Life Matters Media
Start the most difficult conversation American isn’t having- the conversation about our end of life preferences

Clinical Cancer Advances 2013: Annual Report On Progress Against Cancer From The American Society Of Clinical Oncology

Mary F. Mulcahy, M.D.

Jyoti D. Patel, Lada Krilov, Sylvia Adams, Carol Aghajanian, Ethan Basch, Marcia S. Brose, William L. Carroll, Marcos de Lima, Mark R. Gilbert, Mark G. Kris, John L. Marshall, Gregory A. Masters, Steven J. O’Day, Blasé Polite, Gary K. Schwartz, Sunil Sharma, Ian Thompson, Nicholas J. Vogelzang and Bruce J. Roth

Journal of Clinical Oncology, December 2013

The American Society of Clinical Oncology (ASCO) has been dedicated to improving cancer outcomes and the delivery of quality care since its founding in 1964. ASCO’s 2013 report on progress against cancer features 76 exciting advances in our understanding of the disease, therapy and quality care. Advances in cancer care have led to an overall decrease in cancer-related deaths in the United States by 1.5% per year from 2000 through 2009. Despite this, cancer remains the second most common cause of death with an estimated 580,000 Americans losing their lives to cancer in 2013.

Ensuring consistent delivery of high-quality cancer care includes understanding not only the biology of cancer, but also the values and priorities of the patient. Two studies endorsed in the report highlight the importance of shared decision making and effective communication.

In this era of greater measurement and accountability in health care, oncologists that communicate honestly with their patients may be at risk for lower patient ratings.

Hospice services are underused by Medicaid patients. A study comparing rates of hospice use in California and New York for patients with advanced lung cancer enrolled in Medicare versus Medicaid found substantially lower use of hospice in Medicaid programs. Hospice use in Medicare patients ages 65 and over was 53 percent in California and 44 percent in New York. The use of hospice services for Medicaid patients ages 21 through 64 was significantly lower, 32 percent in California and 24 percent in New York. Most Medicaid patient deaths occurred in acute-care facilities or at home without hospice.

Reasons are proposed to account for the differences between Medicare and Medicaid enrollment in hospice services. Age has been shown as a determinant for end of life care preferences, but it does not fully explain the differences. Socioeconomic conditions may lead to less hospice services in neighborhoods where Medicaid recipients reside. Medicaid enrollees may lack able-bodied caregivers in the home, which is a prerequisite for many home hospice programs. Medicaid enrollees are more likely to receive care in clinics with high turnover of physicians or physicians-in-training, a circumstance that can lead to suboptimal patient-physician relationships and deficient advance care planning.

This important study identifies the need to develop infrastructure that offers hospice services to patients in both Medicare and Medicaid programs. ASCO endorses candid discussion of the full range of care options soon after the diagnosis of advanced cancer to ensure that patients choices are honored. A guide for patients with advanced cancer is offered by ASCO at

Patients often do not understand the goals of cancer treatment. A national study involving more than one thousand patients found that approximately 70 percent of those with lung cancer and 80 percent of those with colorectal cancer did not understand that they had incurable disease. Nonwhite and Hispanic patients were nearly three times more likely to express inaccurate goals of therapy as compared to non-Hispanic white patients. Patients who received their care in an integrated network (Veterans Affairs, health maintenance organization sites and those in Kaiser Permanente) were more likely to report accurate information about their goals of therapy.

Using a five-item questionnaire, patients rated physician communication.  Those patients that rated high scores for physician communication where more likely to have inaccurate responses in the goal of chemotherapy. This suggests that patients perceive physicians as better communicators when they convey a more optimistic view of chemotherapy.

In this era of greater measurement and accountability in health care, oncologists that communicate honestly with their patients may be at risk for lower patient ratings.

These important studies of 2013 highlight the increased awareness of effective communication in providing quality care. There is a need for targeted education to help all physicians learn to communicate honestly while also maintaining patients’ trust.

Read the full report here