“We’re not ready for that,” is what I often here people say when someone mentions hospice for a terminally ill patient. It’s as if hospice is only good when you’re days away from death. As a volunteer, I’ve seen how wonderful hospice is, but it takes time for the staff at a hospice organization to do their work. Unfortunately, the attitude many people have is that hospice comes only at the very end, after everything else has been tried.
These people are not only missing out on the opportunity to live well and meaningfully in their last days, but a new study shows they may be dying sooner than they would in hospice!
A story in the Cleveland Plain Dealer says, “In a study that sheds new light on the effects of end-of-life care, doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared — but they also lived nearly three months longer.”
The study, published in the New England Journal of Medicine, found “”that palliative care is the opposite of all that rhetoric about ‘death panels,’ ” said Dr. Diane Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine and co-author of an editorial in the journal accompanying the study. “It’s not about killing Granny; it’s about keeping Granny alive as long as possible — with the best quality of life.”
Their longer lives were despite the fact that they had do not resuscitate orders, meaning doctors would not use CPR to revive patients if their lungs or heart stopped working. And they also had less chemotherapy. Of course, chemo is basically poison–meant to kill the cancer–so it shouldn’t be too surprising that people survive without it.
The article continues:
Doctors and patients “traditionally see palliative care as something extended to a hospitalized patient in the last week of life,” said Dr. Jennifer S. Temel, an oncologist and author of the paper. “We thought it made sense to start them at the time of diagnosis. And we were thrilled to see such a huge impact. It shows that palliative care and cancer care aren’t mutually exclusive.”
Dr. Atul Gawande, a Harvard Medical School surgeon and writer who just published a long article in The New Yorker about hospitalized patients’ suffering before death, called the study “amazing.”
“The field was crying out for a randomized trial,” he added.
Although the study could not determine why the patients lived longer, the authors and other experts had several theories: Depression is known to shorten life, and patients whose pain is treated often sleep better, eat better and talk more with relatives. Also, hospitals are dangerous places for very sick people; they may get fatal blood infections, pneumonia or bedsores, or simply be overwhelmed by the powerful drugs and radiation attacking their cancer.
Saying the study was “of critical importance,” Dr. R. Sean Morrison, president of the American Academy of Hospice and Palliative Medicine, said it was the “first concrete evidence of what a lot of us have seen in our practices — when you control pain and other symptoms, people not only feel better, they live longer.”