NEWS

IOM Calls for Improvements in Palliative Care

Charles Marwick

The infrastructure is severely lacking for end-of-life care in cancer patients, and the National Cancer Institute should take the lead in stepping up efforts to improve palliative medicine, concluded a report released in June by the Institute of Medicine.

Pursuing a cure, "the nation has almost ignored the need to reduce the suffering caused by the physical and emotional symptoms of cancer and the side effects of its treatment," said Kathleen Foley, M.D., a neurologist at Memorial Sloan-Kettering Cancer Center in New York, and a member of the National Cancer Policy Board, which wrote the report.



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Dr. Kathleen Foley

 
The report sets out 10 recommendations that call for overcoming barriers that currently limit palliative care for cancer patients. Five of them involve NCI. They include establishing institutions to study palliative care and symptom control and convening a meeting to develop a strategic research agenda in long term care.

Ellen Stovall, vice chair of the IOM’s Policy Board said at a press conference that she, along with other authors of the report, met with senior staff at the NCI who were "very receptive" to the report’s recommendations.

Foley noted the NCI spends less than 1% of its budget on this aspect of managing cancer. "Nothing would have a greater impact on the daily lives of cancer patients and their families than good symptom control and supportive therapy," she said.

The report notes that a major barrier to adequate palliative care has been the "institutionalization of a system that focuses on either active [care] or palliative hospice care and does not allow the appropriate interface between these two approaches." The report makes clear that, at least in cancer, the nation’s health insurance system, both private and public, has not kept up with advances in managing the disease. People with cancer used to die quickly. Today improved treatments mean that more people are living longer with cancer and "most of us for a very long time," said Joanne Lynn, M.D., a consultant to the committee and director of the RAND Center to Improve Care of the Dying.

Yet, the present system of reimbursement for health care is skewed in favor of treatment. "There is a mismatch between what we pay for and what patients at this point in time need. We pay for chemotherapy and radiation, but we don’t pay for medications delivered at home. We pay for hospitalization, but we don’t pay for supportive health. We pay for doctors but not for family services. We pay for research on molecular biology but not on how to provide proven remedies for the relief of suffering," said Lynn.

"I have never met a nurse or a doctor who doesn’t want to provide good palliative care," said Stovall. "We need to look at changing the payment system to accurately reflect the kind of care that we know works and they want to give."



             
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