HOSPICE MANAGEMENT OF PATIENTS RECEIVING CYTOTOXIC CHEMOTHERAPY - PROBLEMS AND OPPORTUNITIES

In Britain, the specialty of palliative medicine continues to develop, encouraging the referral of patients early in the palliative phase of their illness. This has led to an increased number of patients receiv ing palliative chemotherapy and hospice care concurrently, posing spec ial problems to the professionals involved. In this retrospective stud y, 52 patinets were identified who received chemotherapy and hospice c are simultaneously. Case notes were reviewed to reveal problems arisin g from sharing the duty of care. The poor quality of communication bet ween professionals, perhaps reflecting a limited understanding of the various roles in patient care, was found to cause significant difficul ties. The duration and discontinuation of cytotoxic therapy seems to b e a particularly difficult matter. Hospice admission often signalled t he end of this treatment. In a third of the patients, no decision was taken to stop chemotherapy desipite the last dose being an average of just 1 week before death. The value of chemotherapy for patients who a re too ill to return home is questioned. Seven patients were diagnosed as suffering from chemotherapy-induced sepsis and neutropenia either by hospice inpatient or home care teams, and were admitted to their ac ute centres accordingly. Most patients who died during the study perio d received terminal care in the hospice. Suggestions are made on impro ving professional education and communication, including the use of a 'chemotherapy card'.