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Oncology

The following categories are considered “hospice appropriate” due to the small probability that treatment would result in cure or cessation of disease. Since categories 1 and 2 include diseases with a greater probability for successful outcome, they are not included in this chart.

Category 3

Malignancies that are treatable but incurable (when metastatic) in a large percentage of patients, with favorable prognosis.

Diseases:

  • Prostate carcinoma
  • Breast carcinoma
  • Chronic lymphocytic leukemia
  • Chronic myelocytic leukemias
  • Other advanced myeloproliferative disorders
  • Non-Hodgkin’s lymphomas other than large cell
  • Multiple myeloma and the immunoproliferative disorders
  • Myelodysplastic syndrome

Characteristics:

  • Often may be controlled for prolonged periods with oral hormonal therapy or chemotherapy.
  • Often require no therapy or are only treated when symptoms occur.
  • These patients generally have a history of having received and failed one or more (dependent on the illness) standard therapeutic regimens, and should have symptoms compatible with disease progression before considering the hospice option.

Category 4

Malignancies that are treatable in only a small percentage of patients, with less favorable prognoses.

Diseases:

  • Invasive bladder carcinomas
  • Primary brain tumors-glioblastoma
  • Gynecological carcinomas other than ovary
  • Colorectal carcinoma
  • Gastric carcinoma
  • Head and neck carcinomas
  • Esophageal carcinoma
  • Non-small cell bronchogenic carcinomas
  • Soft tissue sarcomas

Characteristics:

  • Majority are adult solid tumors.
  • Presence of metastatic disease is generally indicative of terminal prognosis.
  • Usually 40% or less of patients have an objective response to chemotherapy.
  • Chemotherapy responses are usually not durable.
  • Impact of chemotherapy on symptoms and quality of life is not well documented in the medical literature.
  • As chemotherapy is of limited benefit to most patients once these diseases have metastasized such patients could be offered the option of hospice services in lieu of chemotherapy.
  • If chemotherapy is chosen by the patient as a therapeutic option, failure of first-line therapy should prompt serious consideration of hospice as the most appropriate second-line treatment.

Category 5

Malignancies that are virtually untreatable.

Diseases:

  • Renal cell carcinoma (hypernephroma)
  • Pancreatic carcinoma
  • Malignant melanoma

Characteristics:

  • Generally resistant to currently available chemotherapeutic modalities.
  • With the lack of efficacious systemic therapy available, patients who suffer from these illnesses and have metastatic disease should be offered hospice as an option on presentation.