When to Start Hospice?

Jared Weiss, MD
Last Modified: December 8, 2010

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Question

Dear OncoLink "Ask The Experts,"

My Mother is 75 and has been diagnosed with stage 4 lung cancer in August that’s moved and broke her hip. That’s how they found it. We decided against Chemo and did 10 rounds of radiation. The radiologist gave her less than a year. 3 months later she is feeling better than she has in a while. She also has Alzheimer's. My Question is what are we to expect???? And should we call in Hospice even though she’s doing good now????

Answer

Jared Weiss, MD, Medical Oncologist & Assistant Professor at University of North Carolina’s Lineberger Cancer Center, responds:

No doctor knows how long anyone will live - cancer is just too unpredictable. We do have averages, but there’s a huge spread with half of the people living longer than the average, and half less. So, as far as time course, you just can’t know. This unpredictability is one of the reasons that, in my opinion, it’s a good idea to get hospice involved early, even while a patient still feels well. In case things change quickly or unpredictably, it’s good to already be set up with a good palliative care team that already know her well. One study out of MGH in Boston presented at our big cancer meeting this summer (ASCO) even showed a surprise survival advantage to early palliative care, in addition to the benefits you would expect (better quality of life, lower rates of depression and less aggressive care at the end of life).

Betsy Alexander, RN, MSN, Director of Penn Wissahickon Hospice, adds:

I would recommend hospice right away so she can be monitored for symptom management and quality of life. Hospice would also provide support to the family and help guide them through this process. Unfortunately, many people do not call hospice until the last week or so of life, and while that is still helpful, patients and their families get the most benefit if hospice is called sooner. About 1.5 million people in the US received hospice care in 2009, almost half of these were in hospice care for less than 2 weeks.

The Hospice Foundation of America has wonderful information about hospice (http://www.hospicefoundation.org/)

Here’s how they describe hospice:

Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.

Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management.

The goal of hospice care is to improve the quality of a patient's last days by offering comfort and dignity.

Hospice care is provided by a team-oriented group of specially trained professionals, volunteers and family members.

Hospice addresses all symptoms of a disease, with a special emphasis on controlling a patient's pain and discomfort.

Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient's family and friends.

Hospice offers a variety of bereavement and counseling services to families before and after a patient's death.

This question and answer was part of the OncoLink Brown Bag Chat Series, Lung Cancer Q&A Webchat. View the entire Lung Cancer Q&A transcript here.



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