Some studies have shown that implementing palliative care not only improves quality of life but also prolongs survival.
But the paper suggests that some physicians intentionally do not provide end-of-life discussion or palliative care because they are not compensated for it.
Dr. David Cronin, associate professor of surgery at the Medical College of Wisconsin, disagreed. Many physicians abandon treatments and switch to palliative care options when their patients have little chance of survival.
"This is good medicine, this is what physicians are supposed to do, this is compassionate medicine, this is the responsibility of physicians," said Cronin.
The discussion circles back to communicating the "futility and toxicity" of treatment for these patients, said Dr. Anthony Elias, director of the breast cancer research program at the University of Colorado Health Sciences Center in Denver.
"Would you prefer to die in some comfort with hospice and good supports for your family, or do you want to suffer the side effects of ineffective treatment?" said Elias. "I would not place it in terms of cost or affordability."
However, Smith said that oncologists should be held responsible for the issue of cost, not patients. In the case of cancer care, increasing a patient's quality of life and reducing the cost of care go hand in hand, said Smith. One should not be considered without the other, and it's up to oncologists to take the lead, he said.
"I think oncologists feel that someone else is driving cancer costs up. But in fact, it's us," said Smith.
"We're ordering the tests. We're adding expensive supportive care drugs when they won't extend survival."