Late-Stage Cancer Care Model

Study Finds End-of-life Conversations with Nonclinical Worker Bring Patient Satisfaction, Lower Costs

Manali Patel and her colleagues found that a lay health worker could be trained to talk with patients to learn more about their personal goals for their care.
Steve Fisch

Using CERC’s Late-Stage Cancer Care Model, researchers found that patients with a serious illness are more at ease with decisions about their care when they discuss their care preferences with someone outside the medical context.

Dr. Patel and her team followed 213 patients at the Veterans Affairs Palo Alto Health Care System for 15 months after they were diagnosed with stage-3 or -4 cancer or with recurrent cancer. Patients with advanced cancer who spoke with a trained nonclinical worker about personal goals for care were more likely to talk with doctors about their preferences, report higher satisfaction with their care, and incur lower health costs in their final month of life. Read Stanford Medicine’s news release.

Late-Stage Cancer:  Innovations for Safely Lowering the Cost of Care

In 2012, CERC fellows set out to better understand high-cost cancer care, particularly at the end of life. The cost of cancer care was $124.5 billion in the United States in 2011 and is expected to increase to $157.7 billion a year by 2020 — a rate that outpaces the projected growth of overall medical expenditures. Much of the expenditures occur for late-stage cancers, which are cancers with very poor prognoses due to type or stage. A conservative estimate of net savings from national implementation of the CERC model is $37 billion dollars in direct US health care spending per year.

Setting out to safely reduce per capita spending for late-stage cancer care, CERC’s team found three addressable opportunities in current methods of care delivery

  • Help patients and their caregivers better formulate their goals for care and select treatment options that better meet their goals.       
  • Offer immediate treatment of pain and other symptoms associated with late-stage cancer at home through a 24/7 call center staffed by nurses specializing in cancer care, using symptom treatment algorithms and pre-placed emergency medication packets in patients’ homes.    
  • Provide chemotherapy mostly in the patient’s home or in safe, economical sites close to patients’ homes.

The CERC Design Team included Manali Patel, MD, Graham Abra, MD, David Moore, PhD, Terry Platchek, MD, Donna Zulman, MD, MS, and Arnold Milstein, MD, MPH.

Delivering End-of-Life Cancer Care: Perspectives of Providers

Am J Hosp Palliat Care. 2018 Mar;35(3):497-504. DOI: 10.1177/1049909117719879. Epub 2017 Jul 10