Hospice is a philosophy of care that aims to give a sense of control to people at the end stage of a terminal illness, such as metastatic breast cancer. Hospice care provides support services to patients and their families.
Because hospice programs personalize care, they can help preserve quality of life and allow a person to die as comfortably and with as much dignity as possible. Hospice care does not aim to shorten or prolong life, but rather to enhance the time remaining as much as possible .
People in hospice programs and their families receive comprehensive palliative (PAY-lee-uh-tiv or PAL-ee-ay-tiv) care from the members of the hospice team.
The goal of palliative care is to maximize quality of life. It focuses on symptom control, rather than the control of the cancer and treats physical, emotional, social and spiritual needs . This extra layer of care can be given along with treatments for the breast cancer.
Palliative care specialists work with oncologists to relieve or prevent symptoms such as pain, fatigue, anxiety or depression in people with metastatic breast cancer. They can help people weigh the burdens versus the benefits of different treatments for symptoms as well as for medications or other therapies to treat the cancer.
Palliative care specialists can also help with advanced care planning. They can help people identify their personal values and goals that will guide their care.
Palliative care is a standard part of metastatic breast cancer care and becomes the focus of care when active treatment ends. It can improve quality of life for patients and caregivers [52-53].
Learn more about pain management for metastatic breast cancer.
Hospice care is most often given at home, where the patient is usually the most comfortable .
Sometimes, hospice care is given as in-patient care at a freestanding hospice house or at a hospital with hospice services. Some people prefer to get hospice care in these settings and sometimes, certain situations prevent someone from staying at home.
A typical hospice care team includes a:
Most often, a family member becomes the primary caregiver, with guidance and support from the hospice team.
Family members or other caregivers provide care about 22 hours a day. A hospice nurse and home health aides help the other 2 hours.
Hospice care can begin when a person has a life expectancy of 6 months or less (as estimated by the person’s doctor and confirmed by the hospice program’s medical director) .
Some hospice programs only enroll people who have stopped active cancer treatment. Others enroll people who are still receiving cancer treatment (sometimes called “open access” programs).
A “DNR” (do not resuscitate) order is not required to enroll in a hospice program. CPR (cardiopulmonary resuscitation) can still be given if a person stops breathing or his or her heart stops beating.
Although a survival time period is set for enrollment, hospice care does not have a time limit. A person enrolled in a hospice program may live longer than 6 months and hospice care will continue.
The cost of hospice care is covered by:
Hospice programs cover the cost of the health care team as well as any medicines, therapies, counseling, equipment and supplies related to care . Talk to your insurance provider about the specifics of your coverage.
Although active treatment for the cancer may stop once hospice care begins, treatments to improve quality of life and ease symptoms continue. This care includes [50,54]:
Hospice care provides special support to caregivers.
Home health aides can provide a break for caregivers. And, for times when a caregiver is called away or needs a longer break, hospice care can be moved to an in-patient facility for up to 5 days .
The hospice team may be able to help ease some of the depression and emotional burden caregivers often feel during this time . Grief and bereavement (loss) counseling are important parts of hospice care.
Hospice care at any time is helpful, but enrolling earlier rather than later can be better for the patient and the family. The earlier the enrollment, the more time the hospice team has to get to know the patient and the family so they can give the best personal care possible.
Discussions on end-of-life care are very difficult. As hard as it can be to talk to family members and health care providers about end-of-life issues, these discussions help ensure your wishes are carried out [56-57].
With your guidance, hospice care can make the later stage of cancer care as comfortable as possible for you and your family.
For more information about hospice care and to find local sources of care, visit the National Hospice and Palliative Care Organization or call their helpline at 1-800-658-8898.
The National Institutes of Health (NIH) website has information on end-of-life planning and care, including questions to ask your health care provider.
The American Society for Clinical Oncology (ASCO) has a guide for patients and their families to help make decisions on end-of-life care.
Learn more about metastatic breast cancer.
Learn more about the management of pain related to metastatic breast cancer.
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