Palliative care:
Not just for people with cancer
03 October 2013
Ahead of World Hospice and Palliative Care Day on
13 October, Dr Stephen Connor, senior fellow to the Worldwide
Palliative Care Alliance, busts the myth that palliative care is only
for people with cancer.
In the early days of the
hospice movement the great majority of patients cared for had a
diagnosis of cancer. This is still true in many countries where
palliative care is just emerging. Cancer patients have heavy symptom
burdens, including moderate to severe pain in about 84% of cases[1].
Prognostication is also easier to do in cancer as the trajectory of
decline in metastatic cancer is more predictable than with many other
progressive non-malignant diseases.
For these reasons and because resources for palliative care are
limited in most countries, there has been a focus on cancer in hospice
and palliative care. However when we look at the real need for
palliative care in a population we find that the greater need is for
those suffering from non-cancer diseases such as heart failure, chronic
obstructive pulmonary disease, stroke, dementias, liver and kidney
failure, motor neuron diseases, and other less common conditions. For
children there are many that have congenital anomalies, neonatal
conditions, endocrine disorders, and other illnesses specific to
childhood.
In a report that will soon be
released by the World Health Organization and the WPCA, the estimated
percentage of patients needing palliative care at the end-of-life with
cancer is only about one-third of the total. In the United States, where
hospice care has been covered by insurance benefits since the early
1980’s, the National Hospice and Palliative Care Organization reported
that only about 35% of patients admitted to hospices had a primary
diagnosis of cancer in 2010[2]. Thus 65% of persons admitted had a non-cancer diagnosis.
The WHO collaborating center for palliative care and public health
policy in Barcelona, Spain reports that about 1.5% of the entire
population at a given time would benefit from palliative care in the
country[3].
The largest group of those needing palliative care in that report were
the frail elderly, many with multiple chronic conditions.
While the needs of cancer patients for
palliative care are great, we can say that when the real needs for
palliative care are met in a country the great majority of the patients
will have diagnoses other than cancer.
References
[1] Higginson, I. J. Palliative and Terminal Care Health
care needs assessment: The epidemiologically based needs assessment
reviews. A. R. Stevens, J. . Oxford and New York, The Wessex Institute
for Health Research and Development, 1997.
[2] National Hospice and Palliative Care Organization. NHPCO Facts and figures on hospice care in America, 2012 Edition. http://www.nhpco.org/sites/default/files/public/Statistics_Research/2012_Facts_Figures.pdf
[3]
Gómez-Batiste X, Martínez-Muñoz M, Blay C, et al. BMJ Supportive &
Palliative Care Published Online First: 00 Month 0000
doi:10.1136/bmjspcare-2012-000211
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