Blog | Monday, February 13, 2012

QD: News Every Day--Young doctors pick up the slack in palliative care

Palliative care is a growing need and a growing career choice for doctors. Professional societies are recommending palliative care at the first diagnosis, and young physicians are flocking toward the field to meet that demand.

American Society of Clinical Oncology issued a provisional clinical opinion that patients with metastatic non-small-cell lung cancer should be offered palliative care and standard oncologic care when they are diagnosed.

The opinion reads, "Although there's no proven survival benefit, substantial evidence demonstrates that palliative care--when combined with standard cancer care or as the main focus of care--leads to improvement in symptoms, quality of life and patient satisfaction, with reduced caregiver burden. Earlier involvement of palliative care also leads to more appropriate referral to and use of hospice, and reduced use of futile intensive care."

The provisional clinical opinion was released in the Journal of Clinical Oncology on Feb. 6.

Currently, palliative care is synonymous with end-of-life care, often within the final month of a patient's life. End-of-life discussions don't take place until then, too. But the provisional clinical opinion comprised seven published randomized controlled trials that showed there have been no trials to date have demonstrated harm to patients and caregivers, or excessive costs, from early involvement of palliative care. The panel's expert consensus is that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden.

Palliative care physicians have long advocated for earlier integration into health care delivery, citing the advantages. They want to overcome the myth that palliative care equates throwing in the towel.

The Center to Advance Palliative Care reported last year that the number of palliative care teams within hospital settings has increased approximately 138% since the year 2000, from more than 600 then to more than 1,500 today.

Fortunately, there's a growing workforce to potentially match the need. The San Jose (Calif.) Mercury News reports that about 12% of the doctors certified in hospice and palliative care in 2010 are now 36 or younger, citing data from the American Board of Medical Specialties. One factor is that mid-career physicians would have to undergo a one-year fellowship to become certified, which many doctors would find financially prohibitive.

This leaves the younger doctors to pick up the slack.