Physicians and patients are entering a new era where complex medical decisions and health care costs are multiplying. One area where these challenges become extremely complicated is near the end of life. Recently, the physicians at Southeast Nebraska Cancer Center (SNCC), led by Dr. Mark Joseph Stavas, started one of the first oncology-focused outpatient palliative care clinics in Nebraska.
“Our primary goal as physicians is to improve the health, wellness and independence of our patients," says Dr. Stavas. "Patients are now coming in with much bigger questions focusing on their hopes and fears, quality of life and treatment affordability.”
Palliative care is often considered a comfort and support specialty for people with advanced or complicated illness. It is commonly described as an interdisciplinary approach that provides an extra layer of support to help both families and patients handle the pain, symptoms and stress of serious illness. The goal of palliative care is to encourage individuals to live as well as they can with their disease. Most importantly, it is provided in parallel with disease-modifying and curative treatments such as chemotherapy or radiation.
In 2010, The New England Journal of Medicine published a study evaluating the integration of palliative care for patients with incurable lung cancer. It showed that early integration of palliative care led to improvements in both quality of life and overall survival despite less aggressive care at the end of life.
“This study put palliative care on the map by showing that patients experienced less suffering, spent more time at home instead of the hospital and lived 25% longer,” says Dr. Stavas.
Both Dr. Stavas and Amanda Bauer, APRN, spend the majority of their time in the SNCC Palliative Care clinic asking questions like these:
• What matters to you most now?
• How much are you willing to go through for the possibility of more time?
• Where do you find strength in moments of need?
• What is the minimum quality of life you find acceptable?
“We’ve found by aligning one’s goals and preferences with their treatment plan, the trajectory of our patients is changing,” says Justin Rousek, PhD, SNCC executive director. He notes the preliminary data show a significant reduction in hospital admissions and aggressive treatment near the end of life.
To take things one step further, Dr. Stavas has developed a unique digital palliative care platform that explores the intersection of art and medicine near the end of life (www.pallidocs.com).
“Thinking about what matters most in your life and sharing your hopes and fears will give you more control over the care you receive in the future," says Dr. Staves. "Plus, it will help your loved ones make decisions for you if you can’t make them at some point down the road.”
Moving forward, the hope is to expand the palliative care service line to include spiritual and psychosocial support, and better care coordination between patients transitioning into and out of the hospital.
“We have a lot of work ahead of us, and Nebraska’s aging rural population provides a unique set of challenges,” remarked Dr. Stavas.
SNCC provides comprehensive cancer care at two locations in Lincoln and 12 communities in southeast Nebraska. It is composed of seven medical oncologists and two radiation oncologists along with multiple supportive care service lines. For more information, visit LeadingCancerCare.com.