(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.