Hospice Care for End-Stage Cancer Patients

Despite the doctor’s hard work, the patient’s best efforts and the family’s loving support, sometimes cancer treatments stop working and a cure or long-term remission is no longer possible. When that happens, hospice can do so much for the patient.

Hospice ensures that a cancer patient is cared for, supported and surrounded by the people and things they love. Hospice doesn’t always add more days to a cancer patient’s life, but it can add life—quality of life—to the final months, weeks and days. On this page, we've provided answers to these questions:

• When is the right time for hospice?
• How can hospice help cancer patients?
• How can hospice help the family of a cancer patient?
• What are the overall benefits of hospice care?
• How can I approach the hospice discussion?

When Is the Right Time to Consider Hospice for a Cancer Patient?

While hospice is a choice made by the patient, family, and healthcare professional, only a doctor can make the clinical determination about a cancer patient’s prognosis. When the patient has six months or less, they are considered to have advanced-stage cancer, and can benefit from hospice services. Each patient is different, and symptoms vary according to the kind of cancer they have, but there are a few signs consistent among cancers that commonly mean the disease has progressed to the advanced stage:

• The patient is rapidly weakening and the malignancy is progressing
• Treatment is no longer fully effective
• The burden of treatment on the patient and family outweighs the potential benefits

Are you a healthcare provider? Learn about the clinical characteristics of end-stage cancer patients and download a PDF of our hospice eligibility guidelines.

“I wish I had known about hospice sooner,” is a common statement among those caring for a loved one with cancer. Although it’s up to the patient’s oncologist or attending physician to order a hospice evaluation, the sooner a patient is admitted to hospice, the more benefits they and their loved ones will see during their finals months and weeks.

One of the most common misconceptions about hospice is that it is only appropriate in the last days or weeks of life. In reality, the Medicare hospice benefit is designed for patients with a prognosis, or life expectancy, of six months or less.

How Can Hospice Help End-Stage Cancer Patients?

Research shows that cancer patients and their families who use hospice services report a higher quality of life than those who don’t.¹ An interdisciplinary team of professionals brings hospice to the patient. The team looks at advanced-stage cancer from the point of view of both the patient and the patient’s caregiver and other loved ones. The team consists of a physician, nurse, hospice aide, social worker, chaplain, volunteer and bereavement specialist.

Cancer patients receiving hospice care can take comfort knowing they are not alone on this journey and that every member of the hospice team is experienced in guiding people through the most challenging stage of the disease and their lives.

Cancer patients receive care based on their specific health issues and what they do and do not want in the healthcare they receive. Your status will be regularly evaluated, and your plan of care will be continuously updated to meet your needs as your symptoms and condition change, even on a day-to-day basis.

Hospice offers the following services for patients with cancer:

• Coordinated care at every level—A plan of care is developed with the advice and consent of the patient’s oncologist or other physician. At weekly meetings, the team reviews the patient’s physical, mental and spiritual condition as well as any needs or concerns the family may have. In addition, hospice coordinates and supplies all medications, medical supplies and equipment related to the diagnosis to ensure patients have everything they need.
• Pain management and symptom control—Hospice specializes in ensuring patients are comfortable, free of pain and able to enjoy life and remain in control of day-to-day decisions as much as possible. If symptoms become severe, continuous care can be introduced, with shifts of staff providing 24-hour care until symptoms are under control.
• Emotional and spiritual assistance—A terminal cancer diagnosis can bring strong feelings to the surface or spiritual questions may arise. Hospice has the resources to help patients maintain their emotional and spiritual well-being.
• Services provided wherever a patient calls home—VITAS offers care for patients wherever they live - in their homes, long-term care facilities or assisted living communities. If symptoms become too difficult to manage at home, inpatient services can provide round-the-clock care until the patient is able to return home.

¹www.cancer.gov/about-cancer/advanced-cancer/care-choices/care-fact-sheet 

How Can Hospice Help the Family of a Cancer Patient?

Taking care of a loved one with cancer can be emotionally draining and physically strenuous. Family caregivers make difficult healthcare and financial decisions as well as provide emotional support to others. Making the decision to stop medical treatment can bring about strong emotions; many families feel overwhelmed. Hospice cares for families of cancer patients in several ways:

• Caregiver education and training—The family caregiver is vital in helping the hospice team care for the patient. Hospice can relieve families’ concerns by educating them on what to expect and how to take care of their loved one as symptoms increase and communication becomes difficult.
• Help with difficult decisions—The hospice team helps families make tough choices that impact the patient’s condition and quality of life.
• Emotional and spiritual support—Caregivers keep their emotions intact, but they need an outlet to express their feelings. Hospice care supports those who care for the patient, bringing outside resources, a listening ear or a shoulder to cry on.
• Financial assistance—Although hospice services are covered by Medicare, Medicaid/Medi-Cal and private insurers, families may have financial concerns as a result of an extensive illness. Social workers can assist families with financial planning and finding financial assistance during hospice care. After a death, they can help grieving families find financial assistance through human services, if needed.
• Respite care—Caring for a loved one with an end-stage illness can create tremendous stress. Hospice offers up to five days of inpatient care for the patient when the caregiver needs to be away.
• Bereavement services—The hospice team works with surviving loved ones for up to 13 months after a death to help them express and cope with their grief in their own way.

What Are the Overall Benefits of Hospice Care?

Whether you already know about hospice or are looking for information, you may not be fully aware of the benefits hospice care has for cancer patients and their loved ones. If you or a loved one is struggling through the advanced stages of cancer, hospice can offer:

• Comfort and personal attention. Hospice provides one-on-one care and support to patients and families throughout this challenging chapter in their lives. We listen. We advocate. We work to improve quality of life.
• Reduced rehospitalization. As the disease progresses, symptoms may worsen, and many patients find themselves making frequent trips to the emergency room or enduring repeated visits to the hospital. Hospice reduces rehospitalization by controlling pain and managing symptoms in the patient’s home.
• Security. One of the greatest benefits of hospice is having clinical support whenever you need it. VITAS Telecare® assures clinical support around the clock. And VITAS gives families the training and resources they need to make a difference in their loved ones’ lives.

How Can I Approach the Hospice Discussion?

Talking about the end of life can be difficult. Here are some tips to begin the conversation.

For patients speaking to families:

• Education is key. Know as much about what to expect from hospice care as you can in order to dispel any apprehension your loved ones may feel. A good resource is our Hospice Family Discussion Guide. You can also learn hospice basics in our “What is Hospice” series.
• Determine what your loved one knows. Before bringing up hospice, make sure your loved ones have a clear understanding of your health status and your prognosis. People handle difficult information in different ways. If family members are not accepting or understanding of your prognosis, you might want to have a trusted physician, faith leader or friend speak with them on your behalf.
• Discuss your goals for the future as well as theirs. As a patient, your greatest concern might be to live without pain, or to stay at home or not to be a burden. Ask your loved ones what their concerns are for the coming months, weeks and days. Explain that hospice is not giving up. It is an active choice to ensure that everyone’s needs are met.
• Take initiative. Remember, it’s up to you to express your wishes. Sometimes, out of concern for your family’s feelings, you might be reluctant to raise the issue of hospice care.

For families speaking to patients:

• Learn as much as you can about hospice. Before you broach the subject to your loved one, educate yourself about hospice care and services. It’s normal for a patient with a serious illness to be uncertain about hospice. They may have misconceptions. Reading our Hospice Family Discussion Guide will help you find the best way to begin the conversation.
• Ask permission. Asking permission to discuss a difficult topic assures your loved one that you will respect their wishes and honor them. Say something like, “I would like to talk about how we can continue to ensure you get the very best care and attention as your condition progresses. Is that okay?”
• Determine what is important to your loved one. Ask him or her to consider the future: “What are you hoping for in the coming days, weeks or months? What are you most concerned about?” The patient might express a desire not to be in pain, to be able to stay at home or to not become a burden.
• Discuss hospice care as a means of fulfilling the patient’s wishes. Now that your loved one has told you what is important to them, explain that hospice is a way of making sure wishes and desires are met. For some, the word hospice evokes a false notion of giving up. Explain that hospice is not about surrendering to their cancer or death. It is about bringing quality of life to their remaining months, weeks or days. Assure the patient that they are in control. Hospice gives patients options: the option to remain in the comfort of their own home, the option to take advantage of emotional and spiritual support, the option to have their own doctor actively involved in their care, the option to live life as they wish. Reassure your loved one that you will honor their choices about what is important to them.
• Be a good listener. Keep in mind that this is a conversation, not a debate. Hear what the other person is saying. Know that it is normal to encounter resistance the first time you talk about hospice care. But if you listen and understand your loved one’s reasons for resisting, you will be prepared to address and ease their concerns in your next hospice discussion.