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Palliative vs Hospice Care

Reach out towards care that brings you comfort.

“A paradigm shift of viewing palliative care or hospice as a gift instead of seeing it as giving up has the potential to change the way we experience advanced age.”

- Lisa J. Shultz, A Chance to Say Goodbye: Reflections on Losing a Parent

If you are diagnosed with advanced or metastatic cancer, there are a number of issues that you need to get clarity on. You and your cancer team owe each other a frank and realistic discussion on future steps and goals that may change over time, especially in the light of the latest diagnosis. Sometimes pursuing aggressive treatments or clinical trials is the right way to proceed while in some cases, palliative care or hospice care may be the right option to help control the symptoms and side effects of advanced cancer.

“There is one and only one goal for all of us—to ensure that all our intellectual efforts are directed toward the relief of humanity’s suffering.” ― Azra Raza, The First Cell: And the Human Costs of Pursuing Cancer to the Last

Palliative care is quite often misunderstood in cancer care. A lot of people don’t know what it is; many more believe it’s for patients who are dying and have no options left with regards to treatment. In fact, palliative care is compassionate comfort care that provides relief from the symptoms and physical and mental stress of a serious or life-limiting illness, whether cancer or other. Palliative care can be put into place right at diagnosis, during treatment or at the end of life. Palliative care can occur alongside your cancer treatment. From stage one patients grappling with chemo-induced nausea to metastatic patients coping with constant pain from their ongoing therapy – everyone can benefit from palliative care.

Palliative care can occur alongside your cancer treatment.

Palliative care helps to make the transition from treatment meant to cure or control the disease to hospice care by preparing patients and their caregivers for the so many physical and emotional changes that occur during this time. Research shows that palliative care and its many components are significantly helpful to the patient’s health and wellbeing. In recent years, some studies have shown that integrating palliative care into a patient’s cancer treatment soon after a diagnosis of advanced cancer can improve his or her quality of life (including emotional and mental wellbeing) and may prolong survival.

Hospice care is similar to palliative care, but there are important differences. Hospice care begins when curative treatment is no longer the goal of care and the sole focus is quality of life. Hospice care is reserved for terminally ill patients, usually during the last 6 months of life, assuming the disease takes its normal course. In a few words, hospice care is compassionate comfort care (as opposed to curative care). Hospice eligibility requires that two physicians certify that the patient has less than 6 months to live if the disease follows its usual course. Palliative care patients, on the other hand, do not have to meet the same requirements.

Choosing hospice care doesn't mean that you've given up hope.

Instead, hospice care means you’re changing what you hope for. This could be hoping for a good quality of remaining life, including more time with loved ones and friends. Hospice care can be given in different places although most often is given at home. But it can also be provided in special inpatient facilities, hospitals, and nursing homes. It can also take place along with professional home care if necessary. In the case of hospice care, it is important to have advanced directives in place. Families and healthcare professionals know that when someone is in hospice care, painful or intrusive treatments, admission to intensive care units, or frightening ambulance trips to emergency rooms, for example, may not be wanted or accepted. In fact, if a patient has a medical emergency, families or caregivers are instructed to call the hospice provider rather than 911.

“Endings matter, not just for the person but, perhaps even more, for the ones left behind.” - Atul Gawande, Being Mortal: Medicine and What Matters in the End

Both types of care, whether palliative or hospice, provide support during a very challenging time. Both are difficult decisions to make, complicated, emotionally draining and even, heartbreaking. Yet, both help patients and caregivers during an often lonely and frightening time, prevent caregiver burnout and allow cancer patients to have the final say.

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Reason to Hope

There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054 

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