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Should Patients Receiving Palliative Chemotherapy be Able to Receive Hospice Care?

Orlando, Fla. (April 30, 2005) -- Research shows that the median survival of cancer patients who participate in phase 1 clinical trials is six and a half months. Yet, patients with advanced or metastatic cancer sometimes seek active treatment in hopes that an experimental therapy will make a difference, said Jeanne Held-Warmkessel, MSN, RN, APRN, BC, AOCN, clinical nurse specialist at Fox Chase Cancer Center in Philadelphia, Pa. Held and colleagues explore the use of active treatment in patients suitable for hospice care, including reimbursement issues and pilot programs today, at the 30th Annual Oncology Nursing Society (ONS) Congress.

"Many patients seek active treatment to provide hope and optimism in a difficult time or they choose to participate in a clinical trial in hopes that what is learned can benefit other cancer patients," said Held-Warmkessel. "However, Medicare does not provide funds for chemotherapy and hospice care or clinical trial participation and hospice care to occur at the same time." As a result, patients forgo the psychosocial and other benefits of Hospice care.

"There needs to be a shift in the paradigm of care," continued Held-Warmkessel. "Pilot programs are looking into no longer separating hospice care and active chemotherapy. Some patients require the benefits of each."

More recent research points outs that some FDA approved drugs have a minimal effect on survival rate in patients with advanced disease but may positively affect quality of life. However, that small amount of time gained by therapy allows patients to accomplish important life events with their families and friends or to reach important family milestones such as a wedding or graduation. "Our job as nurses is to provide the best care possible and ensure the comfort and safety of our patients," said Held-Warmkessel.

According to Held-Warmkessel, oncology nurses are on the forefront of this subject and need to confirm that the patient is well aware of the risks verses benefits involved in clinical trials, as explained by the physician or included in the informed consent process. Nurses also communicate with patients and their families not willing to abandon chemotherapy and start hospice care or those suffering from the emotional effects of dealing with adaptation and adjustment to disease progression.

Held-Warmkessel notes the sensitively to this subject and realizes the importance of further discussion and research.

Fox Chase Cancer Center, part of the Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence four consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach.  For more information, call 1-888-FOX CHASE or (1-888-369-2427).

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