Hospice Early-Early HospiceF. Amos Bailey, MD Dec 3, 2019
The Safe Harbor Palliative Care Unit at the Birmingham VAMC had been open for a few years when Carol was admitted.
Donna, “We just got a call from the Medical Oncology Clinic. They say that they want to admit someone straight to Safe Harbor?” The Palliative Medicine Fellow was dispatched to check this out while we made ready for an admission.
Carol B, was a veteran who had picked up smoking while she was in the Navy. Now in her mid-50’s, she was devasted. She had been diagnosed with Small Cell Lung Cancer but it was already widely metastatic and involved her pancreas. She was nauseated always, vomiting frequently and barely able to walk; too sick for chemo.
After admission to Safe Harbor, some fluids and meds, she was looking much better. We began talking about the meaning of this cancer.
Small Cell Lung Cancer is very sensitive to chemotherapy and most people respond even when widely metastatic. Without chemotherapy, she probably only had a few weeks to live. If she got chemotherapy, tolerated it and responded to it she might have 8-10 months. It was a big difference.
“I want to try… What do I have to lose? If it kills me, I am dying anyways.” Carol said.
It took some effort to convince the Medical Oncologist to give Carol, a hospice patient, chemotherapy. Carol told them she knew the risk and we promised to support her no matter what. She got the chemo. The first few weeks were rough but slowly she was feeling better and clearly, she was getting better. Even the mass that we once could palpate in the abdomen had melted.
Carol went home, with home hospice and continued the chemotherapy. She had 8 really good months but as we all knew, the cancer reoccurred. In the end, Carol was with us on Safe Harbor.
Now concurrent care, hospice and treatment for lung cancer, is routine in the VA. In a new study by Mor, Wagner, Levy, et al. (2019) outcomes for over 13000 veterans with lung cancer from 2006-2012 were analyzed. The results confirm many of the findings of the famous Temel et al. study of palliative care for non-small cell lung cancer. Early and concomitant palliative care, often in the form of hospice, results in better symptom control and better quality of life, better survival with less “aggressive” treatments including ICU and hospital stays. This approach most often aligns with patient goals and has an added benefit of costing less.
Learn more here:
Mor, V., Wagner, T. H., Levy, C., Ersek, M., Miller, S. C., Gidwani-Marszowski, R., … & Kinosian, B. (2019). Association of expanded VA hospice care with aggressive care and cost for veterans with advanced lung cancer. JAMA oncology, 5(6), 810-816.