Unfortunately, Medicare patients have to make the choice between receiving cancer treatment or hospice care; they cannot have both due to cost constraints. However, through the Veterans Health Administration (VHA), cancer treatment and hospice care can occur simultaneously if a patient opts for both. This concurrent treatment can be very valuable to patients and their loved ones; it is important to have the option to receive both treatments at once.
"Often, Medicare patients with terminal cancer and their families are given a terrible choice: you can continue treatments or have hospice care, but not both. But the VA has this unique structure where we can provide cancer therapies that are designed to be disease-modifying while also referring patients for hospice care in the community. Now Medicare is exploring the possibility of concurrent treatment and hospice, and we said, 'Wait, we've been doing this in the VA for a long time!' Maybe our experience can inform Medicare's experiment," claimed Cari Levy, MD, PhD, Investigator at the University of Colorado Cancer Center, Professor in the University of Colorado School of Medicine Department of Health Care Policy and Research, and geriatrician specializing in hospice and palliative care at the Veterans Affairs Eastern Colorado Health Care System in Aurora, CO.
While this concurrent treatment system is rare, it can be very beneficial for patients. Often, even though cancer may be incurable at times, chemotherapy or radiation treatments can be offered to hospice patients to alleviate pain or ease tumor burden. In a study published in Supportive Care in Cancer, investigators interviewed 76 health care providers who offer both cancer and hospice treatments.
An analysis of interview results of concurrent care perception led to three main views: 1) hospice care occurring with cancer treatment is a practical option, in which patients and loved ones reserve hope while meeting patient goals; 2) omnipresent staff provide education and care for patients; and 3) there is a general concern that Medicare guidelines limit concurrent treatment.
Because of this concern, hospice staff are reluctant to give patients cancer treatment that could really benefit them.
"This stuff is really confusing to people. Hospices wondered, if the VA pays for treatments, am I going to get into trouble with Medicare for providing palliative care? The hospices in the community don't want to be noncompliant with Medicare guidelines. Sometimes this led to hospice hesitating to provide their support while a patient was on VA treatment," Dr. Levi explained.
It is important to properly equip clinicians with the knowledge they need to best treat their patients.
"The hope is that all of this informs the Medicare demo and that they can say you just need to provide good care to people," emphasized Dr. Levi. "People want good care that makes them feel good."
For More Information
Haverhals LM, Manheim CE, Mor V, et al (2018). The experience of providing hospice care concurrent with cancer treatment in the VA. Support Care Cancer, 272(27):1-8. DOI:10.1007/s00520-018-4552-z
Image courtesy of Cathy Cox