Palliative and hospice care serve a critical role in the progression of life-threatening diseases, yet they’re often overlooked and not used to full advantage. In light of November being National Hospice and Palliative Care Month, we wanted to spend a few minutes highlighting this important form of care, particularly as it relates to cancer.
Is there a difference between them?
Given that both forms of care provide comfort and support—focusing on caring, not curing, they’re understandably often lumped together.1,2 Yet palliative care can be given to patients or families and it’s most effective if it begins at diagnosis and continues alongside traditional treatment.1 Hospice care, on the other hand, is patient-specific and initiated towards the end of life, once treatment is no longer controlling the disease or a terminal diagnosis has been given (life expectancy of about six months or less).2
What do they entail?
Both palliative and hospice care can be provided in a hospital, outpatient facility, assisted/nursing home, or at home, and the approach can be designed to meet an individual’s needs. In general, a comprehensive palliative care approach includes services to relieve the physical pain associated with cancer, cope with its emotional strain, assist with legal and financial concerns, and encourage spiritual exploration and reflection.1 Although these are also components of hospice care, once hospice has begun the emphasis typically shifts to alleviating any physical pain in order to make the patient as comfortable as possible.2
Who delivers it?
There are a lot of moving parts when it comes to the delivery of palliative and hospice care, and any number of people can help provide some component, per the National Hospice and Palliative Care Organization’s (NHPCO) figure of a typical interdisciplinary team.3
Do people use it?
Unfortunately both palliative and hospice care are underutilized, perhaps due in part to financial concerns, hospice’s stigma of “giving up,” and the misconception that palliative care is only necessary at the end of life.3,4 According to the NHPCO’s recent report, the greatest proportion of hospice stays in 2012 were for less than seven days, meaning those patients were not reaping the full benefits of such care.3 Both palliative and hospice care have its merits and should be considered much earlier in the process for added benefits.
Do they work?
A recent review concluded that early integration of palliative care services with standard treatments for advanced cancer led to improvements in quality of life, symptom burden, mood, and quality of care at the end of life across the board.5 In some cases it may even help prolong patient survival.5 And in addition to helping manage pain and other issues, hospice can help patients with acceptance and provide some dignity during a difficult time.
Additional Information
To learn more about palliative and hospice care, what’s covered by Medicare, Medicaid and other insurance plans, how to determine when they’re is appropriate, and more, visit Caring Connections, a national program of the NHPCO’s designed for patients and caregivers.
Caryn Huneke is completing her dietetic internship and MS degree in Nutrition Education at Teachers College, Columbia University to become a Registered Dietitian.
References
Fact Sheet: Palliative Care in Cancer. National Cancer Institute. Accessed on November 19, 2013.
Fact Sheet: Hospice Care. National Cancer Institute. Accessed on November 19, 2013. http://www.cancer.gov/cancertopics/factsheet/Support/hospice
NHPCO Facts and Figures: Hospice Care in America. Alexandria, VA: National Hospice and Palliative Care Organization, October 2013.
Gazelle, G. Understanding Hospice — An Underutilized Option for Life’s Final Chapter. N Engl J Med 2007;357:321-324.
Greer, J.A., Jackson, V.A., Meier, D.E., Temel J.S. Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA: Cancer Journal for Clinicians. 2013;63(5):349-363.
