Few people want to die in a hospital. Yet every year, millions do –– often needlessly. It’s an unpleasant and unnecessarily expensive way to conclude a life. Fortunately, there’s a better way. If you or a loved one has decided not to continue with cancer treatment or has received a terminal prognosis, then end-of-life and hospice care may be ideal. Here’s what you should know.
Cutting Back on Cancer Treatment
Although the cells in our body usually do their job and pass through their life cycles without incident, occasionally a cell is damaged. Cancer happens as the result of mutations in your DNA –– a damaged cell that divides instead of dying. Although the tumor that results is often benign, occasionally it’s cancerous. Extreme measures may need to be taken to stop its spread. Even healthy young adults often forgo treatment, opting for riskier alternative methods because chemo and radiation have such fearsome side effects. For people who are older or in poor health, treating cancer may not be in their best interests or desired by the patient.
Survival rates for many cancers are improving, but those odds diminish with age. In fact, while cancer-related mortality has decreased by five percent in people under the age of 65, for those over age 65 it has actually increased by 15%. Compared to younger adults, when a person turns 65 they face an 11-fold increased risk in developing cancer. Fighting cancer can be extremely involved, requiring multiple trips to inconvenient medical centers. Besides the side effects common to many cancer treatments, it’s also very expensive. Those who wish to leave their children something more than medical debt often decide to forgo treatment. For these reasons, many people, especially older adults, choose to either discontinue ongoing treatment or decide not to embark on a program at all. Of course your oncologist may even advise you that the chance of treatment succeeding is punishingly small. If you or a loved one has recently learned that you’ll have less than six months to live, then end-of-life or hospice care may be the best option.
About Hospice Care
The good news is that fewer Americans are dying in hospitals. The Centers for Disease Control and Prevention reports that the percentage of deaths from all causes that occurred in a hospital decreased by nearly 50% between the year 2000 and 2018. Although the COVID-19 pandemic likely altered those statistics, the percentage of people dying at home also increased from 22.7% to 31.4% during the same period.
Unfortunately, many people needlessly die in hospitals because they haven’t made their end-of-life preferences clear to their loved ones. That’s why experts recommend planning ahead and providing a clear directive for your final wishes including location and whether or not to permit extreme measures to remain alive. Otherwise, you may be incapacitated and subjected to painful, invasive, and pricey treatments in a failing effort to keep you alive.
Of course, the best option is to be able to choose hospice care while you’re lucid and able to make your own decisions. Keep in mind that hospice and palliative care are often confused. Palliative care is about managing symptoms and side effects. A medical team including pain management specialists and spiritual advisors is deployed to increase the patient’s comfort. Palliative care often works in concert with traditional treatment, but it can also be utilized during end-of-life care when the patient stops traditional treatment. End-of-life care doesn’t necessarily mean stopping all medical interventions. If you take medication for your high blood pressure, for example, you’ll likely continue it.
Just as with palliative care, your hospice care will be overseen by a team. At least one team member will be available by phone around-the-clock for assistance. Hospice teams coordinate with loved ones and the patient to make sure that their comfort and peace of mind is maintained. Spiritual advisors are a component, as is pain management. Hospice care is often covered by Medicaid and private insurance assuming the patient has a qualifying diagnosis that they have six months or less of life to live.
Although people often think of an outside facility when they think about hospice care, in truth, most end-of-life care is delivered to the patient’s home. This is where they are most comfortable after all. Hospice care isn’t a prison sentence. You can choose to change your medical plan and resume treatment at any time. Often patients surprise even their physicians and outlive a terminal diagnosis by months or even years.
As the American Cancer Society explains, “The hospice philosophy accepts death as the final stage of life: it affirms life, but does not try to hasten or postpone death. Hospice care treats the person and symptoms of the disease, rather than treating the disease itself… Hospice care is also family-centered –– it includes the patient and the family in making decisions.”
Not every patient choosing end-of-life care is over 65 as terminal illnesses don’t discriminate on the basis of age or for any other reason. Unfortunately, around 70% of people under 18 with life-limiting conditions die in hospitals –– with many of them either economically deprived or from ethnic minorities. Meanwhile young adults may opt for hospice care over invasive, unlikely treatment. It’s important to discuss your choice with your primary care physician and oncologist as in some cases they may expect that you’ll choose treatment over hospice. Some 70% of adults would rather die at home than in a hospital. If you’re one of them, it’s important to make plans for your end-of-life today regardless of your current health.
Written by John Bankston
References
- DNA damage and gene mutations
- Cell Cycle
- Neoplasm (Tumor)
- What is Cancer?
- Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers
- Applications in Geriatric Oncology
- QuickStats: Percentage of Deaths,* by Place of Death† — National Vital Statistics System, United States, 2000–2018
- What Are Palliative Care and Hospice Care?
- Most children with life-limiting conditions still die in hospital, not home or hospice
- Views and Experiences with End-of-Life Medical Care in the US