title: Why oncologists should refer patients earlier for hospice care.
abstract: The majority of patients with advanced malignancy die with a predictable disease trajectory. Increasing use of chemotherapy and radiotherapy near the end of life has not changed that trajectory. For adults with advanced solid tumors, the period from becoming symptomatic to death of the patient is 4 to 6 weeks. Poor performance status is still the most important prognostic factor, among others that have been described. The data are now in; hospice care is the best standard of care for cancer patients, it is not an alternative to standard care. Payers for high-quality cancer care will expect referral with an interval of care--generally on the order of 4 to 6 weeks of enrollment--as a measure of quality cancer care given by the oncologist. In this article, prognostic data are summarized and a suggested approach for discussing hospice enrollment with patients is presented.
authors.affiliation: Institute for Palliative Medicine at San Diego Hospice, San Diego, California 92103, USA. cvongunten@sdhospice.org
authors.forename: Charles F
authors.initials: CF
authors.lastname: von Gunten
authors.forename: Stephen
authors.initials: S
authors.lastname: Lutz
authors.forename: Frank D
authors.initials: FD
authors.lastname: Ferris
mesh_terms: D017051:Hospice Care; D006801:Humans; D006278:Medicare; D009369:Neoplasms / Q000628:therapy*; D011787:Quality of Health Care; D012017:Referral and Consultation; D014481:United States