Recent research has found that receiving high-acuity services alongside supportive care can help ease pain. The findings come as regulators navigate the future outlook of these services in end-of-life care delivery.
More than two-thirds (67%) of liver cancer patients receiving radiotherapy concurrently with supportive/palliative care reported reduced pain intensity levels after one month of treatment in a study published in The Lancet Oncology, a Science Direct journal. This compared to 22% of patients who received supportive care without radiation.
The findings suggest that greater access to high-acuity services in combination with palliative care could lead to improved outcomes, according to researchers.
“Single-fraction radiotherapy plus best supportive care improved pain compared with best supportive care alone in patients with liver cancer and could be considered a standard palliative treatment,” researchers stated in the study.
The clinical trial examined outcomes among 66 patients receiving care at nine cancer centers across Canada between July 25, 2015 and June 2, 2022. Patients included individuals with liver cancer suffering with high levels of pain and discomfort who did not respond to treatment.
Patients’ pain levels were assessed using the Brief Pain Inventory (BPI) index. A primary finding was that patients reported improvement in pain and discomfort by at least 2 points on the BPI intensity index after receiving both radiotherapy and supportive care. Patients most commonly reported symptom relief of abdominal pain.
A main driver of the research was to determine the potential efficacy of alternative care routes alongside traditional treatments.
“Palliative treatment options for painful hepatic cancer can be restricted due to patients eventually becoming refractory to standard treatment,” researchers said.
The data come at a time when regulators are mulling over the future outlook of high-acuity services in end-of-life care.
The U.S. Centers for Medicare & Medicaid Services (CMS) in its proposed 2025 hospice rule featured a series of request for information (RFIs) that included questions about the utilization of higher-cost palliative treatments within the Medicare Hospice Benefit. The agency is seeking greater clarity on the financial risks and costs that providers have indicated as barriers to offering services such as palliative chemotherapy, radiation blood transfusions or dialysis, among others.
Legislators have also increasingly recognized a need to open up reimbursement pathways for high-acuity palliative care services as demand and costs swell. The Hospice Care Accountability, Reform and Enforcement (Hospice CARE) Act, announced in June at the Hospice News Elevate conference, includes proposed ways for hospice providers to have clearer definitions and improved payment avenues for services such as radiation therapy and palliation.
Currently in a discussion draft phase, the bill also proposes to boost reimbursement for other high-acuity services such as dialysis and blood transfusions, among others.
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