Hospice Care Admission Guidelines for Cancer
LCD Guidelines
Cancer
- Cancer diagnosed with distant metastasis at the time of presentation
OR
- Disease progression from an earlier stage to metastatic cancer, accompanied by:
- Continued decline in the patient’s condition despite receiving treatment
- The patient chooses to forgo any further treatment aimed at controlling the disease
Note: Certain cancers with particularly poor prognoses, such as small cell lung cancer, brain tumors, or pancreatic cancer, may qualify for hospice care without needing to meet the other outlined criteria.
Comparative Data
Tumor Growth: The tumor has grown significantly, previously the size of a golf ball and now comparable to a softball.
Decline in Activity: The patient, who once enjoyed leaving their room for activities, is now mostly confined to their room.
Comorbid Conditions: Conditions such as CHF, COPD, and others are present.
Reduced Intake: A month ago, the patient was consuming all meals but is now down to just one meal per day, reporting changes in taste, weight loss, and signs of anorexia.
Depression and Anxiety: Once outgoing and socially engaged, the patient now remains in their room and shows a lack of communication.
Changes in Medication: Depression and anxiety have progressed, requiring adjustments in medications to manage these conditions.
Increased Pain: The intensity of the patient’s pain has escalated, affecting their ability to carry out daily activities.
Alterations in ADLs: The patient, who needed minimal assistance two months ago, now requires help with bathing and dressing. The PPS score has dropped from 60% to 40%, indicating increased weakness.
Skin Changes: Skin issues have emerged, including pallor, lesions, non-healing wounds, bruising, and a dusky appearance.
Comorbidities
- Kidney Failure
- Pain
- SOB
- Skin Issues
- Anorexia
- Ascites
- Bleeding
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