Medical oncology and hospice: compatible or not?

No othersinglediseaseor classofdiseasesexceedscanceras a diagnosismostgreatlyfearedbymodem society.Thefearofsufferingwithuncontrolledsymptomssuchas pain is no lessprofoundlyfearedthandeath itself. The imageof the cancerpatientwastingawayin hisbed,racked with pain, unfortunatelyis the picture one immediately constructs whena diagnosisof canceris given. The most frequentquestionsasked at the time of diagnosisare: “How long can I live?” and “Will I have pain?” In theUnitedStates,therewill be 985,000newcancercasesdiagnosed in 1988.’While an estimated50 percentof thesecan becuredbypresent medical treatmentsincluding surgery, radiation therapy, and chemotherapy,there remainsthe soberingfact thatmorethan490,000 of thosepatientswill ultimately die oftheir malignantdisease. In fact, in 1985, 461,563 personsin the U.S. succumbedto cancer.’Thisaccounts for 22 percentof all deathsduring thatyear.To statethesestatisticsyet anotherway, 170personsper 100,000 populationdiedof cancerin 1985.In my owncommunityof800,000(1985 census),this translatesto 1,360 estimatedcancerdeaths. Is dying of cancerverymuchdifferentfrom dyingof otherdiseases? Certainly,the endresultis the same. However, getting to the terminal eventmaybe quite differentfor the patientwith a malignancy.As contrastedwith the circumstancesinvolved in deathby heart disease, cerebrovasculardisease,accidents, andchronicobstructivelungdisease, the other most commoncausesof deathin this country,mostpatients who succumbto cancerdo not die suddenly.Granted,deathdueto any chronicdiseasemaypresenta situation in which the patientundulysuffers.Symptomsof pain,shortnessof breath,weakness,nausea,and anorexiaarenot exclusiveto malignant disease,but aspredictable,expected symptomsduring the terminal period of illness, theseare more often than not experiencedby the cancerpatient. In termsof predictability,cancer differs from otherterminaldiseases in yet anotherway. The differenceis relatedto expectedsurvival.Virtuallyeverycancer is consideredinterms of annualor five-yearsurvival. Data are so voluminousand statisticsso analyzed,thateachmalignantneo-