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From the JAMA Network
July 2016

Family Perspectives on Aggressive Cancer Care Near the End of Life

Author Affiliations
  • 1Division of Gerontology and Geriatric Medicine, Department of Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle
  • 2Cambia Palliative Care Center of Excellence at UW Medicine, A. Bruce Montgomery– American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle
JAMA Oncol. 2016;2(7):957-958. doi:10.1001/jamaoncol.2016.0441

The costs of cancer care are expected to grow from $72 billion in 2004 to $173 billion by 2020.1 Unfortunately, the fee-for-service Medicare reimbursement model provides financial incentives for administering chemotherapy even in the last weeks of life, another day in the intensive care unit (ICU), and recurrent hospitalizations and disincentivizes having conversations that educate patients diagnosed as having cancer and their families about their prognosis and treatment options and developing a care plan consistent with patients’ informed goals of care. These incentives are important, but do not wholly determine the quality of care that patients receive. However, a 2013 Institute of Medicine Report2 concluded that our cancer care system is in crisis, stating that “cancer care is often not as patient-centered, accessible, coordinated, or evidence-based as it could be.”

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