Congress Abstracts 2005

46

TRENDS IN THE USE OF PALLIATIVE CHEMOTHERAPY IN HOSPICE. Terri Maxwell, MSN, APRN, BC-PCM, and Linda Hoplamazian, MHA, BSN, RN, excelleRx, Inc., Philadelphia, PA; and JoAnne Reifsnyder, PhD, APRN, BC-PCM, Ethos Consulting, Haddon Heights, NJ.

Chemotherapy may be used to control symptoms that are directly or indirectly due to malignancy. Palliative chemotherapy can provide symptom relief by local tumor reduction and improve quality of life by improving pain, appetite, or performance status not associated with an obvious reduction in tumor burden. Palliative chemotherapy is generally given on the basis of “clinical benefit” rather than survival prolongation. Increasingly, chemotherapy agents are FDA-approved or marketed on this basis alone. Patients who opt to forego life prolonging treatment and have a limited life expectancy are eligible for hospice. Since palliative chemotherapy may be provided for symptom control rather than life prolongation, more and more hospices are increasing access for patients receiving such palliative treatments.

To describe trends in palliative chemotherapy and to discuss emerging norms for chemotherapy use in hospice settings. Survey findings describing hospice admission practices for patients receiving or requesting palliative chemotherapy are presented.

Interventions included literature review of trends and practices in palliative chemotherapy for advanced cancer. Seventy-nine of 395 hospices responded to a survey to evaluate chemotherapy and related treatment access in hospice. Items assessed: (1) whether and how frequently hospices admit patients receiving interventions such as palliative chemotherapy, immunologic , and hematopoetic agents; (2) hospice administrator’s perceptions regarding advantages/disadvantages of admitting patients receiving these therapes; (3) perceived barriers to providing chemotherapy in hospice, and (4) hospice future plans if they indicated no current use of chemotherapy. Survey responses were analyzed using summary of descriptive data and tabulation of correlation matrices.

Findings illuminate current practice regarding administration of chemotherapy and related therapies in hospice care settings. Prevalence of chemotherapy administration, hospice administrators’ attitudes, and characteristics of hospices providing these therapies will be presented. Recommendations for future research and program development will be discussed.

Debate continues concerning the definition of palliative care and the suitability of certain therapies for patients approaching the end of life. As both cancer and palliative care have evolved, so has the definition of “palliative chemotherapy.” A growing number of hospices are classifying some chemotherapy and related treatments as palliative in certain circumstances.