What is hospice?
Hospice is a philosophy of care that aims to return 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 personalizes care, it 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 .
Central to this philosophy is palliative (PAY-lee-uh-tiv) care.
What is palliative care for metastatic breast cancer?
The goal of palliative care for metastatic breast cancer is to relieve or prevent symptoms such as pain, fatigue, anxiety or depression. Palliative treatment focuses on symptom control, rather than the control of the cancer . Learn more about pain management for metastatic breast cancer.
Hospice care provides palliative treatment as part of a comprehensive approach to patients and their families, focusing on their physical, emotional and spiritual needs.
Where is hospice care given?
Hospice care is most often given at home, where the patient is usually the most comfortable .
In-patient care at a freestanding hospice facility or at a hospital with hospice services is available in some areas. Some people prefer to get hospice in these settings and sometimes, certain situations prevent someone from staying at home.
The hospice care team
Most often, a family member becomes the primary caregiver, with guidance and support from health care providers and trained volunteers. A typical hospice team includes a [36-38]:
- Registered nurse (who is on call 24 hours a day, seven days a week)
- Home health aide(s) (who can help provide personal care)
- Medical director (who coordinates the medical care)
- Social worker
- Spiritual counselor (for example, a chaplain)
- Grief counselor(s) (for patients and their families)
Who can enroll in hospice?
Hospice care can begin when a person :
- Has a life expectancy of six months or less (as determined by a health care provider)
- Chooses to move from active treatment of the cancer to palliative care only
Although a survival time period is set for enrollment, hospice care does not have a time limit. A person enrolled in hospice may live longer than six months and hospice care will continue.
Who covers the cost of hospice?
The cost of hospice is covered by:
- Health maintenance organizations (HMOs), such as Blue Cross/Blue Shield
- Most private insurance companies
Hospice covers 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.
Benefits for patients
Although active treatment for the cancer is stopped once hospice care begins, treatments to improve quality of life and ease symptoms continue. This care includes [36,38]:
- Control of pain, nausea and other symptoms
- Treatment for non-cancer health conditions
- Emotional support
- Help with practical concerns (such as financial issues or child care)
- Spiritual and grief counseling
- Relief for caregivers
Benefits for caregivers and other loved ones
Hospice provides special support to caregivers. Home health aides can help with daily care to 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 a short time .
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.
When should a person enroll in hospice?
Hospice 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. And, one study found early palliative care may improve survival in cancer patients .
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 [41-42]. With your guidance, hospice 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.
Learn more about metastatic breast cancer.
Learn more about the management of pain related to metastatic breast cancer.
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.