Hospice care can be a valuable resource for patients with late-stage cancer who want to improve the quality of the rest of their life.
Hospice — which is sometimes referred to as end-of-life care — can help patients with cancer and their loved ones feel empowered and enjoy their time together in the final weeks and months of the cancer trajectory, explained Lori Marshall, vice president of hospice, health care at home, at Allegheny Health Network.
“I think one of the best things we could do is start having the (hospice) conversation sooner,” Marshall, who has been a hospice nurse for nearly three decades, said in an interview with CURE®. “Not one person ever says, ‘I wish I hadn’t signed up so early.’ They always say, ‘I wish I had known sooner,’ because hospice provides a lot of emotional support. It pays for all the medications related to the diagnosis. So pain medicine, meds for nausea and vomiting, as well as medical supplies, are all covered under the hospice benefit.
To qualify for hospice care, two doctors must certify that a patient is an appropriate candidate. These clinicians will consider if a patient is at the end of their disease process, if they have pain or other side effects that need management and, if the disease follows its normal trajectory, the patient has six months or less to live.
There’s also a psychological aspect, too, Marshall explained: patients need to be willing to end treatments. Oftentimes, they have other life goals — such as seeing loved ones or enjoying a high quality of life versus quantity of life — that aids them in their decision, she said.
Once a patient is on hospice, they will have nurses and other providers — such as home health aids, chaplains and social works — meet with the family to help reduce the patient’s symptoms and improve their quality of life, while simultaneously providing counseling and support to the family members as well.
“As the patient declines, truthfully, in my mind, the patient's symptoms are controlled, and they become less and less prominent than the family,” Marshall said. “You're really supporting the family through it at that stage. The more you can teach a family of what to expect … the less scary it is for them. As they feel empowered, and they're able to take care of it.”
This can often be done at the patient’s house, as is the case for former president Jimmy Carter, who was diagnosed with metastatic melanoma in August 2015 and has been on hospice since February 2023.
“The certifications (for hospice) go 90 days, 90 days, 60 days,” Marshall said. “Jimmy Carter's the perfect (example): (over the course of a few months) you get established with the patient, the patient gets comfortable, you're able to identify some wishes that they want, something they might want to do.”
Marshall emphasized that it is not rare for patients to come off hospice either. In the world of cancer care, there are new drugs that are being investigated and improved all the time. If a patient sees an opportunity for a treatment they would like to try, they can always talk to their hospice team about being taken off of hospice care.
“If there’s a miracle cure that comes along, we’re discharging you (from hospice care); you’re going to get it if you want it. I’m here to fulfill whatever your goal is,” she said.
Additionally, if a patient lives beyond six months on hospice care, typically one of two things will happen, according to Marshall. The patient may be taken off hospice if their disease is stabilized and they are no longer declining. In this instance, they may, instead, be put on home care and/or therapy services (physical therapy, occupational therapy, etc.). If that is not the case, the patient’s clinical team will re-enroll them for another period.
Ultimately, it is important for patients with cancer to have end-of-life conversations early on in the disease process — even for those whose disease could be cured or with a good prognosis, Marshall explained.
Marshall said that there are resources available to help guide these difficult and emotional conversations, such as the Conversation Project, an initiative that offers guides and workbooks about hospice care, talking to health care providers, caregiving and more. Additionally, the Five Wishes project offers help with advanced-care planning as well.
“It's a difficult conversation. I would never say that it's easy. But over time, if you are a cancer patient and you are declining, you're going to start thinking about it. It's just, you know, eventually you get there,” she said.
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