Quality of death… No, that is not a misprint. It is actually the main premise of a recent report released by the Economist Intelligence Unit (EIU) which exposed the global disparities in the availability of palliative care relative to the estimated need.
While a key objective of shedding light on the value of palliative care particularly given the aging of society was met, the use of the term “death” indeed misrepresents the main intention of these types of services. In fact, it is quite common for many stakeholders within the medical industry including clinicians, patients and therapy manufacturers to equate palliative care with end-of-life care or hospice.
Rather, palliative care is a valuable complement to an actual treatment which ideally takes place throughout the course of disease management. According to the World Health Organization (WHO), palliative care is:
“An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems physical, psychosocial and spiritual.”
In the context of palliative care “life threatening” should not mean imminent death, but refers to a condition that can ultimately result in a person’s demise. According to a 2013 report titled, Essential Medicines in Palliative Care, these interventions should:
- Provides relief from pain and other distressing symptoms;
- Intends neither to hasten or postpone death;
- Will enhance quality of life, and may also positively influence the course of illness;
- Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications
These points drive to the fact that end of life care or preparing for death are only a small fraction of palliative care. As echoed by Diane Meier, MD a primary-care geriatrician and director of the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York City, “The vast majority of patients who need palliative care are not dying”. She supports that all patients regardless of their ability to recover from serious illness should be receiving palliative care measures.
While not characterized as such, the therapeutics industry has been long engaging in
palliative care. These measures are designed to treat the often debilitating symptoms associated with an illness or its treatment such as pain, anxiety, depression, cachexia, nausea/vomiting, constipation, and dyspnea.
Among non-drug interventions, pharmaceutical management is an essential part of alleviating them and the industry is marketing and developing a multitude of therapies for this purpose. Despite all of the efforts in this area, companies fail to tout their palliative care portfolios.
The reason is likely due to points made earlier; the perception that palliative care equates to preparing an individual for death. As an industry, we revel in the thrill of the “cure”, “control” and “putting disease into remission”. There is likely poor awareness of the benefits of palliative care beyond relief of individual suffering even though a significant amount of evidence supports that palliative care in addition to conventional medical care results in improved quality of life, higher satisfaction with medical care, lower rates of readmission/emergency department visits, and even greater survival in certain diseases (cancer).
Is there benefit for the industry to formalize our role in palliative care?
Absolutely – though significant analysis is critical to determine how this should be defined. It can be as simple as pulling disparate agents into a single portfolio or creating a subset of within a given disease state portfolio to provide a coordinated method for “care and cure”. Products may be incorporated with other non-pharmaceutical methods and even certain types of training to offer a whole palliative care “service”.
Regardless of the nomenclature used by the EIU to discuss palliative care, the report is still
worth a read. It reinforces that the need for palliative care is growing. The aging of our society brings with it the increases in diseases such as cancer, arthritis, dementia and chronic obstructive pulmonary disease which will expand the need for primary care.
This is a ripe opportunity for the therapeutics industry to take hold of. The therapies are already being marketed and the relationships with stakeholders are in place. Through sharing of information and coordination, the therapeutics industry can take advantage of this significant opportunity – to move the focus away from quality of death with disease to living in comfort with disease.
Melissa Hammond, MSN, GNP is Managing Director at Snowfish at commercial insights firm. She is an expert in aging and aging issues as it relates to therapy development and commercialization. Please go to www.snowfish.net or call +703-759-6100 to learn more about our services.