While “the mandate” is making the health care news these days, I am daring to hope that we can increasingly pay attention to the other end of the money issue which is cost of care and its attendant issue- quality. So far, what discussion there has been on this question has mostly focused on how to cut the costs of care, mostly by reducing the amount of care patients receive including repetitive and unproductive tests and drugs which have marginal or unproven benefit. As much as I can tell, these attempts to “bend the cost curve” have brought little if any results. At least part of the issue with this problem I think is that people in the US have this idea that they should be able to receive any care that they want, no matter how unproven, and no matter how costly- even if they can’t pay for it.
Noting this same tendency, Dr. Steven Pantilat from UCSF has written a wonderful commentary promoting palliative care (Arch Intern Med. 2012;():3-4. doi:10.1001/archinternmed.2012.2894, http://archinte.jamanetwork.com/article.aspx?articleid=1211996). In the commentary, he announces the discovery of a new drug, palliatosin, which, when given to patients with malignant non-small cell lung cancer, reduces depression, improves quality of life and extends life by 2.5 months- a huge advance in this uniformly fatal disease. The drug is outrageously expensive and unproven in any other cancer, but none the less, it is soon being demanded and given to people with all kinds of cancer- a scenario which any of us who have worked in oncology have seen repeated often.
The drug of course does not exist but the results are real. The magic ingredient in the study which produced these results is palliative care. And yet, as Dr. Pantilat points out, there has been no stampede to get palliative care for every oncology patient- let alone every other patient who could benefit. Amazing- since this care not only has the results above, but has been shown to successfully reduce costs in the system. Why that is the result is not clear to me and maybe not worth the speculation. Dr. Pantilat also points out that, if that had been the response, the health care system does not have the workforce and other resources to meet the need.
Dr. Pantilat then proposes several steps to counter this situation including making a palliative care team a condition of participation in Medicare, increasing palliative care training positions, and better marketing campaigns. Studies by the Center to Advance Palliative Care have shown convincingly that when people understand what palliative care is, they want it for themselves.
Dr. Pantilat is right. This is a case in which we should not be looking to limit care. More palliative care will certainly increase patients’ and family’s quality of life. It will increase patient satisfaction. It will reduce costs to the system. And it may even extend people’s lives.
The time is here for all of us, inside and outside health care, to educate ourselves and those around us about what palliative care is and can do. If you need educating yourself, the CAPC website is a great place to start.