Hospice & Palliative Care

End Stage Disease Progression and Complications – Oncologic Disorders (Learning Hospice)

End-stage disease oncologic disorders may vary depending on the type of cancer and the areas of metastasis but often includes the following:

  • Pain: This is the most common complication due to pressure from tumors on surrounding tissue, causing ischemia and nerve compression. Pain may be localized or generalized. Opioids are the treatment of choice, usually on a continuous round-the-clock schedule with additional doses for breakthrough pain at end-stage to provide as much comfort as possible.
  • Nausea/ vomiting: Anti-emetics and /or medical marijuana may help to reduce nausea and vomiting. The patient’s diet should be altered to include those foods the patient can best tolerate, often soft, bland or liquid foods.
  • Dyspnea: Dyspnea is common, and supplementary oxygen may help to provide some relief.
  • Confusion: Supportive care and reorientating the patient may help to reduce confusion, but confusion often persists, especially with high doses of opioids.
  • Bowel/ bladder dysfunction: This is common because of dehydration and opioid use. Stool softeners, laxatives, and encouraging fluid intake may help. If the patient is till able to eat, adding yogurt, fiber, and prune juice to the diet may be helpful.

Factors supporting hospice referral:

  1. Disease with distant metastases at presentation

OR

2. Progression from an earlier stage of disease to metastatic disease with either:

  • Continued decline in spite of therapy (like palliative chemo or radiation)

OR

  • Patient refuses further disease related therapy

Certain cancers with poor prognoses, such as small cell lung cancer, brain cancer, and pancreatic cancer, may be hospice eligible without fulfilling the other criteria in this section.

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