How will accepting hospice care affect my job?

A fellow caregiver asked...

My spouse has small cell lung cancer which metastasized to the brain. He had 15 radiation treatments that shrunk the lesions. Now new ones have appeared. His oncologist wants to have hospice to come in. He is still working.

At what time do we need hospice to help and will hospice affect his job? He is stopping cancer medications. The oncologist says the medications he is taking will not help the brain at this time, there is nothing else that can be done.

Expert Answer

Audrey Wuerl, RN, BSN, PHN, is education coordinator for Hospice of San Joaquin in California. She is also a geriatric trainer for the End-of-Life Nursing Education Consortium (ELNEC), which promotes education in geriatric nursing and end-of-life care.

You should consider hospice when your husband, 1) has completed all his therapies, such as radiation, chemotherapy, blood transfusions, or other therapies and, 2) when his physician can state he/she estimates his life expectancy at 6 months or less, should his disease run its normal course.

You state he has stopped taking his medications"”could this mean his chemotherapy? But, does he still want radiation? If he can still work, I would assume he is feeling O.K. at this point. Usually, people with cancer and with metastases are weakened and have pain and symptom issues. Generally they are at home, and are no longer working.

If your husband still has a good quality of life, and wants to continue working, be thankful. Enjoy every day. You can call your local hospice, state that his physician has suggested hospice care, and allow them to explain what they can do to help him (and you) to maximize what time he has and to learn to live with his disease. After all, hospice is an option of care that can be beneficial for most people, but not everyone embraces it.

Your hospice may have some supportive care in the form of a "program" for people who either are still pursuing therapies, or who are not yet emotionally ready for hospice care. This can be very helpful to both of you to answer questions that come up, reassurance as you progress through his illness, and help normalize this process. I wish you good luck!