Cancer Diary: To Hospice or Not to Hospice - and Where

When facing advanced cancer, one of the most profound decisions patients and families encounter is whether to continue aggressive treatment or transition to hospice care. This decision is deeply personal, influenced by medical circumstances, values, and personal preferences. Today, I'd like to explore the considerations that might guide this difficult choice.

Continuing Active Treatment: When It May Be Right

Potential benefits of continuing active treatment:

• New treatments and clinical trials may offer hope, particularly for cancers with emerging therapies
• Some aggressive treatments can extend life meaningfully for certain patients
• Continuing treatment aligns with the desire to "fight" that many patients feel
• For some, pursuing all possible options provides peace of mind that everything was tried

Considerations to keep in mind:

• Treatment side effects may significantly impact quality of life
• Time spent in treatment and recovery means less time with loved ones
• Some treatments have diminishing returns as cancer advances
• The financial burden of continued treatment can be substantial

Transitioning to Hospice Care: A Different Kind of Care

Hospice isn't about "giving up" but rather shifting focus to quality of life and comfort. This approach acknowledges the reality of the situation while prioritizing comfort and meaningful time.

Potential benefits of hospice care:

• Focus on comfort, pain management, and symptom control
• Support for both patient and family, including emotional and spiritual care
• More time and energy to focus on relationships and closure
• Less time spent in hospitals and medical settings
• Professional guidance through the end-of-life process

Home Hospice vs. Facility-Based Hospice

Home hospice allows patients to remain in familiar surroundings, offering:

• Comfort of being in one's own space
• More control over daily routines
• Continued close proximity to family, pets, and personal belongings
• Private, intimate setting for visitors

However, home hospice requires:

• Family members who can assist with care
• Potential modifications to the home environment
• Managing the emotional impact of transforming the home into a care setting

Facility-based hospice provides:

• Professional care available 24/7
• Specialized equipment readily available
• Trained staff to handle all aspects of care
• Relief from caregiving responsibilities for family members
• Community of support from staff and sometimes other families

Finding Your Path Forward

There is no single "right" answer for everyone. Some factors that might influence your decision include:

• Prognosis and likelihood of responding to further treatment
• Your goals and values at this stage of life
• Available support systems and caregiver resources
• Financial considerations and insurance coverage
• Personal preferences about where and how you want to spend your remaining time

Many people find that a thoughtful conversation with their healthcare team, family, and perhaps a palliative care specialist can help clarify the path that feels right for them.

Remember that these decisions aren't necessarily all-or-nothing choices. Some patients choose a blended approach, perhaps trying a time-limited course of treatment with clear benchmarks for success, while simultaneously preparing for hospice if needed.

Whatever path you choose, focus on what brings meaning, comfort, and peace during this difficult journey. The measure of a good decision isn't necessarily how long it extends life, but how well it honors your values and wishes during the time that remains.

Blog editor's note: As a memorial to Carl Leaver, MSI Press graphic arts director and designer, who died of Cancer of Unknown Primary August 16, 2021, and simply because it is truly needed, MSI Press is now hosting a web page, Carl's Cancer Compendium, as a one-stop starting point for all things cancer, to make it easier for those with cancer to find answers to questions that can otherwise take hours to track down on the Internet and/or from professionals. The web page is in its infancy but expected to expand into robustness. To that end, it is expanded and updated weekly. As part of this effort, each week, on Monday, this blog carries an informative, cancer-related story -- and is open to guest posts: Cancer Diary. 

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