VITAS Advantage: Case Study on Complex Modalities for Physicians

Supportive Palliative Radiation, a VITAS Care Option, Wanes Among Many Hospice Providers

Even though the number of freestanding hospice programs grew by more than 500 between 2011-2018, far fewer programs offered palliative radiation to end-of-life patients with advanced cancer during the same 7-year period. 

This reduction in supportive palliative care stands in contrast to evidence and current clinical hospice practices, including VITAS data, showing that patient-centered radiotherapy in particular can provide comfort and enhanced quality of life for patients who are receiving hospice care for advanced cancer

While hospice programs grew numerically to 2,948 ($15 billion total expenses) from 2,404 ($1.2 billion total expenses) between 2011-2018, their radiotherapy expenses dropped by 75% ( $6.3 million to $1.3 million), according to Pennsylvania and Connecticut researchers. The raw number of hospice programs offering palliative radiotherapy dropped by nearly half, from 307 to 159.

The researchers’ 2020 findings in JAMA Oncology linked the drop in aggressive palliative modalities to 2016 hospice reimbursement changes by the Centers for Medicare and Medicaid Services (CMS) for palliative interventions.

According to study coauthor Shi-Yi Wang, MD, of Yale Cancer Center, quoted in Medscape (May 16, 2020), “the results suggest that many hospice patients may be missing out on palliative radiotherapy that might make their final days more comfortable… Palliative radiotherapy can reduce pain and symptoms, such as radiotherapy for bone metastasis, and the side effects of radiotherapy are minor. Symptom relief can improve quality of life for these patients.

Likewise, a 2017 study in the Journal of Palliative Medicine proposes that “hospice services provide better monitoring, palliative treatment, and increased social support, factors which have individually been associated with improved survival.”

Complex Modalities: The VITAS Advantage

VITAS offers many complex modalities and comfort-focused treatments that other hospice providers do not. Palliative radiation is among numerous modalities to manage symptoms, address pain, provide comfort, and enhance hospice patients’ quality of life. An independent analysis, in fact, shows that palliative procedures by VITAS have increased.*

Supported by clinical expertise, 24/7 availability, and the VITAS open formulary, additional VITAS-provided modalities include:

  • Intravenous therapies for pain management, hydration, antibiotics, etc.
  • Paracentesis and thoracentesis
  • Chest tube/PleurX
  • High-flow oxygen therapy
  • Palliative blood transfusions
  • BiPAP, CPAP, and Trilogy non-invasive ventilation
  • PEG-tube care and tube feedings

*Internal VITAS data on file

Sources:

Hsu, H., and Wang, S. (2020). Trends in provision of palliative radiotherapy and chemotherapy among hospices in the United States, 2011-2018. JAMA Oncology (Research Letter), 6(7):1106-1108.

Duggan, K & Hildebrand Duffus, S. (2017). The impact of hospice services in the care of patients with advanced stage nonsmall cell lung cancer. Journal of Palliative Medicine, 20(1):29-34.

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