 - Loss of tight junction barrier protein results in gastric cancer development
December 13, 2018 - Novel way to efficiently deliver anti-parasitic medicines
December 13, 2018 - RKI publishes new data on disease prevention and utilization of medical services
December 13, 2018 - High-tech, flexible patches sewn into clothes could help to stay warm
December 13, 2018 - The CCA releases three reports on requests for medical assistance in dying
December 13, 2018 - Restoring Hair Growth on Scarred Skin? Mouse Study Could Show the Way
December 13, 2018 - Probiotic use may reduce antibiotic prescriptions, researchers say
December 13, 2018 - Drug repositioning strategy identifies potential new treatments for epilepsy
December 13, 2018 - Chronic rhinitis associated with hospital readmissions for asthma and COPD patients
December 13, 2018 - Food poisoning discovery could save lives
December 13, 2018 - Cloned antibodies show potential to treat, diagnose life-threatening fungal infections
December 13, 2018 - Exercise may reduce colorectal cancer risk after weight loss
December 13, 2018 - Russian scientists create hardware-information system for brain disorders treatment
December 13, 2018 - Moderate alcohol consumption linked with lower risk of hospitalization
December 13, 2018 - Nurturing Healthy Neighborhoods | NIH News in Health
December 13, 2018 - Rise in meth and opioid use during pregnancy
December 13, 2018 - Researchers gain new insights into pediatric tumors
December 13, 2018 - FSU study finds racial disparity among adolescents receiving flu vaccine
December 13, 2018 - Study investigates attitudes toward implementation of ‘sex as a biological variable’ policy
December 13, 2018 - Drug cocktail induces cancer cell death by switching off energy supply
December 13, 2018 - Baculovirus virion completely eliminates liver-stage parasites in mouse model
December 13, 2018 - Researchers create noninvasive technology that detects when nerve cells fire
December 13, 2018 - Allen Institute for Immunology to partner with CU Anschutz to understand dynamics of human immune system
December 13, 2018 - Inability to do daily living tasks delays discharge of mental health patients
December 13, 2018 - Treating patients with hypertension induced albuminuria
December 13, 2018 - New substance could improve efficacy of established breast cancer treatments
December 13, 2018 - Scientists develop new stem cell line to study conversion of stem cells into muscle
December 13, 2018 - Re-programming the body’s energy pathway boosts kidney self-repair
December 13, 2018 - Research findings could help improve treatment of anxiety and post-traumatic stress disorders
December 13, 2018 - The Microbiome Movement announce Microbiotica as official industry partner
December 13, 2018 - New study reveals potential benefits of cEEG monitoring for infant ICU patients
December 13, 2018 - Whole-body imaging PET/MRI offers information to guide treatment options for prostate cancer
December 13, 2018 - International investigators fight against the negative campaign on benzodiazepines
December 13, 2018 - Targeting biochemical pathway may lead to new therapies for alleviating symptoms of anxiety disorders
December 13, 2018 - FDA Approves Tolsura (SUBA®-itraconazole capsules) for the Treatment of Certain Fungal Infections
December 13, 2018 - Are scientists studying the wrong kind of mice?
December 13, 2018 - Computer memory: A scientific team builds a virtual model of a key brain region
December 13, 2018 - Visual inspection alone is insufficient to diagnose skin cancer
December 13, 2018 - Paternal grandfather’s access to food associated with grandson’s mortality risk
December 13, 2018 - Our brain senses angry voices in a flash, study shows
December 13, 2018 - PM2.5 Exposure Linked to Asthma Rescue Medication Use
December 13, 2018 - Can’t exercise? A hot bath may help improve inflammation, metabolism, study suggests
December 13, 2018 - Can artificial intelligence help doctors with the human side of medicine?
December 13, 2018 - Virginia Tech and UC San Diego researchers team up to develop nonopioid drug for chronic pain
December 13, 2018 - NIH offers support for HIV care and prevention research in the southern United States
December 12, 2018 - Activating brain region could revive the urge to socialize among opioid addicts
December 12, 2018 - Relationship impairment appears to interfere with seeking mental health treatment in men
Researchers examine the experiences of veterans receiving both cancer treatment and hospice care

Researchers examine the experiences of veterans receiving both cancer treatment and hospice care

image_pdfDownload PDFimage_print

Veterans Health Administration (VHA) hospitals offer something Medicare does not: In some cases, treatments meant to alter the course of a disease can be offered along with hospice care. Now 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 basis for wider adoption of this nonstandard practice.

“Often, Medicare patients with terminal cancer and their families are given a terrible choice: You can continue treatments or have hospice care, but not both. But the VA has this unique structure where we can provide cancer therapies that are designed to be disease-modifying while also referring patients for hospice care in the community. Now Medicare is exploring the possibility of concurrent treatment and hospice, and we said, wait we’ve been doing this in the VA for a long time! Maybe our experience can inform Medicare’s experiment,” says Cari Levy, MD, PhD, investigator at the University of Colorado Cancer Center, professor in the CU School of Medicine Department of Health Care Policy and Research, and geriatrician specializing in hospice and palliative care at the Veterans Affairs 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 cost to a patient’s care, and Medicare has traditionally only allowed the initiation of hospice care after a patient decides against further treatment.

The cost analysis of concurrent care is currently under review. The qualitative analysis of community hospice and VHA providers offering care is published this week in the journal Supportive Care in Cancer. For the current study, researchers interviewed 76 providers at six different sites involved in offering concurrent cancer therapy/hospice and analyzed interviews for common themes.

One theme expressed by VA and hospice professionals was that offering the option to continue therapy while also initiating hospice care often helped patients and their families preserve hope while transitioning into end-of-life care.

“People have this association of hospice with death. If you can say let’s continue all these therapies you’re receiving now and add 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 care was useful to facilitate the flow of information between these two systems.

“Providing care at the VA and through hospice requires a honed relationship between the two. In our study, sometimes that liaison was a social worker and sometimes an oncologist. With great collaboration, concurrent care was more common and more successful,” says first author Leah Haverhals, PhD, health research specialist at the Department of Veterans Affairs in Aurora, Colorado.

However, the study also found that hospice care providers were often unaware or even skeptical of their ability to provide hospice concurrent with cancer treatment such as radiation and chemotherapy through the VA.

“This stuff is really confusing to people. Hospices wondered, if the VA pays for treatments, am I going to get into trouble with Medicare for providing palliative care? The hospices in the community don’t want to be noncompliant with Medicare guidelines. Sometimes this led to the hospice hesitating to provide their support while a patient was on VA treatment,” says Levy.

Additionally, the study found that when veterans are referred to hospice provided in the community, many patients continue to want a connection with the VA system.

“I’m a palliative care physician in the VA system, and when I refer patients to hospice, I hear the oncology team and veterans saying, but, but, but… Veterans really do want 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 want to feel cut off from their providers,” says Levy.

The researchers point out that the strategy of continuing therapy while starting hospice isn’t appropriate for all patients. Many patients, in fact, experience additional symptoms due to cancer treatments like chemotherapy and radiation, and if therapies are not having the intended effect, there remains more benefit in the current model of ending treatment before starting hospice. However, based in part on pioneering work at the VA, Medicare and other insurance providers are starting to recognize the potential benefit, 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 can say you just need to provide good care to people,” says Levy. “People want good care that makes them feel good.”

Tagged with:

About author

Related Articles