Guías Médicas por Condición

Cancer

While a patient's goal is long-term control of the malignancy, there may come a time when the cancer can no longer be controlled or when the response to treatment is less than hoped for.

Hospice care for a cancer patient is designed for the treatment of a wide range of issues, including pain, weight loss and progression of other symptoms, such as dyspnea. Additionally, Hospicio Toque de Amor provides the emotional and spiritual support so many oncology patients and their loved ones seek-all tailored to the patients' needs.

When is your cancer patient ready for hospice care?

Below are a variety of systems used to assess prognosis in patients with oncological diseases. Because specific patient prognosis varies from individual to individual, we suggest using these factors as general guidance.

ECOG Score

Using the ECOG (Eastern Cooperative Oncology Group) scale, a median survival of three months roughly correlates with an ECOG score of >3.

0: Asymptomatic
1: Symptomatic but completely ambulatory
2: Symptomatic, <50% in bed during the day
3: Symptomatic, >50% in bed but not bedbound
4: Bedbound
5: Death

Ask the Patient

The simplest method to assess functional ability is to ask patients: How do you spend your time? How much time do you spend in a chair or lying down?

If the response is that >50% of their time is spent sitting or lying down and that time is increasing, you can roughly estimate the prognosis at three months or less. Survival time tends to decrease further with increasing numbers of physical symptoms—especially dyspnea, if secondary to the cancer.

Karnofsky Ratings

Using the Karnofsky Performance Status scale1, a median survival of three months roughly correlates with a Karnofsky score <40.

100: Normal; no complaints; no evidence of disease
90: Able to carry on normal activity; minor signs or symptoms of disease
80: Normal activity with effort; some signs or symptoms of disease
70: Cares for self; unable to carry on normal activity or do active work
60: Requires occasional assistance, but is able to care for most personal needs
50: Requires considerable assistance and frequent medical care
40: Disabled; requires special care and assistance
30: Severely disabled; hospital admission is indicated although death is not imminent
20: Very sick; hospital admission necessary; active supportive treatment necessary
10: Moribund; fatal processes progressing rapidly
0: Dead

Number Staging Systems

Number staging systems usually employ the TNM (tumor, nodes, metastasis) system to divide solid tumor cancers into stages. Most types of cancer have 4 stages, numbered from 1 to 4 in Roman numbers.

Here is a brief summary of what the stages mean for most types of cancer:

I. Usually means a cancer is relatively small and contained within the organ it started in.

II. Usually means a cancer has not started to spread into surrounding tissue but the tumor is larger than in stage I. Sometimes stage II means that cancer cells have spread into lymph nodes close to the tumor. This depends on the particular type of cancer.

III. Usually means the cancer is larger. It may have started to spread into surrounding tissues.

IV. Means the cancer has spread from where it started to another body organ. This is also called secondary or metastatic cancer.

Other factors

Several common cancer syndromes have well-documented short median survival X2:

Malignant hypercalcemia: 8 weeks, except newly diagnosed breast cancer or myeloma
Malignant pericardial effusion: 8 weeks
Carcinomatous meningitis: 8–12 weeks
Multiple brain metastases: 1–2 months without radiation; 3–6 months with radiation
Malignant ascites, malignant plural effusion or malignant bowel obstruction: <6 months

Categories of Cancer Treatment

Categories of end-stage cancer treatment can be considered as well. Categories listed here are evaluations of tumor progressions and likely treatment or non-treatment options.

Oncologists traditionally rely on charts that rank malignancies on scales of treatability/probability of cure/prognosis, from curable to untreatable. The most common malignancies are categorized from the point of view of hospice appropriateness. Treatments and medications change quickly; this chart is a guideline as specific diseases may move from one category to another.

Category 1:

Treatable; high or moderate expectation of cure.
Testicular carcinoma
Choriocarcinoma and trophoblastic malignancy
Childhood acute lymphoblastic leukemia
Other pediatric malignancies
Acute promyelocytic leukemia
Hodgkin's disease

Category 2:

Treatable; high probability of complete remission, low probability of cure.
Ovarian carcinoma
Adult acute myeloblastic leukemia and acute lymphoblastic leukemia
Intermediate and high-grade non-Hodgkin's lymphoma
Small-cell (oat cell) bronchogenic carcinoma

Category 4:

Treatable in a minority of patients with metastatic disease; less favorable prognosis
Bladder carcinoma
Primary brain tumors
Glioblastoma
Grade III astrocytoma
Gynecological malignancies other than ovary
Colorectal carcinoma
Non-small-cell bronchogenic carcinoma
Squamous-cell carcinoma
Adenocarcinoma
Large-cell carcinoma
Broncho alveolar carcinoma
Head and neck carcinomas
Esophageal carcinoma
Gastric carcinoma
Pancreatic carcinoma
Soft-tissue sarcomas
Renal cell carcinoma

Category 5:

Generally unresponsive to standard therapy
Renal cell carcinoma
Malignant melanoma
Hepatobiliary and gall bladder carcinoma
Adrenal carcinoma
AIDS-associated high-grade lymphoma

CMS Medicare provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.