Hospitals vs. hospice: Which one will REALLY let your loved ones rest in peace?
Dr. Craig C. Earle of the Dana-Farber Cancer Center in Boston has thrown a hand grenade into the chemotherapy debate, which no one will actually notice unless some crank like me pulls the pin. But it took great courage for a physician at the center of the chemotherapy war to say what he said. He did soften his attack as much as possible so as not to wage a full-out battle, but the message is clear to those of us who know the heartless way cancer patients are exploited by the chemo-Mafia.
The crux of Earle's research was summed up nicely in the Reuters article I read on it, which said "The care of cancer patients near the end of life may be getting more aggressive-perhaps overly aggressive compared to patients treated in 1993, those treated in 1996 were more likely to receive chemotherapy, including during the last two weeks of life."
Let's reword that sentence: "These dying patients received chemotherapy for two weeks-and then died."
Earle's study noted that there has been an increase in hospital admissions of terminal cancer patients. This leads to "more aggressive care" if an oncologist joins the treatment team. The trend toward more aggressive care may be related to the availability of new types of chemotherapy, Dr. Earle posited.
Not that these "new types of chemotherapy" are any more effective than the old ones but because patients associate "new" as "better."
"As more and more chemotherapy drugs became available, we oncologists used them," Earle said. "That's not a bad thing as long as it doesn't interfere with appropriate end-of-life care."
Well, that's where Dr. Earle and I disagree: Chemotherapy is a bad thing and is never appropriate-especially in terms of end-of-life care. It destroys the immune system, which makes it counterproductive. "End-of-life care" should not include these drugs unless you are practicing chemo-euthanasia. (That is illegal, of course-unless you are an oncologist who can claim to be administering chemotherapy to a terminal patient "for his own good.")
The best way to stay out of the clutches of chemotherapy
Dr. Earle went on to send a clear message to his colleagues: " it may be a good idea to expand access to hospice services, which are designed to meet the needs of terminally ill patients and their families during the last weeks or months of life."
"It appears," he added, "that patients who live in an area where hospice is more available are less likely to experience what some might call overly aggressive treatment." In a more diplomatic way, Dr. Earle is actually saying: "You can stay out of the clutches of the heartless and unthinking robots, called chemotherapists, if you have a hospice center in your neighborhood."
Earle even admitted that the situation isn't likely to change on its own: "When hospice is not as easily available, we oncologists do what we know how to do-keep giving chemotherapy."
The REAL saviors
Dr. Earle is right: Hospices are definitely a better option than hospital care for a patient nearing death. They're meant to make a patient comfortable in his final days, rather than making every attempt to "save" him.
Hospice care involves a team of trained professionals, which typically includes a physician, a nurse, a home health aide, a social worker, a chaplain, and a volunteer.
The hospice nurse is in charge of pain relief and makes regular visits to the patient to provide it. He is also available 24 hours a day, seven days a week for any additional care the patient might need. The nurse keeps the primary physician informed of the patient's condition.
Home health aides assist with personal care of the patient-things like bathing, etc.
Social workers work more with the patient's family, helping them with practical and financial aspects of the hospice care. They also provide emotional support, counseling, and bereavement follow-up.
Basically, it's a much more caring, comfortable way for patients to live out their final days. And it's one that most people, if given the option, choose for their loved ones.
According to the Reuters article: "Despite the increase in aggressive treatment, over time cancer patients were more likely to receive hospice care and less likely to die in a hospital, according to the report. In fact, people who lived in an area where hospice services were more readily available were more likely to receive this type of care."
Translation: Patients and their families flee from chemotherapy when they have a choice.
Government regulations are keeping people in pain
One way to improve the quality of care for cancer patients may be to reduce barriers to hospice care, according to Earle.
That's true. But what would be an even better option to improve the quality of life for those people suffering through the final stages of a terminal illness would be to allow doctors to relieve their pain. Unfortunately, most doctors will not, or cannot, give adequate narcotic relief at home due to heartless governmental restrictions. The war on drugs is more a war on patients in pain than a war on big drug dealers.
It is ironic that chemotherapists can kill the patient with useless and highly toxic drugs in the final stages of the disease but the humanitarian doctor giving morphine at the patient's home can be punished with a jail term and/or have his medical license revoked.
Action to take:
If you or someone you know has cancer or any other illness that has been diagnosed as terminal, find out what hospice care is available in your area. Contact HospiceNet (www.hospicenet.com) or the Hospice Foundation of America (www.hospicefoundation.org; 800-854-3402) for more information on hospices, as well as a directory of centers near you.
According to the HospiceNet website, hospice care is covered in full by Medicare with the exception of some centers that may require a 5 percent or $5.00 co-pay for medication.
"Cancer Treatment Increasingly Aggressive: Study," Reuters Health News, 1/15/04
"Trends in the Aggressiveness of Cancer Care Near the End of Life," Journal of Clinical Oncology 2004; 22(2): 315-321