Roughly 30% of all healthcare expenses occur in the last year of a patient’s life, and for most patients, it is debatable whether these expenses lengthen life or improve quality of life; in fact, some studies suggest the opposite. Aha, you say, but how does one know a patient is in his/her last year, isn’t hindsight 20/20? Well, I would posit that modern medicine often knows when there is no “evidence” that further treatment will help, but for a variety of reasons, treatment continues.
One way to reduce healthcare costs might be to reduce the amount of treatment in the final year, and instead, opt for a branch of medicine called palliative care whose goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. Unfortunately, many Americans feel palliative care is akin to “giving up” as opposed to medical “treatment” which focuses on delaying, reversing, or curing the illness itself.
This August, a study was published in the New England Journal of Medicine, “Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer”. The results of the study were important for the following reasons:
- The results would appear to refute the notion that palliative care means giving up. Patients received palliative care alongside their curative treatment.
- The data show that patients receiving palliative care early in their illness lived longer and with better quality of life.
- Patients receiving palliative care early in their illness opted for less aggressive end-of-life care, resulting in fewer hospitalizations and emergency department visits, a proxy for lower costs.
Patients, Providers, Payers, and Pharma should take note! There are few ideas in healthcare that lower costs, improve quality, and extend survival. If these results are reproducible, early stage palliative care might be appropriate for several illnesses such as other types of cancer (e.g. pancreatic), Alzheimer’s disease, congestive heart failure, lung disease, stroke, and kidney disease.
Which businesses stand to benefit the most from delivering early stage palliative care? I think the government, payers and the 5,000 or so hospitals, hospices, and long-term care businesses that currently offer palliative care services.
Questions for the reader:
- If you or someone you love were diagnosed with a terminal illness, would you seek early-stage palliative care in conjunction with treatment? Why or why not?
- Do you believe these findings will be replicated in other cancers? Other terminal illnesses? Why or why not?
- Do you believe early-stage palliative care will lower healthcare costs? Why or why not?