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Cancer docs often delay referrals to hospice care

By Frederik Joelving

NEW YORK (Reuters Health) - Cancer doctors often refer their patients to palliative care very late in the course of disease, according to a new survey from Canada.

About a third of oncologists said they refer patients to palliative care, or hospice, when they diagnose a cancer that has spread and therefore usually is incurable.

Another third, however, said they wait until chemotherapy has been stopped, which is often just a few months or even weeks away from death.

"All palliative specialists believe that palliative care should be involved early," said Dr. Camilla Zimmermann of Princess Margaret Hospital in Toronto, who led the study with funding from the Canadian Cancer Society.

"Despite that and despite guidelines to refer early, many studies have shown that palliative still happens too late, in the last few months of life."

Rather than providing aggressive medical treatments, palliative care focuses on improving a person's well-being by offering pain management as well as psychological, social and sometimes spiritual care.

"It is basically team-based whole-person care," Zimmermann told Reuters Health. "The take-home message for me is that the palliative care specialists and oncologists need to work more in collaboration."

The new findings, published in the Journal of Clinical Oncology, are based on a survey of 603 physicians. Most of the doctors did have palliative services available to them, although some were more comprehensive than others.

In the U.S., the picture might be different. A previous survey found six out of 10 National Cancer Institute-designated centers had access to palliative clinics, whereas less than a fourth of cancer centers that didn't carry that designation had such access.

There are also differences in the insurance coverage of hospice between the U.S. and Canada. Zimmermann said patients in the U.S. cannot receive hospice benefits if they are still getting chemotherapy, which would be an obvious barrier to early referral.

However, she added, that shouldn't prevent oncologists from reaching out to palliative specialists at the hospital and make sure the transition is as smooth as possible.

"What we are trying to encourage is that everybody gets involved a bit earlier," Zimmermann told Reuters Health.

SOURCE: http://bit.ly/Phb4FH Journal of Clinical Oncology, online October 29, 2012.

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