To the Editor: The observations of Dr Hui and colleagues1 on palliative care at US cancer centers are timely. Hospice and palliative care is a rapidly emerging discipline encompassing the care of many patients with terminal illness in addition to those with cancer. For many reasons, including the limited ability until recent years to cure most malignancies, the foundations of palliative care were laid by programs focused on cancer patients. Although cancer is the second leading cause of death in the United States, accounting for 23% of deaths in 2007, 44% of deaths occurred from other categories of chronic conditions, including heart disease, cerebrovascular disease, chronic lung disease, dementia, diabetes, and renal disease.2 Many of the deaths in these categories occurred in patients with advanced stages of their illness for whom the palliative model, which emphasizes symptom control over disease eradication, should become the primary focus of care.
The prognosis for patients with cancer has perhaps been better defined than for patients with progressive failure of several organ systems, and hospice eligibility criteria have tended to reflect this. Guidelines have been developed for determining prognosis in nonmalignant diseases,3 but these require further validation.4 The development of disease-specific palliative care models for nonmalignant conditions is in its early stages but will be necessary to meet the needs of this large population of patients.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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