We just posted on some of the measures within the House and Senate bills that may help lead us to improved care for people at the end of life. Here, Dr. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., returns as a guest poster to tell us what it all means for his patients -- and the doctors who treat them. Byock, the author of Dying Well, has written for us before about the need to think more broadly about what kind of changes we need in our health care system -- and our communities -- to do a better job of caring for sick and frail people trying to get by in their homes.
We get really tired of hearing foes of health reform go on and on about waiting lists in Canada and how it's rationing... And how nobody in the United States lacks care because they can always go to the emergency room. We know that yes, people in other wealthy industrialized countries sometimes wait for elective procedures, but here in the United States people -- particularly the poor and the underserved or the uninsured -- do plenty of waiting and postponing even when lives are at stake. (And how many people do you know who get cancer diagnosis, surgery, chemo, radiation and follow up care in their local ER?)
The American Cancer Society has made the point during the health care debate that uninsured and underinsured people get diagnosed later and die sooner. A new study in the Journal of Thoracic Oncology (which we read about on Health News Daily) found that the length of time a newly diagnosed lung cancer patient has to wait for treatment depends in part on whether they are treated at a public (safety net) or private hospital, whether they are insured, their age, and their race.
As U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius emphasizes, "One in eight women will have breast cancer at some point in their life but fewer women are dying from it because of medical advances in detection and treatment." But we still have many problems to address -- including the out of pocket costs of cancer care, and the difficulties cancer patients have in getting ongoing insurance coverage with a dreaded "pre-existing condition." Health reform can help, a fact underscored by all those pink outfits and accessories last Friday at an American Cancer Society Cancer Action Network White House Breast Cancer Awareness event .
Breast cancer is the second leading cause of death for women with cancer, but many women don't get regular exams. The Department of Health and Human Services reports that in 2005, 67 percent of women aged 40 and older had a mammogram within the past 2 years -- a fall in screening since 2003. There are complex reasons for that -- but insurance and cost is part of the picture.
The National Cancer Institute (NCI) just released an updated booklet, Understanding Breast Changes: A Health Guide for Women that encourages women to:
We get so caught up following the health reform goings-on in Washington that we sometimes forget how desperately important it is to real people -- like cancer patients. Health reform will only be as good as its ability to improve the health and welfare of all Americans -- including those who are sick or who have been sick.
For me this is a season of hope -- new hope for a justice and fair prosperity for the many, and not just for the few -- new hope.
And this is the cause of my life -- new hope that we will break the old gridlock and guarantee that every American - north, south, east, west, young, old - will have decent, quality health care as a fundamental right and not a privilege.
Much will be made of the fact that Ted Kennedy died without seeing the "cause of his life" come to fruition. Much should be made, too, of his prodigious accomplishments in expanding access to care, corralling the power of government to combat lethal disease, and striving to have a health system that embraced the sick, the weak, the poor, the hurt, and the vulnerable.
If we were a foreign policy blog, we could go on and on about his accomplishments in war and peace and diplomacy. If we were a legal blog, we could talk at length about his expansion and protection of Americans' rights and the quality of our jurisprudence, the assistance and protection offered to victims of crimes. If we were an education blog, we could expound on how he fought for opportunity and equality for poor children, from early childhood right through college.
But we are a health care blog. And looking at his record on health, it's hard to know where to even start.
Hundreds of thousands of patients undergo cancer treatment each year, using all sorts of combinations of drugs and treatments and therapies. Not all are in clinical trials—but many of them have something to teach us. We linked to Gooznews touching on this topic a few months ago. Now Merrill Goozner has a longer analysis at Science Progress of how, in part because of advances in health IT, we could tap this untapped pool of knowledge:
A redrawn battle plan—one that focuses on turning the treatment system into a research and learning system that can teach oncologists the best use of the weapons they already have—is long overdue...
…Many of the nation’s 30,000 oncologists are engaged in what could be described as an unobserved and uncontrolled science experiment, especially when it comes to treating the 560,000 Americans who die each year from the more than 100 forms of the disease. As these patients’ cancers advance, their physicians try regimens they read about in journals or hear about from colleagues. The outcomes are never gathered. The data is never analyzed. And the findings are never disseminated.’
"If we can fix health care system for cancer patients, we will fix it for millions of others."
That's the mantra of the American Cancer Society Cancer Action Network, which plans on spending $3 million on advertising and grassroots organizing in the next couple of months to push for comprehensive health reform. The cancer society is all too well aware of how the system fails sick people, particularly sick people who have little or no health insurance. For starters, they are more likely to die—even if their cancer is detected early.
ACS CAN released a poll Monday that showed how scary cancer can be. Not the disease. The bills.
Of the 1000 people surveyed, four in 10 said they didn't think they would be able to afford cancer treatment if they got sick. One in five said it's likely that they or someone in their household would lose health coverage in the next year. One in seven have delayed a cancer screening test in the past year because of cost (and the proportion was higher in lower income groups).
A recent ASC CAN study of national health spending data found that only 7 in 10 cancer patients had "adequate" insurance. Nearly 10 percent were uninsured, and 18 percent underinsured.
We recently blogged about a report by the American Cancer Society and the Kaiser Family Foundation on the costs of cancer. More specifically, we wrote about how vulnerable even people with health insurance can be when they get a serious and costly disease like cancer.
Merrill Goozner, a blogger and author whose work we like reading, commented that we should have written more about the reasons cancer costs are so high, especially the pricey new drugs. At the Kaiser event itself, he had also raised a very intriguing point about how to glean knowledge from ongoing cancer treatment, which can be a sort of a trial and error affair for individual patients. The goal is to harness that clinical experience so we can do a better job treating other patients with a similar disease and trajectory, or as he put it, how we can "turn cancer care into a learning system." We'll come back to that in a moment.
A few weeks ago we wrote about a small study indicating that health costs had contributed to the mortgage meltdown which in turn has wrought havoc with the entire global economy; it found that 49 percent of foreclosures had a health-spending factor (and keep in mind that people miss work or lose their job—and their insurance—when they or a family member become seriously ill) Today's Wall Street Journal takes a look at people squeezed between paying for medical bills or the mortgage. The Journal didn't come up with a firm number of how many foreclosures are health related—except that it's a lot.
Just how many people are being forced to choose between home and health care is hard to tell. Freddie Mac, the big government-sponsored home-loan investor, says illness appears to be a growing reason homeowners with some of the company's 12 million mortgages are falling behind in payments. Illness was the chief cause for 15% of Freddie Mac's delinquencies in the first half of this year, behind such reasons as loss of income and too much debt. Although that percentage is down from previous years, the actual numbers are higher because more people are delinquent on their loans.