How do doctors know how long a person will continue to live?

PATIENTS and their family members often want to know how long a person who has cancer or any other terminal illness will continue to live. It’s normal to want to be prepared for the future. But predicting how long someone will continue to live is a hard question to answer. A number of factors, including the type of cancer, its location, and whether the patient has other illnesses, can affect what will happen.

Although doctors may be able to estimate the amount of time someone will continue to live based on what they know about that person, they might be hesitant to do so. They may be concerned about over- or under-estimating the person’s remaining life span. They also might be fearful of giving false hope or destroying a person’s will to live.

When should someone call for professional help if they’re caring for a person who has cancer at home?

People caring for patients at home should ask them if they’re comfortable, if they feel any pain, and if they’re having any other physical problems.

There may be times when the caregiver needs assistance from the patient’s healthcare team. A caregiver can contact the patient’s doctor or nurse for help in any of the following situations:

• The patient is in pain that is not relieved by the prescribed dose of pain medication.
• The patient is experiencing onset of new symptoms, such as nausea, vomiting, increasing confusion, anxiety or restlessness.
• The patient is experiencing symptoms that were previously well controlled.
• The patient shows discomfort, such as by grimacing or moaning.
• The patient is having trouble breathing and seems upset.
• The patient is unable to urinate or empty the bowels.
• The patient has fallen.
• The patient is very depressed or talking about committing suicide.
• The caregiver has difficulty giving medicines to the patient.
• The caregiver is overwhelmed by caring for the patient, is too sad, or is afraid to be with the patient.
• The caregiver doesn’t know how to handle a certain situation.

Keep in mind that palliative care experts can be called upon by the patient’s physician at any point in the person’s illness to help with these issues. They are increasingly available not only in the hospital, but also in the outpatient setting.

When is the right time to use hospice care?

Many people believe that hospice care is only appropriate in the last days or weeks of life. Yet Medicare states that it can be used as much as six months before death is anticipated. And those who have lost loved ones say they wish they had called in hospice care sooner.

Research has shown that patients and families who use hospice services report a higher quality of life than those who don’t. Hospice care offers many helpful services, including medical care, counseling, and respite care. People usually qualify for hospice when their doctor signs a statement saying that patients with their type and stage of disease, on average, aren’t likely to survive beyond six months.

Maybe you have always thought that hospice is for patients who have cancer, but this is not true at all. Any diagnosis that may cause death within six months such as severe heart disease or end stages of any illnesses such as renal failure, or a bad neurologic disorder or stroke, as well as respiratory conditions when it reaches end stage, and end stage liver problems with cirrhosis is acceptable diagnosis for hospice care. Any condition that will result in death in six months or less is what Medicare requires for enrollment in hospice. Again your primary care is well versed in this issue and if you haven’t brought it up for yourself or your loved one, maybe it is time to start thinking of it. Planning ahead makes things easier for everyone, for patients and their loved ones.

As difficulty as it is to say “farewell,” end of life is unavoidable for everyone. As with any difficult issue, the less we talk about it the harder it becomes. End of life is a family event, if not a community event. We all know that if we live, someday we will die. In order to make things a little bit easier and acceptable, we should bring it up, talk about it and try as much as possible to disperse our fears. Your primary care as well as the hospice team are good resources when it comes to end of life.

Stay tuned, we will have more to follow!