94 Cancer

• Clinical findings of malignancy with widespread, aggressive, or progressive disease as evidenced by increasing symptoms, worsening lab values, and/or evidence of metastatic disease AND
• PPS 70 % or less AND
• Refuses further life-prolonging therapy or continues to decline in spite of definitive therapy
  • (may receive disease-specific intervention if palliative)

The following cancer disease categories are considered hospice appropriate due to the small probability that treatment would result in cure or cessation of disease:

• Category 3: malignancies that are treatable but incurable when metastatic in a large percentage of patients, with favorable prognosis:
  • prostate, breast, CLL, CML, NHL, multiple myeloma, myelodysplastic syndrome
  • (often may be controlled for periods of time with hormonal and/or chemotherapy, may require no therapy or are only treated when symptoms occur, generally have a history of having received and failed one or more standard therapeutic regimens and should have symptoms compatible with disease progression before considering hospice option)
• Category 4: malignancies that are treatable in only a small percentage of patients with less favorable prognosis:
  • invasive bladder, glioblastoma, gynecological carcinomas other than ovary, colorectal, gastric, head and neck, esophageal, NSCLC, soft tissue sarcoma
  • (majority are adult solid tumors, presence of metastatic disease generally indicative of a terminal prognosis, usually 40% or less of patients have an objective response to chemotherapy, chemotherapy responses are usually not durable, impact of chemotherapy on symptoms and quality of life not well documented in medical literature, as chemotherapy is of limited benefit to most patients once these diseases have metastasized such patients could be offered the option of hospice in lieu of chemotherapy, if chemotherapy is chosen by the patient as a therapeutic option, failure of first-line therapy should prompt serious consideration of hospice)
• Category 5 malignancies that are virtually untreatable:
  • renal cell, pancreatic, malignant melanoma
  • (generally resistant to currently available chemotherapy, with the lack of efficacious systemic therapy – patients with these diseases and have metastatic disease should be offered hospice As an option)