Many physical and psychological symptoms were untreated prior to patients with chronic obstructive pulmonary disease (COPD) being seen in the outpatient palliative medicine clinic, according to a recent survey.1 “One reason that many patients are referred to palliative medicine too late is that many patients and their physicians are not aware of the benefits of palliative medicine,” says J. Randall Curtis, MD, MPH, director of University of Washington’s Cambia Palliative Care Center of Excellence and section head of Pulmonary and Critical Care Medicine at Harborview Medical Center, both in Seattle.

In another study, researchers found that 9.1% of 1,455 COPD patients had palliative care needs. The presence of metastases was the highest risk factor for developing palliative care needs.2 The following are some reasons why COPD patients aren’t referred early enough to palliative care:

Many patients and physicians incorrectly assume that palliative care is synonymous with hospice or end-of-life care.

“They don’t realize that palliative care has a lot to offer patients with serious illness, even if they are still interested in pursuing curative or life-prolonging treatment,” says Curtis.

Although palliative care availability is increasing, there are still hospitals and areas of the country that do not have good access to palliative medicine specialists.

“Most hospitals now have inpatient palliative care consultation teams, but outpatient palliative care programs are just developing now in many parts of the country,” says Curtis.

Physicians don’t always recognize the large burden of diverse symptoms that patients with COPD have.

“Patients experience not just shortness of breath, but also pain, depression, anxiety, and many other symptoms,” says Curtis.

It is more difficult to predict prognosis in COPD than in cancer.

“Therefore, when physicians mistakenly tie their referrals to palliative care to a patient’s prognosis, this can mean that patients with COPD don’t get referred,” says Curtis.

The evidence of the benefits for palliative care for patients with COPD is more recent than for patients with cancer.

Thus, some patients and physicians are unaware of these benefits. “We need to increase awareness of the value of palliative care for patients with chronic lung diseases like COPD, as well as pulmonary fibrosis, pulmonary arterial hypertension, cystic fibrosis, and other lung diseases,” says Curtis.

References

  1. Schroedl C, Yount S, Szmuilowicz E, et al. Outpatient palliative care for chronic obstructive pulmonary disease: A case series. Journal of Palliative Medicine 2014; 17(11):1256-1261.
  2. Meffert C, Hatami I, Xander C, et al. Palliative care needs in COPD patients with or without cancer: an epidemiological study. European Respiratory Journal. Published online before print: May 28, 2015, doi:10.1183/09031936.00208614ERJ May 28, 2015 ERJ-02086-2014.

SOURCE

  • J. Randall Curtis, MD, MPH, Director, Cambia Palliative Care Center of Excellence, University of Washington/Section Head, Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle. Phone: (206) 744-3356. Fax: (206) 744-8584. Email: jrc@u.washington.edu.