Death Panels Add Life
In the three-year study, 151 patients with fast-growing lung cancer at Massachusetts General, one of the nation’s top hospitals, were randomly assigned to get either oncology [= anti-cancer] treatment alone or oncology treatment with palliative care — pain relief and other measures intended to improve a patient’s quality of life. They were followed until the end of 2009, by which time about 70 percent were dead. …
Even though substantially fewer of them opted for aggressive chemotherapy as their illnesses worsened and many more left orders that they not be resuscitated in a crisis, they typically lived almost three months longer than the group getting standard care, who lived a median of nine months. …
During the debate over President Obama’s 2009 health care bill, provisions to have Medicare and insurers pay for optional consultations with doctors on palliative and hospice care led to rumors … that the bill empowered “death panels” that would “euthanize” elderly Americans. Legislators eventually removed the provisions. …
Palliative care experts now want to study patients with other cancers, heart disease, stroke, dementia and emphysema. But … the pharmaceutical industry, has little incentive to study palliative care. (more)
From the paper itself:
Despite receiving less aggressive end-of-life care, patients in the palliative care group had significantly longer survival than those in the standard care group (median survival, 11.6 vs. 8.9 months; P = 0.02). … Any chemotherapy within 30 days of death … [Standard Care N (%)] 21/50 (42.0%) [Early Palliative] 13/40 (32.5%).
Note that by cleverly having their experiment combine patients informally getting less new hi-tech medicine with patients formally getting more “palliative” old lo-tech medicine, docs can frame this result as supporting giving people “more” medicine. HT Carl Shulman.
We should choose how to deal with mental problems?
"not much can be done" - Um, that's not what palliative care is about. If you want to frame it in terms like that, maybe "opt for including realists in your health care team along with interventionalists," but the media (and this thread's) tendency to focus on length of survival is misguided regardless. Quality of life was better and there was less depression - these were the main outcome measures. The length of life data is solid for this particular patient group (this is the New England Journal, after all), but I wouldn't count on it as a consistently reproducible outcome measure for involvement of palliative care. Most interesting, though. [and don't get me started on whatever vague link some people are making between palliative care professionals and 'death panels,' but if that's a connection that's being formed in some people's minds, then Ms. Palin may have done more damage with her popularization of that phrase than with anything else she may achieve. Okay, you did get me started after all:)]