DR LOVE: So one final point was the use of hospice. And quite a few of these patients did go into hospice — not all. I think it was around 85%, 90%. But it looked like they were in a reasonable period of time. I think, to me, it goes along with the rest of the survey in terms of the way the patients were managed, kind of the way you’d hope/expect them to be. Any thoughts about that, hospice?

DR BIRRER: Well, I agree with your observations. I think it was right on. And certainly that’s in the range of what we’re utilizing. My guess is, if you asked a couple of other questions about the other that didn’t end up in hospice, you probably have a number who passed away quickly in hospital. You probably also have a percentage of patients who went home with very supportive families and essentially didn’t need hospice. So that was very appropriate.

It was interesting to me that there were some patients who were on hospice for what looked like 7 to 8 months, which is interesting. I assume that’s probably hospice at home, because logistically that’s hard to do, at least in the State of Massachusetts. But it all made sense.

DR LOVE: Yes. No. I mean I thought that they didn’t read the form right. I was amazed. We’ve done other surveys. We actually thought maybe they misread “weeks” versus “months.” It was way longer than we’ve seen. But in fact, 87% of these patients who died of ovarian cancer entered a hospice.

DR BIRRER: Yes.

DR LOVE: The other thing I thought was interesting —

DR BIRRER: And can I interject on that? Because I could be wrong, but I think our percentage would be higher than colorectal or lung, only because the natural history of the disease, even in platinum-resistant situations, tends to be much more predictable. Our patients get bowel symptoms. They’ll come into the hospital maybe 2 to 3 times with a bowel obstruction. We can usually say to a patient, “Lookit. We’re now to the second bowel obstruction. This is getting worse. I can’t control it. You probably have X time left.” I think for lung and colorectal, that may be sometimes a little bit more difficult.

DR LOVE: From your own point of view, what’s the spectrum of palliative issues you see yourself at the end of life with ovarian cancer?

DR BIRRER: Well, I’ve certainly had not an insignificant number of ladies pass away from ovarian cancer for which the tumor never left the abdomen, in which case we’re not dealing with parenchymal lesions in the lung or the brain or the bone. It’s all centered in the abdomen. And then what is that? Well, as you point out, large-volume ascites is uncomfortable, so we’re doing a lot of, sometimes, paracentesis. Sometimes we’ll put catheters in so we don’t have to repeatedly bring patients into the hospital or the radiology suite to get them tapped.

The bowel problem is really the serious one, which is bowel obstruction with nausea and vomiting. And a substantial percentage of our patients will end up with venting G tubes, which really can be a very effective palliative approach. I’ve had a number of patients who’ve had intractable vomiting, had their venting G tube put in and then lived another 3 to 4 months without any nausea at all. So those would be the major issues.

We do get a lot of abdominal pain from the tumor. And so pain control is important. That’s where the palliative care service can help us, trying to titer the amount of opiates or pain medicines to use without necessarily putting the patient to sleep, because she still has a couple of months to live and she wants to talk to her family. This can be a challenge. And that’s where palliative care can help us.

Metastatic wild-type nonsquamous non-small cell lung cancer (NSCLC)

Metastatic colorectal cancer (mCRC)

Metastatic epithelial ovarian cancer (OC)