Role of Hospice Care at the End of Life for People With Cancer

Abstract

Patient-defined factors that are important at the end of life include being physically independent for as long as possible, good symptom control, and spending quality time with friends and family. Hospice care adds to the quality of care and these patient-centered priorities for people with cancer and their families in the last weeks and days of life. Evidence from large observational studies demonstrate that hospice care can improve outcomes directly and support better and more appropriate health care use for people in the last stages of cancer. Team-based community hospice care has measurable benefits for patients, their family caregivers, and health services. In addition to improved symptom control for patients and a greater likelihood of time spent at home, caregiver outcomes are better when hospice care is accessed: informational needs are better met, and caregivers have an improved ability to move on with life after the patient’s death compared with people who did not have access to these services. Hospice care continues to evolve as its reach expands and the needs of patients continue to broaden. This is reflected in the transition from hospice being based on excellence in nursing to teams with a broad range of health professionals to meet the complex and changing needs of patients and their families. Additional integration of cancer services with hospice care will help to provide more seamless care for patients and supporting family caregivers during their caregiving and after the death of the patient.

Quality of End-of-Life Cancer Care in Canada: A 12-Year Retrospective Analysis of Three Provinces’ Administrative Health Care Data Evaluating Changes over Time

“…Quality indicators are measurable items of health care performance that can be used to identify effective health care interventions or pinpoint areas of concern. For those with cancer, patient-defined outcomes that are important at the end of life include being physically independent for as long as possible, having adequate symptom control, spending time with friends and family, and dying at home or outside of hospital [ 1 ]. Patients who experience poor end of life (EOL) care are those who suffer from pain, are subjected to treatments that are overly burdensome, have their emotional/spiritual needs go unmet, or die in a setting outside of their home.…”

“…Patients who experience poor end of life (EOL) care are those who suffer from pain, are subjected to treatments that are overly burdensome, have their emotional/spiritual needs go unmet, or die in a setting outside of their home. In addition, their caregivers are often less able to move on after their death [ 1 , 2 , 3 ].…”

Consent for withholding life-sustaining treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law

“…Furthermore, from the patient’s point of view, receiving treatment at a specialized facility with caregivers who can provide focused hospice care can reduce emotional and mental stress [ 19 ]. As mentioned above, this could be of great help in improving the patient's quality of life [ 20 ]. Therefore, it can be inferred that a reduction in the length of hospital stay is an important consequence of the enactment of the LEMD law and fulfills the purpose of the enforcement of this law.…”

An urgent call to raise the bar in oncology

“…Patients suffering from advanced cancer are willing to undergo toxic treatments with a very small chance of benefit near the end of life [ 122 ]. However, systemic anticancer treatments often provide limited or no benefit to patients suffering from advanced cancer [ 123 ], lead to harm in the last weeks of life, reduce QOL, limit timely hospice care and increase risk of dying in the hospital with subsequently an increased risk of pathological grievance of bereaved [ 124 , 125 ]. Informing patients of treatment effects in daily practice by quoting point estimates, such as median OS achieved in highly selected patients from RCTs instead of using ‘real-life data’ (if available), could contribute to unrealistic patient expectations [ 126 ].…”