End of Life Considerations

Hospice and palliative care share similar goals of symptom management, pain relief, patient comfort and a focus on quality of life for terminal patients whose treatment options have come to an end or treatment side effects preclude further treatment. 

What is Palliative Care?

Palliative care is care is intended to help terminal patients receive needed complimentary therapy and improve the quality of lifeof patients who have a serious or life-threatening disease, such as metastatic breast cancer. Palliative care is intended to addresses the person as a whole, not just their disease. The goal is to prevent or treat, as early as possible, the symptoms and side effects of the disease and its treatment, in addition to any related psychological, social, and spiritual problems.  Palliative care is also called comfort care, supportive care, and symptom management. Patients may receive palliative care in the hospital, an outpatient clinic, a long-term care facility, or at home under the direction of a physician. Not all hospitals or cancer centers have a palliative care program but you should ask your physician, social worker or nurse navigator at your cancer center.

Palliative care may be provided at any point along the metastatic breast cancer journey, from diagnosis to the end of life. When a person receives palliative care, he or she may continue to receive cancer treatment.

The Center to Advance Palliative Care Treatment has a list of providers by state. You can find out if there is a provider in your area by clicking here https://getpalliativecare.org/provider-directory/

What is End of Life Care?

End of life care is intended to keep you comfortable and pain free. Hospice Care is one service to consider to keep you comfortable.

Hospice care is typically used by patients when treatment is no longer working for your metastatic breast cancer or you may decide you are ready to stop them. Your doctor can make a referral for hospice care, also known as end-of-life care. The referral can be made up to

You may want relief from pain, shortness of breath, and other symptoms so that you can focus on the people and things you care about the most. That's when hospice, or end-of-life care, may help.

Hospice care does not necessarily mean that you are giving up. You may worry that you won’t get the medical care you need. But the service simply focuses on the quality of your life instead of trying to cure a disease.

Your hospice team may include a doctor, nurse, social worker, counselor, chaplain (if you’re religious), home health aide, and trained volunteers. They work together to meet your physical, emotional, and spiritual needs.

Hospice is for family members, too. It offers counseling and help with practical things such as cleaning house and shopping.

You may enter a hospice program if your doctor determines you metastatic breast cancer is progressing and there are no additional treatment options and that death can be expected in 6 months or less. You can stay in hospice beyond that time if your doctor and the team decide you still have only a short time to live.

Hospice isn't always a permanent choice.

For example, if your kidneys are failing, you might choose the hospice program rather than continuing with dialysis. But you can still change your mind, stop hospice care, and start back on treatments. Other people may get better unexpectedly and quit the service with the option of returning later.

Hospice differs from palliative care, which serves anyone who is seriously ill, not just those who are dying and no longer seeking a cure

How Does Cancer Cause Death? Death from cancer can vary by patient and sometimes depends where the cancer has spread. Sometimes, cancer treatments are not effective anymore or a person cannot handle the side effects of treatment.  Cancer can then spread to other healthy tissues and organs taking up the space and nutrients that the healthy organs would use. As a result the healthy organs shut down. Sometime death can come from treatment complications.

During the final stages of cancer, problems may occur in several parts of the body.

  • Lungs: If too little healthy lung tissue is left, or if cancer blocks off part of the lung, the person may have trouble breathing and getting enough oxygen. Or, if the lung collapses, it may become infected, which may be too hard for someone with advanced cancer to fight.
  • Bones: If cancer is in the bones, too much calcium may go into the bloodstream, which can cause unconsciousness and death. Bones with tumors may also break and not heal.
  • Liver: The liver removes toxins from the blood, helps digest food, and converts food into substances needed to live. If there isn’t enough healthy liver tissue, the body’s chemical balance is upset. The person may eventually go into a coma.
  • Bone marrow: When cancer is in the bone marrow, the body can’t make enough healthy blood cells. A lack of red blood cells will cause anemia, and the body won’t have enough oxygen in the blood. A low white blood cell count will make it hard to fight infection. And a drop in platelets will prevent the blood from clotting, making it hard to control abnormal bleeding.
  • Brain: A large tumor in the brain may cause memory problems, balance problems, bleeding in the brain, or loss of function in another body part, which may eventually lead to a coma.

Sometimes patients simply decline slowly, becoming weaker and weaker until they succumb to the cancer.

Every person is different and all have different stages and rates of decline. You will want to consider things like an advanced directive (a signed, notarized document that outlines your wishes to continue efforts to keep you alive if you are incapacitated), your comfort and pain.  Hospice Care is a great service for you to consider as they can provide pain management and care during this time and even at other times during treatment when you aren’t feeling well.

You may want to discuss end of life with your loved ones and determine the best course of action for you.