Hospice of the Comforter

“I’m sorry, but there’s nothing more that we can offer to cure your cancer.” These are the words that no one ever wants to hear, and they are often greeted with a range of reactions including shock, anger, sadness, bargaining, and sometimes even firm denial.

Personally, I’ve had family members and friends diagnosed with incurable cancers, and professionally, I have served as a cancer nurse and a hospice nurse. All of these experiences have proven to me how difficult it can be for the patient, family, and even the medical providers, to transition from a curative approach to a more comfort oriented focus in cancer care.

I have come to understand that for many people living with cancer, hope and resilience requires an unshakable resolve that one can “beat this”. And thank goodness, many do. For months and sometimes for years, those undergoing cancer treatments choose to adapt the schedule of their lives and the lives of the entire family to revolve around their many medical appointments. The dedicated health care providers caring for them envision themselves on the “hope team”, maintaining an attitude of encouragement and a firm commitment to the chance for cure.

Cancer treatment options have now progressed beyond surgery, radiation, and chemotherapy and have come to include hormonal agents, bone therapies and targeted drugs. With each new advance comes a responding hope that something more can be done, some new treatment can be offered.

For many, however, there comes a time when there is no further treatment that can cure the cancer, and a major realignment occurs in goals of care and hopes for the future.

This is when the experienced doctor and nurse often discuss the option of hospice care in a life-affirming manner. Now is the time when the focus of care turns to the relief and prevention of suffering, to maintaining quality of life, and to an affirmation of what’s most important to the patient and family as they face a limited time together.

Noted oncologists Drs Esme Finlay and David Cassarett speak to the value of such discussions: “Strong evidence that patients with advanced cancer and their caregivers benefit from discussing their end-of-life wishes with their oncologists has been generated from the findings of the Coping with Cancer (CWC) study. In this study, patients who talked with their oncologists about end-of-life wishes had better quality of life at the end of life, and their caregivers had better quality of life in the bereavement period.”¹

Nationally, over 40 % of hospice patients have a cancer diagnosis. They are referred to hospice when the doctor feels that a prognosis of six months or less is expected. Drs Esme and Finlay explain that this usually occurs “when patients have exhausted appropriate anticancer therapies, when oncologists have established that cancer-related prognosis is limited, or when patients have palliative care needs that only hospice can meet.”¹

Unfortunately, the median length of stay in hospice care is less than three weeks. That’s a short time to fully take advantage of all that hospice can offer , including home visits from the hospice physician, nurse, social worker, spiritual counselor, home health aide and volunteer. In addition, all comfort medications, equipment and supplies related to the cancer are covered under the Hospice Medicare and Medicaid Benefit. Increased nursing services and inpatient care may also be covered when acute care needs arise. Most private insurances include similar hospice benefits.  

It is not unusual for patients and families to state, "I wish that I had known about hospice sooner." There is research to support not only the improved quality of life benefits and cost savings, but additionally, the actual increase in length of life for those who received hospice care compared to those with similar illnesses who did not have such care.²

For those of us who provide hospice care, these findings are not surprising. When end-of-life care is well coordinated and provided in an expert and compassionate manner, stressors can be relieved or prevented. The patient and family can then be freed to focus on what is most meaningful to them as they share in this end of life journey.

References

1. Making Difficult Discussions Easier

2. Medicare Cost in Matched Hospice and Non-Hospice Cohorts 

Additional Resources:

1. “End-of-Life Care: Questions and Answers” 

2. “Hospice” Fact Sheet