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Noncancer diagnoses on the rise in palliative care

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Comment by Daniel Ouellette, MD, FCCP

"But doc, isn't hospice just for cancer patients?"

Dr. Daniel Oullette

My 80-year-old patient has COPD, requires oxygen at 4 L/min at rest, and cannot walk to his mailbox despite being on a maximum bronchodilator regimen. Too old to be a candidate for lung transplant, I have few additional medical treatments to offer him. I hope that I can help him have comfort during the last days of his life. My response to him is: "Not any longer." The study from the National Palliative Care Registry demonstrates that pulmonary physicians and their patients are increasingly aware that palliation plays an important role in the management of patients with end-stage respiratory disease.


 

Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.

In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.

Referrals by specialty were led by hospital medicine, which accounted for 48% of all patients referred to palliative care in 2015, with internal medicine/family medicine next at 14%, followed by pulmonary/critical care at 13% and oncology at 7%, the report said.

An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.

In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.

Leading diagnosis groups among referrals to palliative care
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