Palliative Care Study Deserves Fanfare

John Carney
Vice President for Aging and End of Life

Center for Practical Bioethics

The title of the study is certainly innocuous, “Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer.” But the results are profound. It’s the endorsement, the confirmation, even vindication that palliative care professionals have been waiting for – for a long, long time.

This week’s New England Journal of Medicine (August 19, 2010) featured the news, along with high profile coverage in both the Wall Street Journal and the New York Times. Not bad press for a study of 150 or so patients with lung cancer.

So why the fanfare? Three reasons:

First, the study passed muster with the medical establishment. It was a randomized study – the holy grail required to get the scientific community’s attention, and laying claim that the results weren’t subject to chance.

Two, the “study also showed that early outpatient palliative care for patients with advanced cancer can alter the use of health care services, including care at the end of life. Other studies of outpatient palliative care have failed either to investigate these outcomes or to show an effect on the use of resources”.

And three – drumroll, please: Patients lived longer when they received palliative care as part of their course of treatment. From the get go, they got palliative care - and they did better, died later and died better.

So, we can now join the rest of the world and begin to face the proven fact that it’s better to take care of the whole person instead of just throwing an arsenal of munitions at a disease, hoping for the best.

Who’d have thunk that science could actually come to our aid in actually proving that the science of medicine and the art of care could actually have been one and the same all along?

And that Americans who believe that “more is better” in healthcare aren’t wrong after all, at least when the “more” relates to things that matter to the patient’s quality of life.

I like this study, not only because it’s scientifically rigorous, but it makes sense, saves money and helps us see how we can help very sick people live longer.

Game Changer: Early Palliative Care for Lung Cancer Patients Improves Quality of Life AND Median Survival

Lyle Fettig, MD
Pallimed
August 19, 2010

The implications of this study, a randomized control trial of early palliative care in patients with stage IV non-small cell lung cancer published in the New England Journal of Medicine, will not be fully revealed for a while, but are likely to be important and long-lasting.

The primary outcomes of the study stand on their own as important--it's yet more evidence that palliative care interventions improve quality of life and reduce psychological morbidity.

For more click here.

The Politics of Palliative Care

Kathleen M. Foley, MD
Flanigan Lecture – August 3, 2010

Kansas City, MO

Death panel discussions in 2009 high jacked real issues around palliative care. Workforce capacity of palliative care limits access, as do some hospice benefits on concurrent active therapies. And prescription drug abuse impacts end of life pain management.

Those are some of the political challenges around palliative care in the US, according to Kathleen Foley, MD, attending neurologist in the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York City. Dr. Foley spoke to these issues during the Flanigan Lecture August 3, 2010 in Kansas City, MO.

In 2009 the Center for Practical Bioethics established a chair in palliative care named after Dr. Foley.

Links:

Audio Podcast: The Politics of Palliative Care

Video: The Politics of Palliative Care

PowerPoint: The Politics of Palliative Care, Kathleen Foley, MD

Powerpoint: Palliative Care: A Standard for Cancer Care

Reflections on the Flanigan Lecture

Terry Rosell, DMin, PhD
Rosemary Flanigan Chair

August 5, 2010

Today I am writing reflections on a stimulating 16th annual Flanigan Lecture August 3 in Kansas City, followed by a breakfast meeting with mostly oncology folk the next morning. There were well over 200 at the lecture and about 80 for breakfast. Excellent.

Our retiring Distinguished Fellow, Dr Rosemary Flanigan, was acknowledged with standing ovations for 18 years of service at the Center for Practical Bioethics. Accolades all around. Words can't say how much she will be missed... and how grateful we are to you, Rosemary.

Our lecturer was neuro-oncologist Dr Kathy Foley from Sloan Kettering. She lived up to her reputation as palliative care pioneer and virtual icon of that hugely successful movement.

Dr Foley documented with citations elements of p.c. success. And ongoing challenges. No synopsis here, but look for audio and video podcasts of her lecture to be posted for free download at www.practicalbioethics.org by August 12.

I had questions afterward for Dr Foley about medical and ethical challenges of palliative and hospice care for persons whose terminal illness includes significant psychiatric involvement, perhaps even as primary diagnosis with voluntary stopping of eating and drinking (VSED). She didn't have answers, only an immediate clinical anecdote that makes the point on which we could both agree: this is a yet mostly unresolved dilemma for palliative and hospice medicine.

I'm guessing that some of you have relevant anecdotes on this theme, as well. Do you? Or as Rosemary would write: Help!!!

Rosemary’s final request of me last Wednesday, while stepping on the elevator to leave us, was that I post something today about the Flanigan Lecture.

I've done my duty. Gladly.

Case Based Palliative Care

Christian Sinclair, MD
Karin Porter-Williamson, MD

August 3, 2010

A new educational tool for palliative care is now available through Humana Press.

It's called Palliative Care: A Case Based Guide, and Bioethics Channel host Lorell LaBoube talks about with Dr. Christian Sinclair of Kansas City Hospice and Dr. Karin Porter Williamson of the University of Kansas Hospital.

Link: Podcast, Case Based Palliative Care

16th Annual Rosemary Flanigan Lecture

The Politics of Palliative Care
Kathleen M. Foley, MD

Tuesday, August 3, 2010
6 pm Reception
7 pm Lecture

St. Joseph Medical Center
Alex George Auditorium, Building D
1000 Carondelet
Kansas City, MO 64114

The lecture is free but registration is requested by clicking here.

Palliative Care: A Case-Based Guide

Happy to pass this along from our good friend Christian Sinclair, who has co-edited Palliative Care: A Case-based Guide.

Click here for listing on Amazon. Review states in part:

Palliative Care: a Case-based Guide provides the clinician with a crucial set of skills to address the challenging issues related to communication and symptom management. Care-oriented and practical, this book is ideal for all health care professionals committed to providing quality, compassionate care to end-of-life patients.

Congratulations Christian!