Experimental treatments and hospice care:
a new “best of both worlds” opportunity for the terminally
ill
A chance to receive experimental treatments for your terminal
illness or an opportunity to have the special comforts of a
hospice program?
For most terminally ill patients, the choice has been one or
the other.
Now, researchers at the Comprehensive Cancer Center and Hospice
of Michigan, along with investigators at St. John Health System
and Providence Hospital, will begin a 3-year study to see if
a new model can't be developed that won't force people to make
such a difficult choice.
Funded by the Robert Wood Johnson Foundation with a $1.35 million
grant, the Palliative Care Study will challenge the current
model of medical care and allow patients the benefits of both
hospice care and the most advanced chemotherapy, radiation and
other treatments.
Under the current model of care, when terminally ill patients
enter an experimental study or receive palliative treatment,
they typically spend all but the last week or two of their lives
receiving treatment. Then, when all life-prolonging options
are exhausted, they are moved into hospice care. The move to
hospice care, coming in the final days of the patient's life,
often is accompanied by feelings of abandonment on the part
of patients, families, and those caring for them. Conversely,
if patients choose hospice care early, they deny themselves
the chance to actively fight the disease.
The Palliative Care research team will evaluate 160 patients
in each of four groups, those with advanced breast cancer, advanced
prostate cancer, advanced lung cancer and advanced congestive
heart failure. Those taking part in the study typically will
have a life expectancy of approximately six months.
"Preliminary studies suggest that integrating hospice
care with traditional treatment improves quality of life for
terminally ill patients and may also be more cost effective
than the current system of care," says Kenneth J. Pienta,
M.D., lead researcher and professor of internal medicine and
surgery at Michigan. "Under this program you can enter
hospice early in the treatment cycle and still receive medicines,
such as chemotherapy, that will relieve symptoms and potentially
help you live longer."
Pienta, a nationally recognized prostate cancer researcher,
will direct the new program along with co-investigator John
Finn, M.D., medical director of Hospice of Michigan, the nation's
largest provider of hospice care, which serves more than 900
patients per day in Michigan communities. "In this study,"
Finn says, "we will provide patients with the best of
both worlds — state of the art treatment plus the best in
palliative care. We think it will significantly improve the
quality of end of life care for terminally ill patients."
Medicare and most insurance companies generally do not pay
for hospice services until all life prolonging options have
been exhausted or refused. Results of the Palliative Care Project
may provide valuable data to regional and national health care
planners about costs of merging life prolonging medical care
with hospice and palliative care,
The Robert Wood Johnson Foundation is the nation's largest
philanthropy devoted exclusively to health and health care.
Based in Princeton, New Jersey, it was founded through a 1968
bequest by Robert Wood Johnson, who built the small but innovative
family firm of Johnson & Johnson into the world's largest
health and medical care products conglomerate. To date, the
Robert Wood Johnson has given more than $13 million in gifts
to support the work of scholars at Michigan.
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ethics into residency programs: Michigan helps lead the way
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