Can a patient do chemo or radiation?

caroladybelle, BSN, RN · Jul 22, 2006

In theory, yes...this is frequently done more with radiation.

In reality, you find difficulty finding an inpatient hospice situation that is cooperative. Basically because the drugs and/or transport to the site of treatment would be prohibitively expensive and difficult to provide.

Most hospice facilities have limits as to how many dollars worth of meds that they can provide a case, and still provide widespread treatment. You get one or two patients with very expensive meds, and the hospice may go under. This was formerly a problem with endstage Aids patients that wanted inpatient hospice and to continue some very expensive antivirals at the same time. If it can be facilitated with the insurance coverer, great but many times they will not provide for hospice and the expensive of chemo.

leslie :-D · Jul 22, 2006

curative treatments are applied under the palliative care benefit; not the same as hospice.

in hospice, there needs to be a life expectancy of 6 months or less to live.

hospice does not cover any treatments considered curative in nature.

in palliative care, there is no set life expectancy and one can continue to seek curative treatment.

both hospice and palliative care focus on the relief of pain/suffering, and improving quality of ones' life.

leslie

RN4ustat, BSN, RN · Jul 22, 2006

The hospice I previously worked for would not allow this under any circumstances. My current employer allows chemo or radiation for palliative purposes such as pain control.

nosonew, BSN, RN · Jul 22, 2006

So more or less it depends on the Hospice Organization itself?

The hospice I work for is non profit and allows this... yet I have a friend across the US that can not find a hospice to help with her 80 yoa MIL who has terminal ca but needs palliative radiation.

I have encouraged her to speak to other hospice organizations in her area. Thanks!

doodlemom · Jul 22, 2006

If the doctor is recommending it for symptom relief then the hospice should be covering the XRT. I have seen a lot of "palliative chemo" patients but have yet to see one who is really being helped symptom wise. We do accept some chemo patients depending on the intent of the physician, but we see and recommend a great deal of XRT for pain relief.

aimeee, BSN, RN · Jul 24, 2006

So more or less it depends on the Hospice Organization itself?
The hospice I work for is non profit and allows this... yet I have a friend across the US that can not find a hospice to help with her 80 yoa MIL who has terminal ca but needs palliative radiation.
I have encouraged her to speak to other hospice organizations in her area. Thanks!

Its wonderful that your hospice can do this. You must be working for either a very large hospice or a hospice that has a lot of donated funds pooled for just such treatments. The cost of radiation treatments is many many times the per diem payment we get from medicare. It isn't that we don't "allow" it, its that we can't provide it for everybody who "needs" it and still remain a viable provider at our current size and level of funding.

I also question the "need" for it in all cases. Yes, there are some who do benefit from palliative radiation but there are also a huge number who just get it automatically. I have had so many disappointed families whose loved one completed a two week long course of daily "palliative" radiation treatments only to have them die two days later. The oncologists and radiologists in our hospital system have a weekly meeting to discuss their interesting cases and seek each other's input. EVERY single case of a stage IV cancer patient that I have seen come before it receives this response from the radiation doc: "I believe this patient would benefit from radiation therapy".

doodlemom · Jul 24, 2006

Its wonderful that your hospice can do this. You must be working for either a very large hospice or a hospice that has a lot of donated funds pooled for just such treatments. The cost of radiation treatments is many many times the per diem payment we get from medicare. It isn't that we don't "allow" it, its that we can't provide it for everybody who "needs" it and still remain a viable provider at our current size and level of funding.
We have a contract with a local hospital to provide XRT for $60.00 a treatment. This is pretty common practice and I'm sure that your hospice could talk to a local hospital and get a contract similar to this. We would not recommend XRT for someone that is that close to dying.

aimeee, BSN, RN · Jul 24, 2006

Its wonderful that your hospice can do this. You must be working for either a very large hospice or a hospice that has a lot of donated funds pooled for just such treatments. The cost of radiation treatments is many many times the per diem payment we get from medicare. It isn't that we don't "allow" it, its that we can't provide it for everybody who "needs" it and still remain a viable provider at our current size and level of funding.
We have a contract with a local hospital to provide XRT for $60.00 a treatment. This is pretty common practice and I'm sure that your hospice could talk to a local hospital and get a contract similar to this. We would not recommend XRT for someone that is that close to dying.
Its certainly worth another look if it can be done that reasonably. Still, I think there should be some clear parameters for specific symptom relief and duration of expected benefit period from it.

nosonew, BSN, RN · Jul 24, 2006

We currently have 58 patients. We live in a rural community and cover many counties. Luckily, we do have many donations and many/most of our clients do memorials to our hospice which helps make payroll (that is paid after paying medical bills of course!) and we also opened a hospice thrift shop with all donated items and that money is also used to pay for things patients need but are not covered.

I love love love my job... I wish I could win the lottery and donate half of it and work for free. Honestly.

Until last year, I have been told this hospice paid for all medications for all clients. They are still sad they can't keep doing that, but medications are just too expensive.

doodlemom · Jul 24, 2006

We currently have 58 patients. We live in a rural community and cover many counties. Luckily, we do have many donations and many/most of our clients do memorials to our hospice which helps make payroll (that is paid after paying medical bills of course!) and we also opened a hospice thrift shop with all donated items and that money is also used to pay for things patients need but are not covered.
I love love love my job... I wish I could win the lottery and donate half of it and work for free. Honestly.
Until last year, I have been told this hospice paid for all medications for all clients. They are still sad they can't keep doing that, but medications are just too expensive.

Are you saying that you are not paying for ANY medications at all?

saribeth · Jul 26, 2006

As far as I know Medicare pays a daily rate of $140???...there is no way our hospice could afford to have a pt on radiation or chemo, however, when we do have a pt that wants radiation for palliative tx we admit them as a home care pt but the hospice team follows them...that way their regular Medicare and or Ins will cover it...and Amy I can just hear those Docs saying "the pt will benefit from radiation" they just can't say no:mad: