End-Stage Cancer: What to Expect

As individuals with cancer near the end of life, several changes and challenges may arise, both physically and emotionally. While the experience can vary from person to person, here are some common challenges that may arise:

Physical Changes: Physical symptoms tend to intensify as cancer progresses. Pain may become more severe and difficult to manage, requiring stronger pain medications or palliative interventions. Fatigue often becomes overwhelming, leading to increased weakness and limited mobility. Loss of appetite and unintended weight loss are common, as the body’s energy needs decrease. Other physical changes may include changes in bowel and bladder function, difficulty swallowing, respiratory distress, and increased susceptibility to infections. The body may gradually slow down, and individuals may spend more time sleeping or in a sedated state.

Emotional and Psychosocial Challenges: Near the end of life, individuals with cancer may experience a wide range of emotional and psychosocial challenges. Anxiety, fear, and sadness are common as they face the reality of their prognosis. They may also grapple with feelings of grief and loss as they confront the impending end of life. Emotional support needs may vary, and some individuals may find solace in seeking spiritual guidance or counseling to address their emotional and existential concerns. Family members and loved ones may also experience significant emotional strain as they navigate their own emotions while providing support and witnessing their loved one’s declining health.

Changes in Cognitive Function: Some individuals may experience cognitive changes, such as confusion, disorientation, or difficulty with concentration and memory. This can be attributed to various factors, including the progression of cancer, side effects of medications, or metabolic imbalances. These cognitive changes can impact communication and daily functioning, requiring additional support and understanding from caregivers.

Increased Need for Personal Care Assistance: As cancer advances, individuals may require more assistance with activities of daily living (ADLs) such as bathing, dressing, toileting, and feeding. The physical limitations and fatigue may make it challenging for individuals to perform these tasks independently, necessitating the support of family members, caregivers, or hospice professionals to ensure their comfort and well-being.

Social and Relationship Changes: Near the end of life, individuals may experience changes in their social relationships and dynamics. They may withdraw from social interactions, preferring solitude or limited company. Relationships with loved ones may become more intense and emotionally charged as individuals reflect on their lives and prepare for their impending departure. Support from hospice professionals can help facilitate open communication and provide guidance to family members, ensuring they have the tools to navigate these changes and maintain meaningful connections.

Spiritual and Existential Reflection: Many individuals facing end-stage cancer experience spiritual and existential contemplation. They may seek to find meaning, resolve unfinished business, or engage in spiritual practices that align with their beliefs and values. Hospice care recognizes the importance of addressing these spiritual needs, offering spiritual support and guidance to help individuals find comfort and peace in their own unique ways.

Hospice care provides invaluable support to individuals with cancer and their families during this difficult time. Hospice teams are experienced in effectively managing pain and other distressing symptoms, employing a multidisciplinary approach to ensure optimal comfort. They work closely with healthcare providers to develop personalized pain management plans, adjusting medications and utilizing various palliative therapies to alleviate discomfort. Hospice professionals also address the emotional and psychosocial needs of individuals, offering compassionate counseling, emotional support, and spiritual guidance to help navigate the uncertainties and emotional toll of the end-of-life journey. Additionally, hospice extends its support to family members, providing them with education, respite care, and bereavement services to help them cope with the challenges and transitions ahead. By providing comprehensive care, hospice aims to enhance the overall well-being, dignity, and quality of life for individuals with cancer and their loved ones.

Hospice Eligibility Guidelines for Cancer

We understand that navigating the complexities of hospice care can be overwhelming, especially when a loved one has cancer. This page aims to provide you with a comprehensive guide to the eligibility guidelines for hospice care specifically designed for individuals with cancer.

Disease Specific Guidelines

Patients who meet the following criteria will be deemed to be in the terminal stage of cancer as highlighted below, with a life expectancy of six months or less if the illness runs its course. These criteria apply to patients with different forms of cancer who ultimately follow a final common pathway for end-stage disease. 

  1. Progression of cancer from an earlier stage to metastatic disease with either:
    1. Patient declining further treatment
    2. Continued decline despite treatment
  2. Disease with metastases at presentation

Non-Disease Specific Guidelines

  1. Physiologic impairment of functional status demonstrated by a score < 70% using either:
    1. Karnofsky Performance Status (KPS)
    2. Palliative Performance Scale (PPS)
  2. Dependence on assistance for two or more of the following activities of daily living (ADLs):
    1. Feeding
    2. Bathing
    3. Dressing
    4. Toileting
    5. Ambulation (walking/moving)
    6. Transfer


Although not the primary hospice diagnosis, the presence of certain co-morbidities should be considered in determining hospice eligibility, as the severity of these conditions is likely to contribute to a life expectancy of six months or less. These co-morbidities may include:

  • Chronic obstructive pulmonary disease
  • Congestive heart failure
  • Ischemic heart disease
  • Dementia
  • Renal failure
  • Diabetes mellitus
  • Liver disease
  • Acquired immune deficiency syndrome (AIDS)
  • Neurologic disease (CVA, ALS, MS, Parkinson’s)
  • Neoplasia

Disclaimer: Please note that the information provided on this page is intended for general guidance purposes only and should not replace professional medical advice. Each individual’s situation is unique, and eligibility for hospice care should be assessed by qualified healthcare professionals.


Benefits of Hospice Care for Individuals with Cancer:

Hospice care offers numerous benefits tailored to the specific needs of individuals with cancer. Some of these benefits include:

1. Pain and Symptom Management: Hospice care focuses on alleviating pain and managing distressing symptoms associated with cancer.

For those with cancer this may include managing symptoms commonly experienced which may include:

  • Pain
  • Anxiety
  • Cognitive decline
  • Weakness and easy fatigue
  • Nausea and vomiting
  • Decreasing functional status
  • Decreased oral intake and weight loss
  • Constipation
  • Depression
  • Restlessness
  • Shortness of breath

The interdisciplinary team, including physicians, nurses, respiratory therapists, social workers, and chaplains, work together to develop a comprehensive plan that addresses the unique needs of each patient.

2. Medication and Equipment Support: Hospice provides medications and other necessary equipment related to managing the symptoms that may arise. This ensures that patients have access to the resources they need to maintain comfort and improve their quality of life. All medications and durable medical equipment related to the terminal condition are covered under the hospice benefit. With cancer, this may include a wide range of supplies including items like a hospital bed, mobility aides, oxygen concentrator, bedside table, or additional items determined to be necessary by agreement of the hospice team, patient, and caregivers.

3. Emotional and Psychosocial Support: Hospice care extends support not only to patients but also to their families and caregivers. Helping a loved one with cancer can be challenging. Social workers and counselors are available to provide emotional support, counseling, and resources to cope with the challenges that arise during this difficult time. The nursing team is available to assist in educating and guiding you through providing the best care to your loved one.

4. Skilled Nursing Care: Hospice care includes skilled nursing services provided by specially-trained hospice nurses who have expertise in managing the complexities of many conditions, including care of those with cancer. These skilled nurses assess and monitor the patient’s condition, provide anticipatory guidance based on disease progression, educate the patient and caregivers, manage medications, provide wound care if needed, and collaborate with other healthcare professionals to ensure comprehensive care.

5. Assistance with Activities of Daily Living (ADLs): Nurse aides, also known as certified nursing assistants (CNAs), are an integral part of the hospice team. They provide hands-on assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, and toileting. For individuals with cancer this can be of vital importance due to increased dependence, shortness of breath, pain, muscle weakness and easy fatigue, and/or cognitive decline.

6. 24/7 Access to Care: Hospice care offers round-the-clock access to the hospice team, providing peace of mind for patients and their families. This availability ensures that assistance is available whenever it is needed, even outside regular office hours.

7. Spiritual and Bereavement Support: Hospice care acknowledges the importance of spiritual and emotional well-being during end-of-life care. Chaplains or spiritual counselors are available to provide spiritual support, and bereavement services are offered to help families cope with grief and loss after the passing of a loved one.

8. Self-guidance: An individual is allowed to receive care in their preferred setting and have input on their care allowing for an increased sense of comfort.

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Not sure if you or a loved one are eligible to receive hospice care?

Contact the Honor Hospice team for an evaluation to determine if hospice is an appropriate care option.

If you have any questions regarding hospice eligibility guidelines for individuals with cancer, please feel free to contact us. Our compassionate team at Honor Hospice is dedicated to providing information, support, and personalized care during this challenging time.

Take the first step towards compassionate care and learn how hospice can make a difference in your life or the life of your loved one.