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.
Malignancies that are treatable but incurable (when metastatic) in a large percentage of patients, with favorable prognosis.
- 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
- 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.
Malignancies that are treatable in only a small percentage of patients, with less favorable prognoses.
- 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
- 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.
Malignancies that are virtually untreatable.
- Renal cell carcinoma (hypernephroma)
- Pancreatic carcinoma
- Malignant melanoma
- 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.