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Progress, Summer, 1999

Cancer Center Leads Effort to Improve End-of-Life Care

Patients with terminal illnesses reach a time when they are faced with a very difficult choice - whether to take part in experimental research or enter a hospice program. Whichever they ultimately choose, they lose the benefits of the alternative.

With this in mind, the University of Michigan Comprehensive Cancer Center and Hospice of Michigan are leading a research study, along with investigators at St. John Health System and Providence Hospital, to improve the quality of life for terminally ill patients while helping them live as long as possible.

Patients in this new program, called the Palliative Care Project, are enrolled in hospice at the beginning of their treatment, allowing them the benefits of both hospice care and cutting-edge medical therapy.

Under the current model of care, when terminally ill patients enter an experimental medical study or receive palliative (symptom relief) treatment, they typically spend all but the last week or two of life-relieving treatment.

Then, when all life-prolonging options are exhausted, they are moved into hospice care. The move to hospice care, coming in the final days of the patient's life, often is accompanied by feelings of abandonment on the part of patients, families and health caregivers.

Conversely, under the present system, if patients choose hospice care early, they deny themselves the chance to actively fight the disease, for example, with chemotherapy or radiation.

The research team will evaluate 160 patients in each of four disease groups: advanced breast cancer, advanced prostate cancer, advanced lung cancer and advanced congestive heart failure. Subjects taking part in the study typically have a life expectancy of six months.

"Preliminary studies suggest that integrating hospice care with traditional treatment improves quality of life for terminally ill patients and may also be more cost-effective than the current system of care," says lead researcher Kenneth J. Pienta, M.D., director of the Prostate Cancer Program and professor of internal medicine and surgery. "Under this program, you can enter hospice early in the treatment cycle and still receive medicines, such as chemotherapy, that will relieve symptoms and potentially help you live longer."

Dr. Pienta, a nationally recognized prostate cancer researcher, directs the new program along with co-investigator John Finn, M.D., Hospice of Michigan executive medical director. Dr. Finn, who is an expert in hospice and palliative care, provides direct patient care to the homebound and supervises the training of all clinical personnel on the study.

"In this study, we provide patients with the best of both worlds - state-of-the-art treatment, plus the best in palliative care. We think it will significantly improve the quality of end-of-life care for terminally ill patients," Dr. Finn says.

Hospice staff are on-call 24-hours-a-day and make weekly in-home visits to the patient. This allows people who take part in the study to continue many of their treatments in the comfort of their homes. As a result, patients do not have to come to the emergency room or be hospitalized for many aspects of their care. The researchers hope to prove that introducing hospice care early in the treatment cycle will lower the cost of care.

Hospice patients are cared for by an interdisciplinary team that addresses the physical, emotional and spiritual needs of the patient and the patient's family. Because hospice helps patients and families cope with the advancing illness and the symptoms and fears that accompany it, patients derive the greatest benefit when they are enrolled in a hospice program early in the disease cycle.

Medicare and most insurance companies generally do not pay for hospice services until all life-prolonging options have been exhausted or refused. It is hoped results of this new study can provide valuable data to regional and national health care planners about costs of merging life-prolonging medical care with hospice and palliative care.

The study is funded, in part, by a three-year, $1.35-million grant from the Robert Wood Johnson Foundation as part of a new national program called "Promoting Excellence in End of Life Care."

Pete Barkey
Media Manager, UMHS

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