End-Stage Cancer: Guidelines for End-Stage Cancer and Related Disorders

LIFE LIMITING CONDITION AS EVIDENCED BY:

• Documentation of clinical progression of disease evidenced by:
  • Physician assessment.
  • Multiple ER visits.
  • Laboratory studies.
  • Inpatient hospitalizations.

AND/OR:

• PPS 70% or less.
• Dependence in 3 or 6 Activities of Daily Living (ADLS) such as bathing, dressing, feeding, transferring,
  continence, ambulation.
• Unintentional, progressive weight loss of 10% of total body weight over the past 6 months.
• Serum albumin <2.5gm/dl (may be helpful prognostic indicator but should not be considered alone).
• Radiologic or other studies.

GENERAL INDICATORS:

• Patient/family desires no further aggressive medical intervention including acute care hospitalization.
• Has diagnosed and medically documented metastatic disease.
• Active co-morbidity accelerating the trajectory of the terminal illness.
• Progressive symptoms despite medical intervention and evidence of decline medically documented such as:
  • Increasing tumor mass.
  • Stage of tumor.
  • Recurrence of disease.
  • Failure or declination of chemotherapy/radiation.

HOW WE HELP — END-STAGE CANCER:

• Educational and emotional support regarding cessation of treatment.
• Aggressive pain management and education with patient and family about what to expect with progression of illness.
• Use of palliative treatments to relieve symptoms as appropriate.
• Nutritional counseling as requested by family and patient.
• Coordination of comfort measures for patient, including durable medical equipment and non-medical therapies.
• Psychosocial and bereavement support for patient and family.
• Caregiver support.
• Spiritual support for patient and family.
• Connection with community resources as necessary.