People equate hospice to dying. I had someone say that their mother went into hospice for 2 days and died, and that makes sense because she probably went very late in her disease. It is a social stigma. It is not really the work, it’s getting in there at the time of diagnoses, which is the biggest challenge.
What steps can we start taking to solve these challenges?
Because it is a fairly new specialty, it is completely educating the providers. I write papers and everything I can do to spread the word of what palliative care means. I have a lot of folks going through treatment for cure, but they still need palliation for QOL reasons. In my opinion, and with what the literature says, there is an education gap. In the meantime, QOL is suffering, patients are suffering, and healthcare costs are going through the roof because they keep going to the emergency room and they don’t have that extra layer of support, which is what we are.
Should every patient diagnosed with cancer undergo palliative care or is there a subset of patients who have a greater benefit?
The ASCO Clinical Guidelines say that at diagnosis, you refer [for palliative care]. It doesn’t matter if it’s curable breast cancer or stage IV lung cancer. That is the guideline because these patients are going to have symptoms of some sort, which are going to affect their QOL. However, that is in a perfect world.
Obviously, for the folks for whom their cancer is not curative and they are going to be on therapy for years, on immunotherapies, or this is just going to be their way of life for a long time, they will probably benefit more because we are a lifeline to them. My patients know that they can call me and I will either call them back or answer the phone call. I can relay messages or work collaboratively with the cancer team to figure out what to do.