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Lynne Eldridge MD

Hospice Enrollment and Lung Cancer Survival

By July 20, 2011

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Simply hearing the word "hospice" conjures about anxious emotions for many people. And it's not just people living with cancer and their loved ones. Physicians are often hesitant to bring up hospice care as well. For both patients and physicians, talking about hospice can be associated with a "feeling of giving up." At least from a physical/survival point of view.

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But a new study suggests a different story. Older people with advanced lung cancer who are referred to hospice may not only live as long as those not enrolled in hospice, but some may live longer.

In this study, researchers looked at nearly 8,000 people over the age of 65 who were diagnosed with advanced lung cancer. Then they separated the group into people who were referred to hospice, and those who did not receive hospice care. The hospice group not only lived as long as the other group, but their overall survival rates were slightly better 1 and 2 years following diagnosis.

As far as the length of hospice care - whether a few days or several months - it didn't matter when it came to survival.

This study seemed very important to me for two reasons. One, of course, is that patients and physicians alike associate hospice with a shortened life. There seems to be an assumption that aggressive end-of-life care without hospice might add to survival. Not so it appears.

But the other reason that made this study jump out at me, is because I have watched so many people benefit from only a few days of hospice care. I don't know how many people have made the comment to me "why didn't we do this sooner?" In fact the average amount of time spent in hospice is very short relative to the required "expect less than 6 months" scenario.

The conclusion of the study was that enrollment in hospice didn't lower the chances for survival for older patients with advanced lung cancer. But what happens if you or a loved one are enrolled in hospice and live longer than 6 months? Nothing. If expected survival is still less than 6 months, hospice can be renewed. If not, well, miracles sometimes happen.

It is important here to quickly note the difference between the definition of "palliative care" and hospice. Many cancer centers are now offering palliative care consults early on after a diagnosis of cancer. Palliative care doesn't require that someone be "terminal," and unlike hospice, is often combined with treatments such as chemotherapy and radiation. And in that setting, lung cancer survival was better as well.

Photo: National Cancer Institute, Daniel Sone (photographer)

Source:

Saito, A. et al. Hospice Care and Survival among Elderly Patients with Lung Cancer. Journal of Palliative Medicine. 2011 Jul 18. (Epub ahead of print).

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