TY - CHAP M1 - Book, Section TI - Hospice Care and End-of-Life Issues A1 - von Gunten, Charles F. A1 - Weissman, David E. A2 - Boyiadzis, Michael M. A2 - Frame, James N. A2 - Kohler, David R. A2 - Fojo, Tito PY - 2016 T2 - Hematology-Oncology Therapy, 2e AB - Hospice CareThe number one complaint about hospice care from patients and families is that no one told them about it sooner. Referral for hospice care is appropriate when the most important goal is comfort rather than making the cancer better. If patients improve or resume anticancer therapy, they can be discharged (graduate) and resume services later without penalty Eligibility: Prognosis of less than 6 months if a patient's disease runs its usual course. Individual patients can continue to be eligible if they live longer than 6 months as long as their physician believes death is more likely than not within 6 months. A patient does not need a DNR order. There is no limit to the number of days a patient can receive hospice care. There is no penalty if a physician is wrong about a patient's longevity Prognosis: Oncologists overestimate prognosis when compared with actual survival. Referral for hospice care is associated with an increase in survival as compared with controlsTable Graphic Jump Location|Download (.pdf)|PrintGeneral Indicators of Poor PrognosisSpecific Indicators of Poor PrognosisPerformance status:Karnofsky 10 or 20 (ECOG/Zubrod 4): <1 monthKarnofsky 30 or 40: 1–2 monthsKarnofsky 50 (or ECOG/Zubrod 3): 2–3 monthsHypercalcemia: 6 weeksMultiple brain metastases: 3–6 monthsAnorexia: <2 monthsDelirium/confusion: <1 monthDyspnea: <1 monthNutritional status:Serum albumin <2.5 mg/dL: <6 monthsSpecific cancers:Stage IV non–small cell lung cancer: 6–12 monthsUnresectable pancreas cancer: 4–7 monthsStage IV esophagus cancer: 3–6 monthsStage IV gastric cancer: 7 months SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - hemonc.mhmedical.com/content.aspx?aid=1128367915 ER -