Hospice & Palliative Care

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

  • Breast cancer is the most frequently diagnosed and is the leading cause of death from cancer in women worldwide.
  • Lung cancer is the most frequently diagnosed and the leading cause of death from cancer in men worldwide.
  • Cancer is the second most common cause of death in the United States following heart disease.

Cancer refers to a group of diseases that are characterized by uncontrolled growth and spread of abnormal of mutated cells that can be caused by external and internal factors. Mutated cells have certain characteristics as follows:

  • can avoid apoptosis (cell death)
  • resist normal aging process
  • can replicate outside normal controlling mechanisms
  • produce chemicals that dissolve surrounding tissue
  • invade other parts of the body
  • overcome the immune system
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Determining Prognosis: Patients with End-Stage Lung Disease (Reading & Sharing)

Disabling Dyspnea & Respiratory Distress

Defined by:

  • Dyspnea at rest or with minimal exertion
  • Dyspnea poorly responsive or unresponsive to bronchodilator therapy
  • Dyspnea results in other debilitating symptoms such as decreased functional activity, fatigue, and cough
  • FEV-1< 30% predicted post-bronchodilator, if available
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Chronic Obstructive Pulmonary Disease (COPD) – Reading & Sharing

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. It is highly prevalent, and as it progresses, causes patients to become too disabled to work, thus creating substantial economic and social burdens. In 2010, U.S. healthcare data estimated the total economic burden from COPD at $50 billion, of which $30 billion was related to direct medical expenditures and the remaining $20 billion related to morbidity, loss of work, and premature death. There are also unacknowledged and unquantified costs including the economic value of care provided by family members and their potential lost wages as they stay home to care for the patient.

As the disease progresses, some patients will choose mechanical ventilation as a palliative treatment option. although the patient with advanced disease is eligible for hospice care, many hospices cannot afford to accept the patient with mechanical ventilation into their programs because this high-tech intervention drives the cost of care beyond the standard insurance reimbursement. Thus, patients and families may be deprived of the benefits of hospice care.

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