Hospice: Medical and Physical Care

The hospice staff will work with the survivor, the primary doctor, and the caregiver to develop a care plan that addresses specific symptoms.  This plan will be adjusted as the survivor’s condition changes with the entire hospice team monitoring and responding to these modifications at all times.

Medical equipment, such as an adjustable hospital bed, may be arranged by hospice for use at home to keep the survivor more comfortable and make caregiving easier.  Hospice also provides necessary medical supplies such as bandages, gloves, syringes and catheters as needed.

Survivors experience many different symptoms as the pancreatic cancer progresses, a lot of time and energy will be spent trying to manage symptoms as they change.  The hospice staff will tell the caregiver what changes or symptoms to watch for.  Different medications, often given around the clock, are used to relieve these symptoms.  Sometimes treating one symptom can cause others to appear.  The caregiver will need to observe and discuss changes with the hospice staff while working to relieve any physical discomfort the survivor may experience.

All difficult symptoms can be either alleviated or relieved completely.  Be sure to ask your hospice team for help.

Some people experience little or no pain at the end of life.  For others, pain may be constant and intense.  It is rare to experience pain that cannot be relieved in any way.   Hospice physicians and nurses are experts in using the most advanced pain control methods available.  

Pain medications are generally taken by mouth, usually on an around-the-clock basis, to control pain and prevent new pain from appearing.  If swallowing becomes difficult, pain medicines may be given in various other ways including in small amounts of concentrated medicine under the tongue or inside the cheek, by suppository, by skin patch, through intravenous (IV) injection, or through a feeding tube (if there is one).   The nurse will show the primary caregiver how to administer medications using some of these options.

Surgical procedures that do not involve removing the tumor may be performed to alleviate, or palliate, pain and other symptoms.  Jaundice, pain, nausea and vomiting can all be caused by blockage of the bile duct and/or stomach.  The main palliative procedures used to treat these symptoms in pancreatic cancer survivors are biliary bypass surgery, gastric bypass surgery, and stent insertion. 

A celiac plexus block is a surgical procedure that can be used to manage abdominal pain in pancreatic cancer.  If the tumor presses on the spine or the nerve bundle in the upper abdomen (celiac plexus), the survivor may experience pain.  A celiac plexus block can prevent the nerves from sending pain messages to the brain.  For more information on surgical procedures to alleviate pain related to pancreatic cancer contact one of the Pancreatic Cancer Action Network’s PALS Associates at 877-272-6226 or pals@pancan.org .

Breathing and relaxation exercises may also be used to treat pain when appropriate.  The increased oxygen in the lungs and blood helps reduce the stress and anxiety often associated with pain.

Different pains need different treatments, so hospice staff will ask many questions about what the pain is like and what makes it better or worse.  In order for the survivor to get needed help with pain, he or she needs to tell the hospice staff and other caregivers when pain is present.

The nurse will tell the survivor and caregiver what they need to track and discuss with the hospice staff.  Use a notebook to write down and describe in detail such things as symptom changes, including different levels of pain, new symptoms, responses to treatments and other changes as instructed by hospice staff.

The primary caregiver will provide most of the personal care with the support of home health aides who may visit the home one to three times per week, depending on the need. 

Personal care involves assisting the survivor with all activities of daily living including eating, dressing, bathing, grooming, using the toilet, and other needs as the cancer progresses.  It is likely that the survivor will eventually be unable to move without assistance.  Caregivers will need to help the survivor change positions in bed or move around the room.  It is important for caregivers to protect their own health at all times.  If any of these tasks are too physically demanding, caregivers should ask for help.

If possible, the survivor should choose the people to perform different tasks based on who he or she is comfortable with.   Also, family members and friends need to determine who feels comfortable performing these tasks.  

Research shows that families find personal care to be the most physically and emotionally challenging aspect of caregiving.   However, for some families it is satisfying and rewarding.   For those who are not comfortable providing this care or need extra help, hiring private home health aides can help.  Insurance companies that provide a hospice benefit may cover home health aide visits a few days a week as needed, but additional hours, if needed, may not be paid for by insurance.  

The physician who has been providing most of the survivor’s care (oncologist or family physician) will discuss the survivor’s current condition and symptoms with the hospice staff, as well as the history and course of the pancreatic cancer.

Some physicians think they can no longer be of service once the survivor enters hospice. The survivor should tell the doctor if he or she want his or her continued involvement. The hospice team will keep the doctor informed about the survivor’s condition on a regular basis. The doctor (oncologist or primary care physician) usually remains in charge of the survivor’s care. However, the hospice physician or medical director works with the outside doctor to help oversee the hospice team and the survivor’s overall end-of-life care.
 

In most cases, cure-focused treatment does not continue once hospice care begins because:

• The goal of hospice care is to provide comfort during the final weeks or months of advanced illness.  
• Most insurance providers do not pay for cancer-fighting treatment once hospice care begins.  However, some will pay for cancer-fighting treatment if the goal of the treatment is to decrease symptoms and increase quality of life rather than to cure the cancer.

Be sure to find out exactly what the hospices in your community can provide and the goal of any treatment.

The information and services provided by the Pancreatic Cancer Action Network, Inc. are for informational purposes only.  The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment.  If you are ill, or suspect that you are ill, see a doctor immediately!  The Pancreatic Cancer Action Network does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site.  111230