Because Choosing Wisely guidelines are against the provision of systemic chemotherapy for patients with terminalstage cancer, 5 the decreased chemotherapy utilization in hospices may be appropriate. However, the dramatic reductions in radiotherapy expenses and in the proportion of hospices providing radiotherapy are alarming. Our findings highlight the concern that patients with cancer in recent years might have postponed enrolling in hospice until the very end of life so that they could continue to receive palliative treatments. 6 Our analyses have several limitations. Our findings, limited to freestanding hospices, cannot be generalized to hospitalaffiliated hospices. Because of data constraints, we could not calculate radiotherapy and chemotherapy expenses per patient with cancer. Additionally, we were unable to determine the factors causing the observed decrease in radiotherapy and chemotherapy expenses. Future research surveying forprofit and nonprofit hospices regarding their practices in these therapies is warranted.Radiotherapy and chemotherapy can relieve symptoms for patients with cancer with terminal illness; yet, over time, fewer hospices were able to offer these expensive treatments. The decreasing trend in palliative treatments indicates that the current MCCM may not provide sufficient incentives for hospices to provide appropriate palliative care for patients with cancer at the end of life. To improve the quality of end-of-life cancer care, it is important for policy makers to identify the barriers hindering the provision of palliative radiotherapy. Intensified efforts to facilitate hospices in providing appropriate palliative treatments for patients with cancer may be needed.
Epidemiological trends during the past decade suggest that although incidence of nasopharyngeal carcinoma is gradually declining, even in endemic regions, mortality from the disease has fallen substantially. This finding is probably a result of a combination of lifestyle modification, population screening coupled with better imaging, advances in radiotherapy, and effective systemic agents. In particular, intensity-modulated radiotherapy has driven the improvement in tumour control and reduction in toxic effects in survivors. Clinical use of Epstein-Barr virus (EBV) as a surrogate biomarker in nasopharyngeal carcinoma continues to increase, with quantitative assessment of circulating EBV DNA used for population screening, prognostication, and disease surveillance. Randomised trials are investigating the role of EBV DNA in stratification of patients for treatment intensification and deintensification. Among the exciting developments in nasopharyngeal carcinoma, vascular endothelial growth factor inhibition and novel immunotherapies targeted at immune checkpoint and EBV-specific tumour antigens offer promising alternatives to patients with metastatic disease.
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