Men dying of PCa referred too late for hospice care

A majority of men dying from prostate cancer wait too long to enroll in hospice care and cannot take full advantage of the palliative care that could make their deaths easier, researchers from UCLA’s Jonsson Comprehensive Cancer Center recently reported.

The researchers also found that men with spouses or partners were more likely to take advantage of hospice care and that African-American men were 20% less likely to enroll than others.

For hospice care to be most effective, patients should be enrolled for several weeks prior to their deaths. However, the study found most men enrolled just 1 to 2 weeks before they died, said senior author Mark Litwin, MD.

"It’s important that we maximize quality of life when quantity of life cannot be changed," Dr. Litwin said. "Most men are being referred to hospice too late, and that timing hasn’t changed in the last 20 years, which is unfortunate. As cancer specialists, we should offer these patients the best quality of life that we can, and that often means offering them the best quality of death that we can give them."

The primary reason for the delay in referrals to hospice is that oncologists often are reluctant to stop trying to save patients, and they have difficulty predicting how long patients have left to live, researchers say. In addition, medical students are not taught that preservation of life may not be the sole goal in caring for patients.

"The optimization of life should be our goal," Dr. Litwin said. "We’ve sworn to help our patients, and a death is a failure to us. Sometimes survival is of such poor quality that it should not be our primary goal."

Programs have been launched at UCLA to address the importance of quality of life and palliative care, Dr. Litwin said. However, it can take time to make a significant change in the institutional mentality.

Results from the study were published online in Archives of Internal Medicine (Oct. 11, 2010).