Hospice & Palliative Medicine

Prescribers and other stakeholders may submit comments about the Food and Drug Administration’s draft document outlining the main messages to be included in educational programs that will be required for prescribing certain opioid products, the agency announced in the federal register on Nov. 4.

An education program for prescribers and patients is the central component of the Risk Evaluation and Mitigation Strategy (REMS) now required for brand-name and generics of long-acting (LA) and extended-release (ER) formulations of buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. The REMS addresses the risk of abuse and misuse of these products, which has become a major public health problem in recent years. This week, the Centers for Disease Control and Prevention released a report saying the number deaths due to overdoses of prescription pain medications is now greater than is the number of deaths due to heroin and cocaine combined.

REMS is required by the FDA for certain products to ensure that the benefits of a drug continue to outweigh its risks.

Health care professionals who prescribe these products "are in a key position to balance the benefits of prescribing ER/LA opioids to treat pain against the risks of serious adverse outcomes including addiction, unintentional overdose, and death," according to the document, titled "Blueprint for Prescriber Continuing Education."

The blueprint includes sections on assessing patients for treatment; initiating treatment, modifying dosing, and discontinuing treatment; and counseling patients and caregivers on how to use these drugs safely.

The federal register notice says that the agency expects that prescriber training should be provided to prescribers at no cost by "accredited, independent, continuing education providers," funded by "unrestricted grants" from the drug manufacturers.

The deadline for comments on the blueprint is Dec. 4, 2011.

Comments can be submitted electronically or by writing to Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville, Md., 20852.

Prescribers and other stakeholders may submit comments about the Food and Drug Administration’s draft document outlining the main messages to be included in educational programs that will be required for prescribing certain opioid products, the agency announced in the federal register on Nov. 4.

An education program for prescribers and patients is the central component of the Risk Evaluation and Mitigation Strategy (REMS) now required for brand-name and generics of long-acting (LA) and extended-release (ER) formulations of buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. The REMS addresses the risk of abuse and misuse of these products, which has become a major public health problem in recent years. This week, the Centers for Disease Control and Prevention released a report saying the number deaths due to overdoses of prescription pain medications is now greater than is the number of deaths due to heroin and cocaine combined.

REMS is required by the FDA for certain products to ensure that the benefits of a drug continue to outweigh its risks.

Health care professionals who prescribe these products "are in a key position to balance the benefits of prescribing ER/LA opioids to treat pain against the risks of serious adverse outcomes including addiction, unintentional overdose, and death," according to the document, titled "Blueprint for Prescriber Continuing Education."

The blueprint includes sections on assessing patients for treatment; initiating treatment, modifying dosing, and discontinuing treatment; and counseling patients and caregivers on how to use these drugs safely.

The federal register notice says that the agency expects that prescriber training should be provided to prescribers at no cost by "accredited, independent, continuing education providers," funded by "unrestricted grants" from the drug manufacturers.

The deadline for comments on the blueprint is Dec. 4, 2011.

Comments can be submitted electronically or by writing to Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville, Md., 20852.

Prescribers and other stakeholders may submit comments about the Food and Drug Administration’s draft document outlining the main messages to be included in educational programs that will be required for prescribing certain opioid products, the agency announced in the federal register on Nov. 4.

An education program for prescribers and patients is the central component of the Risk Evaluation and Mitigation Strategy (REMS) now required for brand-name and generics of long-acting (LA) and extended-release (ER) formulations of buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. The REMS addresses the risk of abuse and misuse of these products, which has become a major public health problem in recent years. This week, the Centers for Disease Control and Prevention released a report saying the number deaths due to overdoses of prescription pain medications is now greater than is the number of deaths due to heroin and cocaine combined.

REMS is required by the FDA for certain products to ensure that the benefits of a drug continue to outweigh its risks.

Health care professionals who prescribe these products "are in a key position to balance the benefits of prescribing ER/LA opioids to treat pain against the risks of serious adverse outcomes including addiction, unintentional overdose, and death," according to the document, titled "Blueprint for Prescriber Continuing Education."

The blueprint includes sections on assessing patients for treatment; initiating treatment, modifying dosing, and discontinuing treatment; and counseling patients and caregivers on how to use these drugs safely.

The federal register notice says that the agency expects that prescriber training should be provided to prescribers at no cost by "accredited, independent, continuing education providers," funded by "unrestricted grants" from the drug manufacturers.

The deadline for comments on the blueprint is Dec. 4, 2011.

Comments can be submitted electronically or by writing to Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville, Md., 20852.

Physicians should start end-of-life conversations early. They can start prognosis discussions by asking broad open-ended questions. Dr. Susan Block shares her practice wisdom at the Chicago Supportive Oncology Conference.

Physicians should start end-of-life conversations early. They can start prognosis discussions by asking broad open-ended questions. Dr. Susan Block shares her practice wisdom at the Chicago Supportive Oncology Conference.

Physicians should start end-of-life conversations early. They can start prognosis discussions by asking broad open-ended questions. Dr. Susan Block shares her practice wisdom at the Chicago Supportive Oncology Conference.

Overall, the American health care system improved its palliative care grade from a "C" to a "B," according to the study America’s Care of Serious Illness: a State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals.

However, location impacts access to palliative care. The District of Columbia and seven other states – Maryland, Minnesota, Nebraska, Oregon, Rhode Island, Vermont, and Washington – earned "A" grades, while Delaware and Mississippi received "F" grades. Hospitals with palliative care programs are currently less common in the South as well as in hospitals with fewer than 50 beds.

The findings were based on data collected by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC).

The data showed that 85% of hospitals with 300 or more beds had palliative care teams, compared with 54% of public hospitals, 37% of sole community provider hospitals, and 26% of for-profit hospitals. Hospitals with 50 or more beds are more likely to be not-for-profit, and thus are more likely to offer palliative care.

The number of states earning an "A" grade improved from only three states in 2008 to seven states plus the District of Columbia in 2011. But the lack of palliative medicine physicians remains a major barrier to the continued improvement of palliative care in the U.S., where there is currently one palliative care physician for every 1,200 individuals living with a serious or life-threatening condition, the researchers noted.

"Focused efforts by hospital administration, the health care community, and policymakers are required to promote the development of quality palliative care programs in all hospitals, with special attention needed in small, rural, public, and for-profit hospitals," the CAPC said in a press release accompanying the report.

Overall, the American health care system improved its palliative care grade from a "C" to a "B," according to the study America’s Care of Serious Illness: a State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals.

However, location impacts access to palliative care. The District of Columbia and seven other states – Maryland, Minnesota, Nebraska, Oregon, Rhode Island, Vermont, and Washington – earned "A" grades, while Delaware and Mississippi received "F" grades. Hospitals with palliative care programs are currently less common in the South as well as in hospitals with fewer than 50 beds.

The findings were based on data collected by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC).

The data showed that 85% of hospitals with 300 or more beds had palliative care teams, compared with 54% of public hospitals, 37% of sole community provider hospitals, and 26% of for-profit hospitals. Hospitals with 50 or more beds are more likely to be not-for-profit, and thus are more likely to offer palliative care.

The number of states earning an "A" grade improved from only three states in 2008 to seven states plus the District of Columbia in 2011. But the lack of palliative medicine physicians remains a major barrier to the continued improvement of palliative care in the U.S., where there is currently one palliative care physician for every 1,200 individuals living with a serious or life-threatening condition, the researchers noted.

"Focused efforts by hospital administration, the health care community, and policymakers are required to promote the development of quality palliative care programs in all hospitals, with special attention needed in small, rural, public, and for-profit hospitals," the CAPC said in a press release accompanying the report.

Overall, the American health care system improved its palliative care grade from a "C" to a "B," according to the study America’s Care of Serious Illness: a State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals.

However, location impacts access to palliative care. The District of Columbia and seven other states – Maryland, Minnesota, Nebraska, Oregon, Rhode Island, Vermont, and Washington – earned "A" grades, while Delaware and Mississippi received "F" grades. Hospitals with palliative care programs are currently less common in the South as well as in hospitals with fewer than 50 beds.

The findings were based on data collected by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC).

The data showed that 85% of hospitals with 300 or more beds had palliative care teams, compared with 54% of public hospitals, 37% of sole community provider hospitals, and 26% of for-profit hospitals. Hospitals with 50 or more beds are more likely to be not-for-profit, and thus are more likely to offer palliative care.

The number of states earning an "A" grade improved from only three states in 2008 to seven states plus the District of Columbia in 2011. But the lack of palliative medicine physicians remains a major barrier to the continued improvement of palliative care in the U.S., where there is currently one palliative care physician for every 1,200 individuals living with a serious or life-threatening condition, the researchers noted.

"Focused efforts by hospital administration, the health care community, and policymakers are required to promote the development of quality palliative care programs in all hospitals, with special attention needed in small, rural, public, and for-profit hospitals," the CAPC said in a press release accompanying the report.

A common chemotherapy regimen gets reclassified as high risk for emesis; a new approach is recommended to tackle treatments with high emetic potential; and a particular antiemetic drug is now preferred for patients at moderate risk – these are among the changes to clinical practice guidelines from the American Society of Clinical Oncology.

The guidelines also include new recommendations for preventing nausea and vomiting associated with radiation treatment.

Treatment-related nausea and vomiting is reported by more than half of patients. If it is severe enough, dehydration and other adverse health effects can result and can limit treatment and patient outcomes.

One key change to the guidelines involves the chemotherapeutic agents anthracycline and cyclophosphamide, each of which carries a moderate risk for emesis if used alone. However, when the two are prescribed together, the patient’s risk for emesis is high. This upstaging to high risk is important, the authors wrote, because these agents are commonly combined, particularly to combat breast cancer and non-Hodgkin’s lymphoma.

For this and other high-risk therapies, the guidelines now recommend use of newer antiemetics. For example, a 5-hydroxytryptamine-3 (5-HT₃) receptor antagonist in combination with dexamethasone and a neurokinin 1 (NK₁) receptor antagonist is suggested to prevent significant nausea and vomiting.

In addition, a new NK1 receptor agonist, fosaprepitant (Emend, Merck), is available as a new, 1-day intravenous formulation of aprepitant, which needs to be infused over 3 days. The therapeutic equivalence of these two drugs was demonstrated in a large trial (J. Clin. Oncol. 2011;29:1495-501) and thus either one is appropriate, according to the guidelines. The briefer administration of fosaprepitant "may represent a more convenient or feasible option for some patients," the guideline update committee noted.

These and other revisions are based on new research findings since the last update to the guidelines in 2006. The 14-member committee reviewed 37 randomized, controlled trials, searched the Cochrane Collaboration Library, and evaluated presentations from the annual meetings of the American Society of Clinical Oncology and the Multinational Association of Supportive Care in Cancer.

The antiemetic recommendations are categorized according to the emesis risk of the chemotherapy regimens. For example, palonosetron (Aloxi, Helsinn Healthcare), is listed as preferential for moderate–emetic-risk regimens when given on day 1 and when combined with dexamethasone on days 1-3. If palonosetron is not available, the authors state that granisetron or ondansetron may be substituted.

In addition, a single, 8-mg dexamethasone dose alone is appropriate before the first dose of cancer-fighting agents associated with a low risk for emesis. And no antiemetic prophylaxis is necessary for chemotherapy regimens deemed to have minimal risk, according to the guidelines. These recommendations have remained the same since the last guideline update.

Recommendations regarding radiation treatment are likewise stratified by risk for emesis. For example, when a radiation course carries a high emetic risk, the guidelines recommend a 5-HT₃ agent prior to each fraction and for at least 24 hours following completion of radiotherapy. The update committee dropped the recommendation that this therapy be given with or without a corticosteroid and added that a 5-day course of dexamethasone is indicated during fractions one to five.

For moderate-risk radiation therapy, a 5-HT₃ antagonist before each fraction throughout radiotherapy remains the recommendation, with addition of a short course of dexamethasone during fractions one to five.

And for low-risk radiotherapy, the committee recommends a 5-HT₃ antagonist alone as either prophylaxis or rescue. This represents a change from the 2006 recommendation for administration of a 5-HT₃ agent before each fraction.

For minimal-risk radiotherapy, the new recommendation is for rescue therapy with either a dopamine receptor antagonist or a 5-HT₃ antagonist. This is similar to the 2006 recommendation for a dopamine or serotonin receptor antagonist on an as-needed basis.

When rescue antiemetic therapy is given, the authors recommend that prophylactic treatment be continued until radiotherapy is completed.

Other major themes of the guidelines include a need for continued symptom monitoring and a recognition that clinicians tend to underestimate the incidence of nausea; therefore, nausea is often less well controlled than emesis.

Some members of the update committee had the following financial disclosures: Dr. Paul Hesketh is a consultant to Eisai, GlaxoSmithKline, Helsinn, and Merck; Dr. Mark G. Kris is a consultant to Sanofi-Aventis and GlaxoSmithKline; and Dr. Petra C. Feyer is a consultant to GSK and Merck. Dr. Rebecca Clark-Snow receives honoraria from Merck, and Dr. Feyer receives honoraria from Merck, GSK, and Roche.

A common chemotherapy regimen gets reclassified as high risk for emesis; a new approach is recommended to tackle treatments with high emetic potential; and a particular antiemetic drug is now preferred for patients at moderate risk – these are among the changes to clinical practice guidelines from the American Society of Clinical Oncology.

The guidelines also include new recommendations for preventing nausea and vomiting associated with radiation treatment.

Treatment-related nausea and vomiting is reported by more than half of patients. If it is severe enough, dehydration and other adverse health effects can result and can limit treatment and patient outcomes.

One key change to the guidelines involves the chemotherapeutic agents anthracycline and cyclophosphamide, each of which carries a moderate risk for emesis if used alone. However, when the two are prescribed together, the patient’s risk for emesis is high. This upstaging to high risk is important, the authors wrote, because these agents are commonly combined, particularly to combat breast cancer and non-Hodgkin’s lymphoma.

For this and other high-risk therapies, the guidelines now recommend use of newer antiemetics. For example, a 5-hydroxytryptamine-3 (5-HT₃) receptor antagonist in combination with dexamethasone and a neurokinin 1 (NK₁) receptor antagonist is suggested to prevent significant nausea and vomiting.

In addition, a new NK1 receptor agonist, fosaprepitant (Emend, Merck), is available as a new, 1-day intravenous formulation of aprepitant, which needs to be infused over 3 days. The therapeutic equivalence of these two drugs was demonstrated in a large trial (J. Clin. Oncol. 2011;29:1495-501) and thus either one is appropriate, according to the guidelines. The briefer administration of fosaprepitant "may represent a more convenient or feasible option for some patients," the guideline update committee noted.

These and other revisions are based on new research findings since the last update to the guidelines in 2006. The 14-member committee reviewed 37 randomized, controlled trials, searched the Cochrane Collaboration Library, and evaluated presentations from the annual meetings of the American Society of Clinical Oncology and the Multinational Association of Supportive Care in Cancer.

The antiemetic recommendations are categorized according to the emesis risk of the chemotherapy regimens. For example, palonosetron (Aloxi, Helsinn Healthcare), is listed as preferential for moderate–emetic-risk regimens when given on day 1 and when combined with dexamethasone on days 1-3. If palonosetron is not available, the authors state that granisetron or ondansetron may be substituted.

In addition, a single, 8-mg dexamethasone dose alone is appropriate before the first dose of cancer-fighting agents associated with a low risk for emesis. And no antiemetic prophylaxis is necessary for chemotherapy regimens deemed to have minimal risk, according to the guidelines. These recommendations have remained the same since the last guideline update.

Recommendations regarding radiation treatment are likewise stratified by risk for emesis. For example, when a radiation course carries a high emetic risk, the guidelines recommend a 5-HT₃ agent prior to each fraction and for at least 24 hours following completion of radiotherapy. The update committee dropped the recommendation that this therapy be given with or without a corticosteroid and added that a 5-day course of dexamethasone is indicated during fractions one to five.

For moderate-risk radiation therapy, a 5-HT₃ antagonist before each fraction throughout radiotherapy remains the recommendation, with addition of a short course of dexamethasone during fractions one to five.

And for low-risk radiotherapy, the committee recommends a 5-HT₃ antagonist alone as either prophylaxis or rescue. This represents a change from the 2006 recommendation for administration of a 5-HT₃ agent before each fraction.

For minimal-risk radiotherapy, the new recommendation is for rescue therapy with either a dopamine receptor antagonist or a 5-HT₃ antagonist. This is similar to the 2006 recommendation for a dopamine or serotonin receptor antagonist on an as-needed basis.

When rescue antiemetic therapy is given, the authors recommend that prophylactic treatment be continued until radiotherapy is completed.

Other major themes of the guidelines include a need for continued symptom monitoring and a recognition that clinicians tend to underestimate the incidence of nausea; therefore, nausea is often less well controlled than emesis.

Some members of the update committee had the following financial disclosures: Dr. Paul Hesketh is a consultant to Eisai, GlaxoSmithKline, Helsinn, and Merck; Dr. Mark G. Kris is a consultant to Sanofi-Aventis and GlaxoSmithKline; and Dr. Petra C. Feyer is a consultant to GSK and Merck. Dr. Rebecca Clark-Snow receives honoraria from Merck, and Dr. Feyer receives honoraria from Merck, GSK, and Roche.

A common chemotherapy regimen gets reclassified as high risk for emesis; a new approach is recommended to tackle treatments with high emetic potential; and a particular antiemetic drug is now preferred for patients at moderate risk – these are among the changes to clinical practice guidelines from the American Society of Clinical Oncology.

The guidelines also include new recommendations for preventing nausea and vomiting associated with radiation treatment.

Treatment-related nausea and vomiting is reported by more than half of patients. If it is severe enough, dehydration and other adverse health effects can result and can limit treatment and patient outcomes.

One key change to the guidelines involves the chemotherapeutic agents anthracycline and cyclophosphamide, each of which carries a moderate risk for emesis if used alone. However, when the two are prescribed together, the patient’s risk for emesis is high. This upstaging to high risk is important, the authors wrote, because these agents are commonly combined, particularly to combat breast cancer and non-Hodgkin’s lymphoma.

For this and other high-risk therapies, the guidelines now recommend use of newer antiemetics. For example, a 5-hydroxytryptamine-3 (5-HT₃) receptor antagonist in combination with dexamethasone and a neurokinin 1 (NK₁) receptor antagonist is suggested to prevent significant nausea and vomiting.

In addition, a new NK1 receptor agonist, fosaprepitant (Emend, Merck), is available as a new, 1-day intravenous formulation of aprepitant, which needs to be infused over 3 days. The therapeutic equivalence of these two drugs was demonstrated in a large trial (J. Clin. Oncol. 2011;29:1495-501) and thus either one is appropriate, according to the guidelines. The briefer administration of fosaprepitant "may represent a more convenient or feasible option for some patients," the guideline update committee noted.

These and other revisions are based on new research findings since the last update to the guidelines in 2006. The 14-member committee reviewed 37 randomized, controlled trials, searched the Cochrane Collaboration Library, and evaluated presentations from the annual meetings of the American Society of Clinical Oncology and the Multinational Association of Supportive Care in Cancer.

The antiemetic recommendations are categorized according to the emesis risk of the chemotherapy regimens. For example, palonosetron (Aloxi, Helsinn Healthcare), is listed as preferential for moderate–emetic-risk regimens when given on day 1 and when combined with dexamethasone on days 1-3. If palonosetron is not available, the authors state that granisetron or ondansetron may be substituted.

In addition, a single, 8-mg dexamethasone dose alone is appropriate before the first dose of cancer-fighting agents associated with a low risk for emesis. And no antiemetic prophylaxis is necessary for chemotherapy regimens deemed to have minimal risk, according to the guidelines. These recommendations have remained the same since the last guideline update.

Recommendations regarding radiation treatment are likewise stratified by risk for emesis. For example, when a radiation course carries a high emetic risk, the guidelines recommend a 5-HT₃ agent prior to each fraction and for at least 24 hours following completion of radiotherapy. The update committee dropped the recommendation that this therapy be given with or without a corticosteroid and added that a 5-day course of dexamethasone is indicated during fractions one to five.

For moderate-risk radiation therapy, a 5-HT₃ antagonist before each fraction throughout radiotherapy remains the recommendation, with addition of a short course of dexamethasone during fractions one to five.

And for low-risk radiotherapy, the committee recommends a 5-HT₃ antagonist alone as either prophylaxis or rescue. This represents a change from the 2006 recommendation for administration of a 5-HT₃ agent before each fraction.

For minimal-risk radiotherapy, the new recommendation is for rescue therapy with either a dopamine receptor antagonist or a 5-HT₃ antagonist. This is similar to the 2006 recommendation for a dopamine or serotonin receptor antagonist on an as-needed basis.

When rescue antiemetic therapy is given, the authors recommend that prophylactic treatment be continued until radiotherapy is completed.

Other major themes of the guidelines include a need for continued symptom monitoring and a recognition that clinicians tend to underestimate the incidence of nausea; therefore, nausea is often less well controlled than emesis.

Some members of the update committee had the following financial disclosures: Dr. Paul Hesketh is a consultant to Eisai, GlaxoSmithKline, Helsinn, and Merck; Dr. Mark G. Kris is a consultant to Sanofi-Aventis and GlaxoSmithKline; and Dr. Petra C. Feyer is a consultant to GSK and Merck. Dr. Rebecca Clark-Snow receives honoraria from Merck, and Dr. Feyer receives honoraria from Merck, GSK, and Roche.

BETHESDA, MD. – Palliative care, once limited to the last days before death, is ripe for research and essential to improving patient quality of life, according to speakers at a summit sponsored by the National Institute of Nursing Research and National Institutes of Health partners.

"We have to put the clinician back in the mix," Dr. Ira R. Byock, professor of anesthesiology and director of palliative medicine at Dartmouth Medical School in Hanover, N.H., said in the opening keynote address.

According to several speakers at the meeting, putting the clinician back in the mix may mean changing the thinking about palliative care from something that begins in the last days of life to something started as early as a patient’s first day of a cancer diagnosis, as well as making it easier for clinicians to explore palliative care strategies.

One route to improving palliative care is through rigorous research in both inpatient and outpatient settings to see what works, according to Dr. Jennifer S. Temel, clinical director of thoracic oncology at Massachusetts General Hospital in Boston.

Dr. Temel made the case for the value of palliative care research when she discussed her recent study of early palliative care for patients with advanced lung cancer (N. Engl. J. Med. 2010;363:733-42).

Chemotherapy can improve symptoms, "but the problem is that patients are trading off their cancer symptoms for chemotherapy-related symptoms (fatigue, nausea, neuropathy), so overall physical quality of life is not significantly changed," she said.

In a randomized, controlled trial of 151 adults with metastatic non–small cell lung cancer, patients who received palliative care soon after their diagnoses had significantly less depression and anxiety, compared with controls. Another significant finding: The median survival was longer among patients in the early palliative care group, compared with controls (11.6 months vs. 8.9 months; P = .02).

Patients with advanced illnesses suffer from both physical and psychological symptoms, Dr. Temel said.

Dr. Temel’s findings suggest that early palliative care can be used in conjunction with chemotherapy, and cancer patients could be managed jointly in an oncology and clinic setting. However, more research is needed to support and expand her findings.

To help promote and enhance additional research in the field of palliative care, Dr. Amy P. Abernethy, an oncologist at Duke University Medical Center in Durham, N.C., described the creation of the U.S. Palliative Care Research Cooperative (PCRC) group. Dr. Abernethy is the coprincipal investigator of the PCRC, which was established in 2010 and funded by the National Institute of Nursing Research. The PCRC is currently establishing research protocols and procedures through which palliative care researchers will be able to suggest topics and submit grant applications, said Dr. Abernethy. "We must focus our scope, choose studies carefully, and do them well," she said.

The need to engage patients and caregivers as partners in palliative care research was addressed in many talks, as was the need for better communication among clinicians, patients, and caregivers about palliative care. Dianne Gray, a parent advocate whose young son died of a rare genetic disease, spoke about the importance of communication between doctors and patients facing end-of-life issues and reminded clinicians that families want to work with doctors. But families also want honesty, even if the answer is "I don’t know," she emphasized.

In the summit’s closing keynote address, Dr. J. Randall Curtis, director of the Harborview/University of Washington End-of-Life Care Research Program, Seattle, discussed how changing attitudes toward palliative are getting clinicians back in the mix.

"Palliative care is much more broadly accepted as an important part of health care" in both inpatient and outpatient settings, he said in an interview.

Palliative care applies to all patients who face a life-limiting illness or a chronic illness that may shorten life, whether they are actively dying or only starting to manage an illness or think about end-of-life care, he said.

"Hospital-based physicians in particular have a very important role in providing palliative care," said Dr. Curtis. They have the opportunity to introduce discussions of palliative care when patients are hospitalized for exacerbation of symptoms, or when they are hospitalized in the last stages of life, he noted.

"I think there is a growing realization that all physicians caring for patients with life-limiting or life-threatening illnesses need to have basic palliative care skills," although specialists can and should be called in for difficult cases, Dr. Curtis said.

Dr. Temel said she had no financial conflicts to disclose. Dr. Curtis has received funding from the National Institutes of Health and the National Institute of Nursing Research. The summit was sponsored in part by the Foundation for the National Institutes of Health and by Pfizer.

BETHESDA, MD. – Palliative care, once limited to the last days before death, is ripe for research and essential to improving patient quality of life, according to speakers at a summit sponsored by the National Institute of Nursing Research and National Institutes of Health partners.

"We have to put the clinician back in the mix," Dr. Ira R. Byock, professor of anesthesiology and director of palliative medicine at Dartmouth Medical School in Hanover, N.H., said in the opening keynote address.

According to several speakers at the meeting, putting the clinician back in the mix may mean changing the thinking about palliative care from something that begins in the last days of life to something started as early as a patient’s first day of a cancer diagnosis, as well as making it easier for clinicians to explore palliative care strategies.

One route to improving palliative care is through rigorous research in both inpatient and outpatient settings to see what works, according to Dr. Jennifer S. Temel, clinical director of thoracic oncology at Massachusetts General Hospital in Boston.

Dr. Temel made the case for the value of palliative care research when she discussed her recent study of early palliative care for patients with advanced lung cancer (N. Engl. J. Med. 2010;363:733-42).

Chemotherapy can improve symptoms, "but the problem is that patients are trading off their cancer symptoms for chemotherapy-related symptoms (fatigue, nausea, neuropathy), so overall physical quality of life is not significantly changed," she said.

In a randomized, controlled trial of 151 adults with metastatic non–small cell lung cancer, patients who received palliative care soon after their diagnoses had significantly less depression and anxiety, compared with controls. Another significant finding: The median survival was longer among patients in the early palliative care group, compared with controls (11.6 months vs. 8.9 months; P = .02).

Patients with advanced illnesses suffer from both physical and psychological symptoms, Dr. Temel said.

Dr. Temel’s findings suggest that early palliative care can be used in conjunction with chemotherapy, and cancer patients could be managed jointly in an oncology and clinic setting. However, more research is needed to support and expand her findings.

To help promote and enhance additional research in the field of palliative care, Dr. Amy P. Abernethy, an oncologist at Duke University Medical Center in Durham, N.C., described the creation of the U.S. Palliative Care Research Cooperative (PCRC) group. Dr. Abernethy is the coprincipal investigator of the PCRC, which was established in 2010 and funded by the National Institute of Nursing Research. The PCRC is currently establishing research protocols and procedures through which palliative care researchers will be able to suggest topics and submit grant applications, said Dr. Abernethy. "We must focus our scope, choose studies carefully, and do them well," she said.

The need to engage patients and caregivers as partners in palliative care research was addressed in many talks, as was the need for better communication among clinicians, patients, and caregivers about palliative care. Dianne Gray, a parent advocate whose young son died of a rare genetic disease, spoke about the importance of communication between doctors and patients facing end-of-life issues and reminded clinicians that families want to work with doctors. But families also want honesty, even if the answer is "I don’t know," she emphasized.

In the summit’s closing keynote address, Dr. J. Randall Curtis, director of the Harborview/University of Washington End-of-Life Care Research Program, Seattle, discussed how changing attitudes toward palliative are getting clinicians back in the mix.

"Palliative care is much more broadly accepted as an important part of health care" in both inpatient and outpatient settings, he said in an interview.

Palliative care applies to all patients who face a life-limiting illness or a chronic illness that may shorten life, whether they are actively dying or only starting to manage an illness or think about end-of-life care, he said.

"Hospital-based physicians in particular have a very important role in providing palliative care," said Dr. Curtis. They have the opportunity to introduce discussions of palliative care when patients are hospitalized for exacerbation of symptoms, or when they are hospitalized in the last stages of life, he noted.

"I think there is a growing realization that all physicians caring for patients with life-limiting or life-threatening illnesses need to have basic palliative care skills," although specialists can and should be called in for difficult cases, Dr. Curtis said.

Dr. Temel said she had no financial conflicts to disclose. Dr. Curtis has received funding from the National Institutes of Health and the National Institute of Nursing Research. The summit was sponsored in part by the Foundation for the National Institutes of Health and by Pfizer.

BETHESDA, MD. – Palliative care, once limited to the last days before death, is ripe for research and essential to improving patient quality of life, according to speakers at a summit sponsored by the National Institute of Nursing Research and National Institutes of Health partners.

"We have to put the clinician back in the mix," Dr. Ira R. Byock, professor of anesthesiology and director of palliative medicine at Dartmouth Medical School in Hanover, N.H., said in the opening keynote address.

According to several speakers at the meeting, putting the clinician back in the mix may mean changing the thinking about palliative care from something that begins in the last days of life to something started as early as a patient’s first day of a cancer diagnosis, as well as making it easier for clinicians to explore palliative care strategies.

One route to improving palliative care is through rigorous research in both inpatient and outpatient settings to see what works, according to Dr. Jennifer S. Temel, clinical director of thoracic oncology at Massachusetts General Hospital in Boston.

Dr. Temel made the case for the value of palliative care research when she discussed her recent study of early palliative care for patients with advanced lung cancer (N. Engl. J. Med. 2010;363:733-42).

Chemotherapy can improve symptoms, "but the problem is that patients are trading off their cancer symptoms for chemotherapy-related symptoms (fatigue, nausea, neuropathy), so overall physical quality of life is not significantly changed," she said.

In a randomized, controlled trial of 151 adults with metastatic non–small cell lung cancer, patients who received palliative care soon after their diagnoses had significantly less depression and anxiety, compared with controls. Another significant finding: The median survival was longer among patients in the early palliative care group, compared with controls (11.6 months vs. 8.9 months; P = .02).

Patients with advanced illnesses suffer from both physical and psychological symptoms, Dr. Temel said.

Dr. Temel’s findings suggest that early palliative care can be used in conjunction with chemotherapy, and cancer patients could be managed jointly in an oncology and clinic setting. However, more research is needed to support and expand her findings.

To help promote and enhance additional research in the field of palliative care, Dr. Amy P. Abernethy, an oncologist at Duke University Medical Center in Durham, N.C., described the creation of the U.S. Palliative Care Research Cooperative (PCRC) group. Dr. Abernethy is the coprincipal investigator of the PCRC, which was established in 2010 and funded by the National Institute of Nursing Research. The PCRC is currently establishing research protocols and procedures through which palliative care researchers will be able to suggest topics and submit grant applications, said Dr. Abernethy. "We must focus our scope, choose studies carefully, and do them well," she said.

The need to engage patients and caregivers as partners in palliative care research was addressed in many talks, as was the need for better communication among clinicians, patients, and caregivers about palliative care. Dianne Gray, a parent advocate whose young son died of a rare genetic disease, spoke about the importance of communication between doctors and patients facing end-of-life issues and reminded clinicians that families want to work with doctors. But families also want honesty, even if the answer is "I don’t know," she emphasized.

In the summit’s closing keynote address, Dr. J. Randall Curtis, director of the Harborview/University of Washington End-of-Life Care Research Program, Seattle, discussed how changing attitudes toward palliative are getting clinicians back in the mix.

"Palliative care is much more broadly accepted as an important part of health care" in both inpatient and outpatient settings, he said in an interview.

Palliative care applies to all patients who face a life-limiting illness or a chronic illness that may shorten life, whether they are actively dying or only starting to manage an illness or think about end-of-life care, he said.

"Hospital-based physicians in particular have a very important role in providing palliative care," said Dr. Curtis. They have the opportunity to introduce discussions of palliative care when patients are hospitalized for exacerbation of symptoms, or when they are hospitalized in the last stages of life, he noted.

"I think there is a growing realization that all physicians caring for patients with life-limiting or life-threatening illnesses need to have basic palliative care skills," although specialists can and should be called in for difficult cases, Dr. Curtis said.

Dr. Temel said she had no financial conflicts to disclose. Dr. Curtis has received funding from the National Institutes of Health and the National Institute of Nursing Research. The summit was sponsored in part by the Foundation for the National Institutes of Health and by Pfizer.

BETHESDA, MD. – Palliative care, once limited to the last days before death, is ripe for research and essential to improving patient quality of life both in and out of the hospital, according to speakers at a summit sponsored by the National Institute of Nursing Research and National Institutes of Health partners.

"We have to put the clinician back in the mix," Dr. Ira R. Byock, professor of anesthesiology and director of palliative medicine at Dartmouth Medical School in Hanover, N.H., said in the opening keynote address.

According to several speakers at the meeting, putting the clinician back in the mix may mean changing the thinking about palliative care from something that begins in the last days of life to something started as early as a patient’s first day of a cancer diagnosis, as well as making it easier for clinicians to explore palliative care strategies.

One route to improving palliative care is through rigorous research in both inpatient and outpatient settings to see what works, according to Dr. Jennifer S. Temel, clinical director of thoracic oncology at Massachusetts General Hospital in Boston.

Dr. Temel made the case for the value of palliative care research when she discussed her recent study of early palliative care for patients with advanced lung cancer (N. Engl. J. Med. 2010;363:733-42).

Chemotherapy can improve symptoms, "but the problem is that patients are trading off their cancer symptoms for chemotherapy-related symptoms (fatigue, nausea, neuropathy), so overall physical quality of life is not significantly changed," she said.

In a randomized, controlled trial of 151 adults with metastatic non–small cell lung cancer, patients who received palliative care soon after their diagnoses had significantly less depression and anxiety, compared with controls. Another significant finding: The median survival was longer among patients in the early palliative care group, compared with controls (11.6 months vs. 8.9 months; P = .02).

Patients with advanced illnesses suffer from both physical and psychological symptoms, Dr. Temel said.

Dr. Temel’s findings suggest that early palliative care can be used in conjunction with chemotherapy, and cancer patients could be managed jointly in an oncology and clinic setting. However, more research is needed to support and expand her findings.

To help promote and enhance additional research in the field of palliative care, Dr. Amy P. Abernethy, an oncologist at Duke University Medical Center in Durham, N.C., described the creation of the U.S. Palliative Care Research Cooperative (PCRC) group. Dr. Abernethy is the coprincipal investigator of the PCRC, which was established in 2010 and funded by the National Institute of Nursing Research. The PCRC is currently establishing research protocols and procedures through which palliative care researchers will be able to suggest topics and submit grant applications, said Dr. Abernethy. "We must focus our scope, choose studies carefully, and do them well," she said.

The need to engage patients and caregivers as partners in palliative care research was addressed in many talks, as was the need for better communication among clinicians, patients, and caregivers about palliative care. Dianne Gray, a parent advocate whose young son died of a rare genetic disease, spoke about the importance of communication between doctors and patients facing end-of-life issues and reminded clinicians that families want to work with doctors. But families also want honesty, even if the answer is "I don’t know," she emphasized.

In the summit’s closing keynote address, Dr. J. Randall Curtis, director of the Harborview/University of Washington End-of-Life Care Research Program, Seattle, discussed how changing attitudes toward palliative are getting clinicians back in the mix.

"Palliative care is much more broadly accepted as an important part of health care" in both inpatient and outpatient settings, he said in an interview.

Palliative care applies to all patients who face a life-limiting illness or a chronic illness that may shorten life, whether they are actively dying or only starting to manage an illness or think about end-of-life care, he said.

"Hospital-based physicians in particular have a very important role in providing palliative care," said Dr. Curtis. They have the opportunity to introduce discussions of palliative care when patients are hospitalized for exacerbation of symptoms, or when they are hospitalized in the last stages of life, he noted.

"I think there is a growing realization that all physicians caring for patients with life-limiting or life-threatening illnesses need to have basic palliative care skills," although specialists can and should be called in for difficult cases, Dr. Curtis said.

Dr. Temel said she had no financial conflicts to disclose. Dr. Curtis has received funding from the National Institutes of Health and the National Institute of Nursing Research. The summit was sponsored in part by the Foundation for the National Institutes of Health and by Pfizer.

BETHESDA, MD. – Palliative care, once limited to the last days before death, is ripe for research and essential to improving patient quality of life both in and out of the hospital, according to speakers at a summit sponsored by the National Institute of Nursing Research and National Institutes of Health partners.

"We have to put the clinician back in the mix," Dr. Ira R. Byock, professor of anesthesiology and director of palliative medicine at Dartmouth Medical School in Hanover, N.H., said in the opening keynote address.

According to several speakers at the meeting, putting the clinician back in the mix may mean changing the thinking about palliative care from something that begins in the last days of life to something started as early as a patient’s first day of a cancer diagnosis, as well as making it easier for clinicians to explore palliative care strategies.

One route to improving palliative care is through rigorous research in both inpatient and outpatient settings to see what works, according to Dr. Jennifer S. Temel, clinical director of thoracic oncology at Massachusetts General Hospital in Boston.

Dr. Temel made the case for the value of palliative care research when she discussed her recent study of early palliative care for patients with advanced lung cancer (N. Engl. J. Med. 2010;363:733-42).

Chemotherapy can improve symptoms, "but the problem is that patients are trading off their cancer symptoms for chemotherapy-related symptoms (fatigue, nausea, neuropathy), so overall physical quality of life is not significantly changed," she said.

In a randomized, controlled trial of 151 adults with metastatic non–small cell lung cancer, patients who received palliative care soon after their diagnoses had significantly less depression and anxiety, compared with controls. Another significant finding: The median survival was longer among patients in the early palliative care group, compared with controls (11.6 months vs. 8.9 months; P = .02).

Patients with advanced illnesses suffer from both physical and psychological symptoms, Dr. Temel said.

Dr. Temel’s findings suggest that early palliative care can be used in conjunction with chemotherapy, and cancer patients could be managed jointly in an oncology and clinic setting. However, more research is needed to support and expand her findings.

To help promote and enhance additional research in the field of palliative care, Dr. Amy P. Abernethy, an oncologist at Duke University Medical Center in Durham, N.C., described the creation of the U.S. Palliative Care Research Cooperative (PCRC) group. Dr. Abernethy is the coprincipal investigator of the PCRC, which was established in 2010 and funded by the National Institute of Nursing Research. The PCRC is currently establishing research protocols and procedures through which palliative care researchers will be able to suggest topics and submit grant applications, said Dr. Abernethy. "We must focus our scope, choose studies carefully, and do them well," she said.

The need to engage patients and caregivers as partners in palliative care research was addressed in many talks, as was the need for better communication among clinicians, patients, and caregivers about palliative care. Dianne Gray, a parent advocate whose young son died of a rare genetic disease, spoke about the importance of communication between doctors and patients facing end-of-life issues and reminded clinicians that families want to work with doctors. But families also want honesty, even if the answer is "I don’t know," she emphasized.

In the summit’s closing keynote address, Dr. J. Randall Curtis, director of the Harborview/University of Washington End-of-Life Care Research Program, Seattle, discussed how changing attitudes toward palliative are getting clinicians back in the mix.

"Palliative care is much more broadly accepted as an important part of health care" in both inpatient and outpatient settings, he said in an interview.

Palliative care applies to all patients who face a life-limiting illness or a chronic illness that may shorten life, whether they are actively dying or only starting to manage an illness or think about end-of-life care, he said.

"Hospital-based physicians in particular have a very important role in providing palliative care," said Dr. Curtis. They have the opportunity to introduce discussions of palliative care when patients are hospitalized for exacerbation of symptoms, or when they are hospitalized in the last stages of life, he noted.

"I think there is a growing realization that all physicians caring for patients with life-limiting or life-threatening illnesses need to have basic palliative care skills," although specialists can and should be called in for difficult cases, Dr. Curtis said.

Dr. Temel said she had no financial conflicts to disclose. Dr. Curtis has received funding from the National Institutes of Health and the National Institute of Nursing Research. The summit was sponsored in part by the Foundation for the National Institutes of Health and by Pfizer.

BETHESDA, MD. – Palliative care, once limited to the last days before death, is ripe for research and essential to improving patient quality of life both in and out of the hospital, according to speakers at a summit sponsored by the National Institute of Nursing Research and National Institutes of Health partners.

"We have to put the clinician back in the mix," Dr. Ira R. Byock, professor of anesthesiology and director of palliative medicine at Dartmouth Medical School in Hanover, N.H., said in the opening keynote address.

According to several speakers at the meeting, putting the clinician back in the mix may mean changing the thinking about palliative care from something that begins in the last days of life to something started as early as a patient’s first day of a cancer diagnosis, as well as making it easier for clinicians to explore palliative care strategies.

One route to improving palliative care is through rigorous research in both inpatient and outpatient settings to see what works, according to Dr. Jennifer S. Temel, clinical director of thoracic oncology at Massachusetts General Hospital in Boston.

Dr. Temel made the case for the value of palliative care research when she discussed her recent study of early palliative care for patients with advanced lung cancer (N. Engl. J. Med. 2010;363:733-42).

Chemotherapy can improve symptoms, "but the problem is that patients are trading off their cancer symptoms for chemotherapy-related symptoms (fatigue, nausea, neuropathy), so overall physical quality of life is not significantly changed," she said.

In a randomized, controlled trial of 151 adults with metastatic non–small cell lung cancer, patients who received palliative care soon after their diagnoses had significantly less depression and anxiety, compared with controls. Another significant finding: The median survival was longer among patients in the early palliative care group, compared with controls (11.6 months vs. 8.9 months; P = .02).

Patients with advanced illnesses suffer from both physical and psychological symptoms, Dr. Temel said.

Dr. Temel’s findings suggest that early palliative care can be used in conjunction with chemotherapy, and cancer patients could be managed jointly in an oncology and clinic setting. However, more research is needed to support and expand her findings.

To help promote and enhance additional research in the field of palliative care, Dr. Amy P. Abernethy, an oncologist at Duke University Medical Center in Durham, N.C., described the creation of the U.S. Palliative Care Research Cooperative (PCRC) group. Dr. Abernethy is the coprincipal investigator of the PCRC, which was established in 2010 and funded by the National Institute of Nursing Research. The PCRC is currently establishing research protocols and procedures through which palliative care researchers will be able to suggest topics and submit grant applications, said Dr. Abernethy. "We must focus our scope, choose studies carefully, and do them well," she said.

The need to engage patients and caregivers as partners in palliative care research was addressed in many talks, as was the need for better communication among clinicians, patients, and caregivers about palliative care. Dianne Gray, a parent advocate whose young son died of a rare genetic disease, spoke about the importance of communication between doctors and patients facing end-of-life issues and reminded clinicians that families want to work with doctors. But families also want honesty, even if the answer is "I don’t know," she emphasized.

In the summit’s closing keynote address, Dr. J. Randall Curtis, director of the Harborview/University of Washington End-of-Life Care Research Program, Seattle, discussed how changing attitudes toward palliative are getting clinicians back in the mix.

"Palliative care is much more broadly accepted as an important part of health care" in both inpatient and outpatient settings, he said in an interview.

Palliative care applies to all patients who face a life-limiting illness or a chronic illness that may shorten life, whether they are actively dying or only starting to manage an illness or think about end-of-life care, he said.

"Hospital-based physicians in particular have a very important role in providing palliative care," said Dr. Curtis. They have the opportunity to introduce discussions of palliative care when patients are hospitalized for exacerbation of symptoms, or when they are hospitalized in the last stages of life, he noted.

"I think there is a growing realization that all physicians caring for patients with life-limiting or life-threatening illnesses need to have basic palliative care skills," although specialists can and should be called in for difficult cases, Dr. Curtis said.

Dr. Temel said she had no financial conflicts to disclose. Dr. Curtis has received funding from the National Institutes of Health and the National Institute of Nursing Research. The summit was sponsored in part by the Foundation for the National Institutes of Health and by Pfizer.

The number of hospital palliative care teams has soared over the past decade, including a 138% increase at institutions with more than 50 beds, according to the Center to Advance Palliative Care (CAPC).

The center looked at data from the American Hospital Association’s Annual Survey and the National Palliative Care Registry from 2000 to 2009. Of the 2,489 hospitals studied, 1,568 (63%) reported having a palliative care team.

Uptake was greater at large hospitals. Among the 699 hospitals with more then 300 beds, 85% had teams, compared with 54% for those with 50-299 beds.

Among the 1,500 hospitals with fewer than 50 beds, only 22% reported having a team, but these smaller institutions were excluded from further analysis.

The rate was lowest in the South, with only 51% of hospitals reporting a team, compared with 73% in the Northeast. In addition, 72% of hospitals in the Midwest, and 68% of hospitals in the West said they had a team.

Palliative care has been a topic of controversy since the implementation of the Affordable Care Act, which contains a provision in Medicare that would reimburse doctors for counseling elderly patients on end-of-life issues and palliative care. Opponents to the provision argued that it would encourage doctors to withhold care from elderly patients.

At a policy summit in March, health experts voiced support for increasing palliative care, arguing that it improved the quality of life for elderly patients.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said Dr. Allen S. Lichter, a panelist at the summit. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, chief executive officer of the American Society of Clinical Oncology,* added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope for a cure."

"Palliative care teams are transforming the care of serious illness in this country because they address the fragmentation of the health care system and put control and choice back in the hands of the patient and family," said CAPC director Dr. Diane E. Meier in a statement. "Hospitals today recognize that palliative care is the key to delivering better quality, coordinated care to our sickest and most vulnerable patients."

Regardless of the controversy among the experts, a CAPC poll showed that 70% of Americans don’t know what palliative care is. The center conducted the poll through a combination of one-on-one interviews with caregivers, Internet focus groups, and a telephone survey of 800 adults aged 25 years and older. Currently, 90 million Americans are living with chronic conditions and that number will only increase as the baby boomers age, CAPC said.

*Correction, 8/18/2011: An earlier version of this story incorrectly identified Dr. Lichter's affiliation.

The number of hospital palliative care teams has soared over the past decade, including a 138% increase at institutions with more than 50 beds, according to the Center to Advance Palliative Care (CAPC).

The center looked at data from the American Hospital Association’s Annual Survey and the National Palliative Care Registry from 2000 to 2009. Of the 2,489 hospitals studied, 1,568 (63%) reported having a palliative care team.

Uptake was greater at large hospitals. Among the 699 hospitals with more then 300 beds, 85% had teams, compared with 54% for those with 50-299 beds.

Among the 1,500 hospitals with fewer than 50 beds, only 22% reported having a team, but these smaller institutions were excluded from further analysis.

The rate was lowest in the South, with only 51% of hospitals reporting a team, compared with 73% in the Northeast. In addition, 72% of hospitals in the Midwest, and 68% of hospitals in the West said they had a team.

Palliative care has been a topic of controversy since the implementation of the Affordable Care Act, which contains a provision in Medicare that would reimburse doctors for counseling elderly patients on end-of-life issues and palliative care. Opponents to the provision argued that it would encourage doctors to withhold care from elderly patients.

At a policy summit in March, health experts voiced support for increasing palliative care, arguing that it improved the quality of life for elderly patients.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said Dr. Allen S. Lichter, a panelist at the summit. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, chief executive officer of the American Society of Clinical Oncology,* added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope for a cure."

"Palliative care teams are transforming the care of serious illness in this country because they address the fragmentation of the health care system and put control and choice back in the hands of the patient and family," said CAPC director Dr. Diane E. Meier in a statement. "Hospitals today recognize that palliative care is the key to delivering better quality, coordinated care to our sickest and most vulnerable patients."

Regardless of the controversy among the experts, a CAPC poll showed that 70% of Americans don’t know what palliative care is. The center conducted the poll through a combination of one-on-one interviews with caregivers, Internet focus groups, and a telephone survey of 800 adults aged 25 years and older. Currently, 90 million Americans are living with chronic conditions and that number will only increase as the baby boomers age, CAPC said.

*Correction, 8/18/2011: An earlier version of this story incorrectly identified Dr. Lichter's affiliation.

The number of hospital palliative care teams has soared over the past decade, including a 138% increase at institutions with more than 50 beds, according to the Center to Advance Palliative Care (CAPC).

The center looked at data from the American Hospital Association’s Annual Survey and the National Palliative Care Registry from 2000 to 2009. Of the 2,489 hospitals studied, 1,568 (63%) reported having a palliative care team.

Uptake was greater at large hospitals. Among the 699 hospitals with more then 300 beds, 85% had teams, compared with 54% for those with 50-299 beds.

Among the 1,500 hospitals with fewer than 50 beds, only 22% reported having a team, but these smaller institutions were excluded from further analysis.

The rate was lowest in the South, with only 51% of hospitals reporting a team, compared with 73% in the Northeast. In addition, 72% of hospitals in the Midwest, and 68% of hospitals in the West said they had a team.

Palliative care has been a topic of controversy since the implementation of the Affordable Care Act, which contains a provision in Medicare that would reimburse doctors for counseling elderly patients on end-of-life issues and palliative care. Opponents to the provision argued that it would encourage doctors to withhold care from elderly patients.

At a policy summit in March, health experts voiced support for increasing palliative care, arguing that it improved the quality of life for elderly patients.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said Dr. Allen S. Lichter, a panelist at the summit. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, chief executive officer of the American Society of Clinical Oncology,* added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope for a cure."

"Palliative care teams are transforming the care of serious illness in this country because they address the fragmentation of the health care system and put control and choice back in the hands of the patient and family," said CAPC director Dr. Diane E. Meier in a statement. "Hospitals today recognize that palliative care is the key to delivering better quality, coordinated care to our sickest and most vulnerable patients."

Regardless of the controversy among the experts, a CAPC poll showed that 70% of Americans don’t know what palliative care is. The center conducted the poll through a combination of one-on-one interviews with caregivers, Internet focus groups, and a telephone survey of 800 adults aged 25 years and older. Currently, 90 million Americans are living with chronic conditions and that number will only increase as the baby boomers age, CAPC said.

*Correction, 8/18/2011: An earlier version of this story incorrectly identified Dr. Lichter's affiliation.