Debunking Hospice Misconceptions: A Focus on End-of-Life Care

If you are reading this, you, your family or loved one have most likely been affected by cancer. As a practicing oncologist, I understand that the diagnosis is draped in fear and wrapped in questions of one's own mortality. I am often the one breaking this dreaded news to patients and their family members: “You have stage 4 cancer, which is treatable but not curable.” I feel their pain and sorrow deeply. “The goals of treatment are to improve symptoms related to your cancer and to extend life, with a focus on quality of life.”

Cancer, accounting for nearly 1 in 6 deaths, is a leading cause of mortality worldwide, as the World Health Organization reported earlier this year. We often think and speak in absolutes: life and death, benign and malignant, cure and incurable, full code or do not resuscitate/intubate, cancer-directed treatment or hospice. We often forget that there is a lot of grey and nuance in life and in death.

The cover feature on correcting hospice misconceptions in this seasonal issue of CURE by Senior Editor Alex Biese elegantly debunks the black and white and dives into the nuance of supportive care, palliative care and hospice care, as well as the crucial role they can play in one's cancer journey.

There is a growing movement for patients and their families to define priorities in life and at the end of life through living wills, health care proxies and the electronic medical orders for life-sustaining treatment form.

Hospice care continues to evolve to meet the needs of patients and families. Initially focused on inpatient end-of-life care, excellence in nursing and symptom management in the last days of life, hospice has evolved to a team-based approach including a wide range of health professionals: nurses, social workers, counselors, pharmacists, physicians and caregivers.

Dr. Jennifer S. Temel at Massachusetts General Hospital and colleagues published groundbreaking work more than 15 years ago in the New England Journal of Medicine, showing that early integration of palliative care and supportive oncologic measures in people diagnosed with stage 4 lung cancer led to improvement in both quality of life and mood. Those who received early palliative care and hospice referral had less aggressive care at the end of life but longer survival when compared with those who received more aggressive systemic anticancer therapy at the end of life.

Stigma with regard to cancer and end-of-life care continues to exist. In my experience, this stigma may be rooted in dogma and fear, but it is almost always rooted in love; the love of a child or sibling, husband or wife ... not bearing the pain or the unknown of living without them. Hospice care can provide support, comfort and dignity at the end of life, both for those afflicted with cancer and for those who love them.