This news release reports results of a study that found that patients with advanced cancers who were referred early to palliative care made better use of support services, including palliative chemotherapy, after being discharged and had fewer hospital re-admissions and invasive treatments.
Researchers at Mount Sinai Hospital obtained their data through a prospective cohort study (one that follows a group of patients over time to observe specific outcomes). Unfortunately, the absolute numbers — readily available in the study — showing the results were not included in the news release. But the release does provide good context in other areas, particularly in explaining what palliative care is and what it entails for patients.
In an era when ethical and economic issues surrounding end-of-life care loom increasingly large, this study addresses a critical issue. As the release points out, palliative care has positive implications for emotional and other quality of life issues for patients. In contrast, extensive time spent on acute-care hospital wards and intensive care units, or receiving invasive procedures, drives up costs and is frequently in conflict with patients’ explicitly expressed wishes. That being the case, it is all the more important that a news release about this issue provide the information readers need to judge the quality of the research method and put the results in context.
As the authors of the journal article state: “Our findings are particularly important because multiple studies suggest that patients with advanced cancer often do not understand their actual prognosis or goals of chemotherapy; when they do not, these patients are more likely to receive nonbeneficial interventions, which contribute to increased suffering.”
Many patients with advanced cancer are classic cases of those who receive too much care, which is of no benefit. Not only that, it adds to their pain, anxiety, and degrades their and their families quality of life. Its costs can be exorbitant, with some chemotherapy drugs costly upwards of $15,000 per month.
The news release makes several general statements about the costs of not referring patients early to palliative care.
It’s not clear whether the cost savings at a large hospital like Mount Sinai would carry over to smaller hospitals across the country that might not have the requisite staff already in place. Additionally, a statement about the implications of costs incurred by patients for early palliative care would improve the release.
Readers learn from this announcement that early referral to palliative care “decreased health care utilization and increased use of support services following discharge” for cancer patients at advanced stages of the disease. But how much? Did health care utilization decrease by 1%? 5%? 40%? The specific results of the study are not reported. To be able to interpret the importance of these results, readers need numbers. Without that, the assertion by one of the researchers that hospitals across the country should adopt this practice appears tenuous.
The study in the Journal of Oncology Practice provided both relative and absolute risk numbers for the claimed benefits of palliative care (PC) referrals. It would have made the release much stronger had the absolute numbers been included.
Among patients that were part of the study in either the control group or the intervention group, 30-day hospital readmission rates decreased from 35% (17 of 48) of patients in the control group compared to 18% (13 of 65) of those receiving the intervention. Referrals to hospice increased from 14% (7 out of 48 patients) among controls to 26% (17 of 65 patients) of the intervention group, and receipt of chemotherapy after discharge decreased from 44% (21 of 48) of controls to 18% (12 of 65) of those in the intervention group.
It’s hard to imagine many harms associated with a palliative care consultation. It might be helpful to point out that patients who are recommended for that type of consultation are still free not to choose palliative care.
Although the news release includes a description of the inclusion criteria for the study and the content of the palliative care consultation, we are given no information about how many patients were involved, what period of time the study took place, or what defined “early” referral in comparison to the status quo. There’s also no mention that this was an observational study. Observational studies can’t prove cause and effect — something that was suggested in the headline. Without a brief recap of those issues, readers can’t assess the quality of the evidence.
The study listed several limitations that were not included in the release. Among them:
There is no disease mongering in this news release. The severity of terminal cancer could hardly be exaggerated. The release provides useful background on what palliative care is and what it entailed at this hospital.
The funding source is not identified.
Alternatives to palliative care for late-stage cancer patients are described clearly.
Although this piece makes it plain that palliative care has positive implications for cancer care, it doesn’t tell readers what is currently happening at hospitals around the country. It assumes readers are already aware of palliative care availability but that may not always be the case.
The release begins with a straightforward statement that this is the first study to demonstrate benefits of early referral to palliative care for terminally ill cancer patients.
There is no sensational language in this release. The tone is objective and factual.