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.