Thursday, July 1, 2010

Futile Care, Examined.

From an AP article by Marilynn Marchione:

Doctors can't predict how soon a patient will die, but they usually know when an illness has become incurable. Even then, many of them practice "exhaustion medicine" — treating until there are no more options left to try, said Dr. Martha Twaddle, chief medical officer of Midwest Palliative & Hospice Care Center in suburban Chicago.
A stunning number of cancer patients get aggressive care in the last days of their lives, she noted. One large study of Medicare records found that nearly 12 percent of cancer patients who died in 1999 received chemo in the last two weeks of life, up from nearly 10 percent in 1993.

Guidelines from an alliance of leading cancer centers say patients whose cancer has spread should stop getting anti-cancer medicine if sequential attempts with three different drugs fail to shrink their tumors. Yet according to IntrinsiQ, a cancer data analysis company, almost 20 percent of patients with colorectal cancer that has spread are on at least their fourth chemotherapy drug. The same goes for roughly 12 percent of patients with metastatic breast cancer, and for 12 percent of those with lung cancer. The analysis is based on more than 60,000 cancer patients.

Often, overtreating fatal illnesses happens because patients don't want to give up.

Here's the clip Thaddeus Pope pulls out at his blog:

Americans increasingly spend more time in hospitals in their final days, trying last-ditch treatments that often buy only weeks of time and racking up bills that have made medical care a leading cause of bankruptcies.

More than 80 percent of people who die in the U.S. have a long, progressive illness such as cancer, heart failure or Alzheimer's.

More than 80 percent of them say they want to avoid hospitalization and intensive care when they are dying, according to the Dartmouth Atlas Project, which tracks health-care trends.

Yet that's not what is happening:

• The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. In 2008, one-third of people who received hospice care had it for a week or less, says the National Hospice and Palliative Care Organization.

• Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

"People are actually now sicker as they die," and some find that treatments become a greater burden than the illness was, said Dr. Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center. "There are worse things than having someone you love die," he said.

See full article from DailyFinance:

Labels: , , ,

More End of Life Discussions by the Supreme Court.

Thaddeus Pope from Medical Futility Blog leaves us with this note:

Yesterday, Melvin I. Urofsky, Professor of Law & Public Policy; Professor Emeritus of History, Virginia Commonwealth University; and Supreme Court Expert, Holds a News Briefing at the Washington Foreign Press Center on the Kagan confirmation hearings. The following is a brief excerpt from Roll Call:

"We should be asking about end-of-life options. . . . America is an aging nation in a sense. There's a lot of young people, but the -- one of the largest growing cohorts are people in their 80s. And I know that just from some medical issues I've had in the last few years, it is very expensive to have a hip replacement or to have retinal surgery or to have other things. And people in their 80s have more medical issues than do people in their 20s. And he said these are the issues we ought to be asking, because the Court's docket for the next 10, 20, or 30 years is going to be much different than it was for the last 30 years.”
My feminist friends aren't buying it; the "pro-life" groups aren't buying it: and yet I think that Pope and Urofsky are onto something when they ascribe elder/terminal care as the new discussion in coming years. What do you think?

Labels: ,