Observational Study on Patient’s Satisfactions and Quality of Life (QoL) Among Cancer Patients Receiving Treatment with Palliative Care Intent in a Tertiary Hospital in Malaysia

The main objective of palliative treatment for cancer patients has been to maintain, if not improve, the qualityof life (QoL). There is a lack of local data on satisfaction and QoL among cancer patients receiving palliativetreatment in Malaysia. This study covers patients with incurable, progressive cancer disease receiving palliativetreatment in a teaching hospital in Kuala Lumpur, comparing the different components of QoL and correlationswith patient satisfaction. A cross-sectional survey using Malay validated SF36 QoL and PSQ-18 (Short Form)tools was carried out between July 2012 -January 2013 with 120 cancer patients receiving palliative treatment,recruited into the study after informed consent using convenient sampling. Results showed that highest satisfactionwere observed in Communication Aspect (50.6±9.07) and the least in General Satisfaction (26.4±5.90). TheMental Component Summary (44.9±6.84) scored higher when compared with the Physical Component Summary(42.2±7.91). In this study, we found that patient satisfaction was strongly associated with good quality of lifeamong cancer patients from a general satisfaction aspect (r=0.232). A poor significant negative correlation wasfound in Physical Component (technical quality, r=-0.312). The Mental Component showed there was a poornegative correlation between time spent with doctor (r=-0.192) and accessibility, (r=-0.279). We found that feelingat peace and having a sense of meaning in life were more important to patients than being active or achievinggood physical comfort. More studyis needed to investigate patients who score poorly on physical and mentalcomponent aspects to understand their needs in order to achieve better cancer care.     

Standards, options and recommendations: nutritional support in palliative or terminal care of adult patients with progressive cancer]

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the National Federation of Comprehensive Cancer Centres (FNCLCC), the 20 French Cancer Centers and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for nutritional support in adult patients with advanced or terminal cancer. METHODS: Data were identified by searching Medline, web sites and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 95 independent reviewers. RESULTS: The main recommendations for nutritional support in adult patients with advanced or terminal cancer are: 1) Palliative care has been defined in a consensual way and is governed by the law (standard). Nutritional support is a palliative care which aim is to maintain and restore the "well-being" of the patient (standard). 2) Digestive symptoms and nutritional troubles are frequently noted in patients with advanced or terminal cancer (standard, level of evidence B2). Karnofsky index (KPS) and performance status (PS) are functional scores with a prognostic value and have to be used (standard, level of evidence B2). 3) Anorexia has a bad predictive value in patients with advanced or terminal cancer (standard, level of evidence B2). 4) In France, patients with advanced or terminal cancer are referred to medical institutions, palliative care units or remained at home (standard). Patients need a multidisciplinary follow-up (standard). An active participation of patients and/or their family circle is very important and physicians have to pay attention for their opinions (standard). 5) Dietetic counseling can help patients to improve their alimentation and its drawbacks (standard). 6) Palliative nutritional care often includes medicinal treatments (standard). 7) Artificial nutrition can slow down nutritional degradation, avoid dehydration and improve quality of life in patients with advanced stage cancer (especially head and neck cancer for enteral nutrition and digestive occlusions for parenteral nutrition) and unable to eat adapted meals (standard, level of evidence C). 8) When life expectancy is below 3 months with a KPS 3/4 50% (or PS > 2), artificial nutrition is not recommended (recommendation, expert agreement). 9) The assessment of nutritional care in patients with advanced or terminal cancer has to include functional scores measurement, quality of life and satisfaction degree of the patient and/or their family (standard, expert agreement).     

Comparison of the JCAHO Scoring System and the ESAS Scoring System in Determining the Palliative Care Needs of Gynecological Cancer Patients Treated at Hasan Sadikin Hospital

Objective: The purpose of this study was to analyze the relationship between quality of life with the JCAHO and the ESAS scoring system, and to compare the JCAHO and the ESAS scoring system in determining the palliative care needs of gynecological cancer patients treated at RSHS. Method: The subjects of this study were all gynecological cancer patients who were treated at RSHS in May-August 2020. This study was an analytic study with a cross sectional design. The data of this study were obtained from interviews, questionnaires and patient medical records, the study was analyzed bivariate using chi square with α = 0.05. Results: The results showed that the quality of life of patients with gynecological cancer was associated with the JCAHO palliative score (p <0.05), the better the patient’s quality of life, the better the JCAHO palliative score. The quality of life of gynecological cancer patients was related to ESAS (p <0.05), the better the patient’s quality of life, the better the ESAS. There was difference between the JCAHO palliative score and the ESAS in determining the palliative care needs of gynecological cancer patients (p< 0.05). Conclusion: Quality of life has correlation with palliative scores, the lower the palliative score, the better the quality of life. This study showed significant difference between the JCAHO palliative score and the ESAS in determining the palliative care needs of gynecological cancer patients. The JCAHO palliative score measures objectively how the patient is on admission for treatment, this score not only measures the intensity of symptoms but measures the underlying disease, comorbid disease, functional status of the patient and other criteria for the patient.  ESAS assesses the intensity of symptoms, the assessment of palliative care needed can change rapidly if the intensity of symptoms in patients changes.     

Addressing the religious and spiritual needs of dying patients by healthcare staff in Korea: patient perspectives in a multi-religious Asian country

Objective: We investigated how patients' spiritual and religious needs are addressed by healthcare staff in inpatient palliative care centers in Korea, a multi‐religious country. Methods: We performed a cross‐sectional, multicenter survey of terminal cancer patients in inpatient palliative care centers. Results: Approximately half (50.5%) of the patients reported that their spiritual and religious needs were addressed by healthcare staff. Patients whose needs were addressed reported better quality of life (QoL), as measured using the European Organization for Research and Treatment of Cancer Quality‐of‐Life Questionnaire for Palliative Care, than patients whose needs were not addressed (p<0.05), although these groups did not differ when measured using the Comprehensive QoL Scale. Patients with a religious affiliation [adjusted odds ratio (aOR), 2.38; 95% confidence interval (CI), 0.70–8.05], those who were admitted to a religious palliative care center (aOR, 2.61; 95% CI, 0.86–7.96), and those whose religious affiliation was the same as that of the palliative care center (aOR, 2.42; 95% CI, 0.96–6.07) tended to have their spiritual and religious needs addressed, although not statistically significant. Conclusions: Although patients whose spiritual and religious needs were addressed by healthcare staff showed significantly better QoL, such needs were not addressed in a significant proportion of patients, especially those who were not religious or were admitted to non‐religious palliative care centers. Strategies should be developed to ensure that spiritual care is provided to all patients with terminal cancer, regardless of the religious background of the patient. Copyright © 2011 John Wiley & Sons, Ltd.     

Does nutrition influence quality of life in cancer patients undergoing radiotherapy?

PURPOSE: To investigate in cancer patients referred for radiotherapy (RT): (1) quality of life (QoL), nutritional status and nutrient intake, at the onset and at the end of RT; (2) whether individualised nutritional counselling, despite symptoms, was able to enhance nutrient intake over time and whether the latter influenced the patient's QoL; and (3) which symptoms may anticipate poorer QoL and/or reduced nutritional intake. MATERIAL AND METHODS: One hundred and twenty-five patients with tumours of the head-neck/gastrointestinal tract (high-risk: HR), prostate, breast, lung, brain, gallbladder, uterus (low-risk: LR) were evaluated before and at the end of RT. Nutritional status was evaluated by Ottery's Subjective Global Assessment, nutritional intake by a 24-h recall food questionnaire and QoL by two instruments: EUROQOL and the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30. RESULTS: Baseline malnutrition was prevalent in HR vs. LR (P=0.02); nutritional intake was associated with nutritional status (P=0.007); the latter did not change significantly during RT. In LR, baseline energy intake was higher than EER (P=0.001), and higher than HR' intake (P=0.002); the latter increased (P<0.03), in spite of symptom increase anew and/or in severity (P=0.0001). According to both instruments, QoL was always better in LR vs. HR (P=0.01); at the end of RT, QoL improvement in HR was correlated with increased nutritional intake (P=0.001), both remained stable in LR. CONCLUSIONS: Individualised nutritional counselling accounting for nutritional status and clinical condition, was able to improve nutritional intake and patients' QoL, despite self-reported symptoms.     

Importance of nutritional screening in treatment of cancer-related weight loss

Weight loss is common in patients with cancer. Many factors, such as physiological abnormalities, response to the tumour, and treatment, contribute to this weight loss. Cancer-related weight loss affects a patient's response to treatment, as well as survival and quality of life. Several nutritional screening and assessment tools have been developed for patients with cancer. This review describes the weight loss seen in patients with cancer as well as the methods of screening for nutritional deterioration and weight loss early in a cancer diagnosis. Nutritional approaches to the supportive care of patients with cancer are also discussed.     

Nutritional status and interventions for patients with cancer – A systematic review

BackgroundMalnourishment is commonly seen in ageing, cancer and many chronic conditions, and is associated with poorer prognosis.AimWe set out to collect all currently available evidence on the association between nutritional status assessed with a validated screening tool and prognosis or course of treatment in older patients with cancer, and on the benefit of nutritional interventions in improving these outcomes.MethodsA systematic search in MEDLINE and EMBASE.ResultsWe included 71 studies on the association between nutritional status and outcome in (older) patients with cancer and 17 studies on the benefit of nutritional interventions in improving outcomes in this patient population. There is a significant association between nutritional status and increased intermediate- and long-term mortality (hazard ratio 1.87 (95% confidence interval 1.62–2.17). Those with poorer nutritional status were less likely to complete oncologic treatment according to plan and had higher health care consumption. Benefit of dietary interventions was limited although dietary counselling may lead to improved quality of life while nutritional support may lead to a decrease in post-operative complication rates.ConclusionNutritional status is associated with poorer survival, decreased treatment completion and higher health care consumption and nutritional interventions are only able to negate these negatives outcome to a very limited degree.     

Proxy perspectives regarding end-of-life care for persons with cancer

BACKGROUND: Each year, greater than a half million people die of cancer in the U.S. Despite progress in increasing access to palliative oncology services, end-of-life care still needs improvement. Measuring the quality of the end-of-life experience is difficult because of patient debility and reduced consciousness as death approaches. Family proxies have been proposed as valuable informants regarding the quality of end-of-life care. This article describes family proxy perspectives concerning care at the end of life in patients who died of advanced cancer. METHODS: In the context of a novel outpatient palliative care demonstration project, 125 family proxy respondents completed a structured survey by telephone 3 months to 6 months after the patient's death from breast, lung, or gastrointestinal cancer. Four key quality of care indicators were measured: decision-making and physician communication, location of death, hospice involvement, and end-of-life symptoms. RESULTS: Proxies reported that 78% to 81% of patients completed at least 1 form of advance directive and approximately half of them were helpful in guiding care. Communication with physicians regarding end-of-life treatment wishes occurred in 67% of cases, but only 57% of the patients actually made a plan with their physician to ensure that their wishes were followed. The majority of patients died in their location of choice, most often at home, and greater than half had hospice involvement for an average of 41.8 days before death. During the last week of life, the majority of patients experienced troublesome physical and emotional symptoms. CONCLUSIONS: Measurement of proxy perspectives is feasible as an indicator of the quality of end-of-life care, and the results of the current study provide actionable data for areas of improvement in palliative oncology care.     

Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area

Malnutrition occurs frequently in patients with cancer of the gastrointestinal (GI) or head and neck area and can lead to negative outcomes. The aim of this study is to determine the impact of early and intensive nutrition intervention (NI) on body weight, body composition, nutritional status, global quality of life (QoL) and physical function compared to usual practice in oncology outpatients receiving radiotherapy to the GI or head and neck area. Outpatients commencing at least 20 fractions of radiotherapy to the GI or head and neck area were randomised to receive intensive, individualised nutrition counselling by a dietitian using a standard protocol and oral supplements if required, or the usual practice of the centre (general advice and nutrition booklet). Outcome parameters were measured at baseline and 4, 8 and 12 weeks after commencing radiotherapy using valid and reliable tools. A total of 60 patients (51 M : 9 F; mean age 61.9+/-14.0 years) were randomised to receive either NI (n=29) or usual care (UC) (n=31). The NI group had statistically smaller deteriorations in weight (P<0.001), nutritional status (P=0.020) and global QoL (P=0.009) compared with those receiving UC. Clinically, but not statistically significant differences in fat-free mass were observed between the groups (P=0.195). Early and intensive NI appears beneficial in terms of minimising weight loss, deterioration in nutritional status, global QoL and physical function in oncology outpatients receiving radiotherapy to the GI or head and neck area. Weight maintenance in this population leads to beneficial outcomes and suggests that this, rather than weight gain, may be a more appropriate aim of NI.     

Optimizing Nutrition Support in Cancer Care

Involvement of a multidisciplinary team in cancer care may have added benefits over the existing system ofpatient management. A paradigm shift in the current patient management would allow more focus on nutritionalsupport, in addition to clinical care. Malnutrition, a common problem in cancer patients, needs special attentionfrom the early days of cancer care to improve quality of life and treatment outcomes. Patient management teamswith trained oncology dietitians may provide quality personalized nutritional care to cancer patients.     

Insulin treatment in cancer cachexia: effects on survival, metabolism, and physical functioning.

PURPOSE: The present study was designed to evaluate whether daily insulin treatment for weight-losing cancer patients attenuates the progression of cancer cachexia and improves metabolism and physical functioning in palliative care. EXPERIMENTAL DESIGN: One hundred and thirty-eight unselected patients with mainly advanced gastrointestinal malignancy were randomized to receive insulin (0.11 +/- 0.05 units/kg/d) plus best available palliative support [anti-inflammatory treatment (indomethacin), prevention of anemia (recombinant erythropoietin), and specialized nutritional care (oral supplements + home parenteral nutrition)] according to individual needs. Control patients received the best available palliative support according to the same principles. Health-related quality of life, food intake, resting energy expenditure, body composition, exercise capacity, metabolic efficiency during exercise, and spontaneous daily physical activity as well as blood tests were evaluated during follow-up (30-824 days) according to intention to treat. RESULTS: Patient characteristics at randomizations were almost identical in study and control groups. Insulin treatment for 193 +/- 139 days (mean +/- SD) significantly stimulated carbohydrate intake, decreased serum-free fatty acids, increased whole body fat, particularly in trunk and leg compartments, whereas fat-free lean tissue mass was unaffected. Insulin treatment improved metabolic efficiency during exercise, but did not increase maximum exercise capacity and spontaneous physical activity. Tumor markers in blood (CEA, CA-125, CA 19-9) did not indicate the stimulation of tumor growth by insulin; a conclusion also supported by improved survival of insulin-treated patients (P<0.03). CONCLUSION: Insulin is a significant metabolic treatment in multimodal palliation of weight-losing cancer patients.     

Advancing a comprehensive cancer care agenda for children and their families: Institute of Medicine Workshop highlights and next steps

This article highlights key findings from the “Comprehensive Cancer Care for Children and Their Families” March 2015 joint workshop by the Institute of Medicine (IOM) and the American Cancer Society. This initiative convened more than 100 family members, clinician investigators, advocates, and members of the public to discuss emerging evidence and care models and to determine the next steps for optimizing quality‐of‐life outcomes and well‐being for children and families during pediatric cancer treatment, after treatment completion, and across the life spectrum. Participants affirmed the triple aim of pediatric oncology that strives for every child with cancer to be cured; provides high‐quality palliative and psychosocial supportive, restorative, and rehabilitative care to children and families throughout the illness course and survivorship; and assures receipt of high‐quality end‐of‐life care for patients with advancing disease. Workshop outcomes emphasized the need for new pediatric cancer drug development and identified critical opportunities to prioritize palliative care and psychosocial support as an integral part of pediatric cancer research and treatment, including the necessity for adequately resourcing these supportive services to minimize suffering and distress, effectively address quality‐of‐life needs for children and families at all stages of illness, and mitigate the long‐term health risks associated with childhood cancer and its treatment. Next steps include dismantling existing silos and enhancing collaboration between clinical investigators, disease‐directed specialists, and supportive care services; expanding the use of patient‐reported and parent‐reported outcomes; effectively integrating palliative and psychosocial care; and clinical communication skills development. CA Cancer J Clin 2016;66:398–407. © 2016 American Cancer Society.     

Response of global quality of life to high-dose palliative radiotherapy for non-small-cell lung cancer

PURPOSE: To estimate the impact of high-dose palliative radiotherapy treatment (RT) for inoperable non-small cell lung cancer (NSCLC) on the patient's quality of life (QoL) over the remaining survival period, and to compute the number of quality adjusted life days (QALDs) gained. METHODS AND MATERIALS: The QoL of an NSCLC patient is modelled as a function of the days left to live, the days since the start of treatment, a patient specific intercept, and a random error term. Least squares regression analysis is used to fit this model to 376 monthly QoL observations supplied by 42 prospectively enrolled high-dose palliative RT patients with NSCLC. Prediction analysis, based on the regression results and on previously published estimates of the survival response to high-dose palliative RT, is used to compute QALDs gained as a result of treatment. RESULTS: QoL improves steadily over the first 86 days after the start of treatment. This improvement then dissipates to 0 over the subsequent 140 days. Median survival after entry (266 days) yields 158.5 QALDs, of which 56.9 can be attributed treatment: 12.6 as a result of a higher daily QoL and 44.3 as a result of longer survival. CONCLUSION: Patients with inoperable NSCLC who received high-dose palliative RT, and survived the median 266 days after entry into the study, can attribute about one-third of their 158.5 QALDs to the QoL and survival responses to treatment.     

食管癌术后康复期患者营养状况及生命质量的纵向研究

目的 了解食管癌术后康复期患者营养状况及生命质量的变化趋势及相关关系。方法 以四川省肿瘤专科医院行食管癌手术治疗的75例患者为研究对象,在患者术后1个月、3个月和6个月时运用患者主观整体营养评估量表进行营养评估,采用肿瘤生命质量测评量表和食管癌患者补充量表进行生命质量评定。结果 食管癌患者术后随时间的延长营养不良发生率由73.4%下降至33.5%。生活质量各维度评分在各评估时间点差异均有统计学意义（P<0.05）,功能领域和症状领域在术后1个月与术后3个月、术后6个月比较有统计学意义（P<0.05）,术后3个月与术后6个月比较差异无统计学意义（P>0.05）。患者营养状态与躯体、角色、情绪及社会功能呈负相关（P<0.05）,与吞咽困难、进食、反流、梗阻、食欲减退、咳嗽症状呈正相关（P<0.05）。结论 食管癌术后1个月患者营养状况及生命质量较差,随时间推移逐渐好转。医护人员应根据患者在不同时间点营养状况及生命质量的变化特点,制定规范化和个体化的延续护理方案,以促进患者术后康复、提高生命质量。     

Palliative cancer care within the Hradec Králové Region Health Care System: own experience

Palliative cancer care is an active treatment and nursing intervention in patients in whom cancer therapy has been withdrawn due to untreatable progression of the cancer disease. The main aim of palliative cancer care is to ensure the best possible quality of life of a cancer patient and the patient's family members. Palliative cancer care is provided in two basic forms, general and specialized. In the present paper, the authors discuss palliative cancer care and its implementation into clinical practice with reference to their own experience in providing this care.     

Spiritual well‐being of Italian advanced cancer patients in the home palliative care setting

This study evaluates the spiritual well‐being (SpWB) in very advanced cancer patients assisted by the home palliative care program of ANT Foundation, a no‐profit Italian organisation. SpWB was assessed by the Functional Assessment of Chronic Illness Therapy–Spiritual Well‐Being Scale (FACIT‐Sp12), including Meaning, Peace, and Faith subscales. The quality‐of‐life (QoL) was evaluated by using the Functional Assessment of Cancer Therapy‐General scale. Questionnaires were distributed to 1,055 patients and 683 were compiled and evaluable for analysis. The mean scores of FACIT‐Sp12 as well as of QoL were notably lower than reference values for cancer survivors. The FACIT‐Sp12 score was higher in patients with less impaired Karnofsky Performance Status, fully participating in religious rituals and living in central Italy. A high Pearson's correlation was found between QoL and FACIT‐Sp12 (r = .60), Peace (r = .71) and Meaning (r = .52), while it was marginal for Faith (r = .27). The hierarchical regression analysis showed that FACIT‐Sp12 is a significant predictor of QoL. The study suggests that Italian patients with advanced cancer assisted by expert multi‐professional teams in the home palliative care setting have a low level of SpWB thereby highlighting the need for the integration of spiritual support as part of comprehensive cancer care.     

Psychosocial interventions for patients with advanced cancer - a systematic review of the literature

Advanced cancer is associated with emotional distress, especially depression and feelings of sadness. To date, it is unclear which is the most effective way to address these problems. This review focuses on the effects of psychosocial interventions on the quality of life (QoL) of patients with advanced cancer. It was hypothesised that patients will benefit from psychosocial interventions by improving QoL, especially in the domain of emotional functioning. The review was conducted using systematic review methodology involving a systematic search of the literature published between 1990 and 2002, quality assessment of included studies, systematic data extraction and narrative data synthesis. In all, 10 randomised controlled studies involving 13 trials were included. Overall interventions and outcome measures across studies were heterogeneous. Outcome measures, pertaining to the QoL dimension of emotional functioning, were most frequently measured. A total of 12 trials evaluating behaviour therapy found positive effects on one or more indicators of QoL, for example, depression. The results of the review support recommendation of behaviour therapy in the care of patients with advanced cancer.     

Importance du support nutritionnel dans les cancers digestifs

In patients with gastrointestinal cancer, the systematic screening of nutritional status is mandatory. Malnutrition is widely recognized as a significant source of postoperative morbidity and high rates of toxicity during chemotherapy or radiotherapy, resulting in longer hospital stays, increased medical costs, decreased performance status, and lower quality of life. Patients who experience weight loss should receive dietary counselling and immunonutrition. For surgical patients, practical information, such as weight status and subjective global assessment data, provides a solid basis for deciding whether or not to delay surgery. At least 10 days of nutritional support is recommended in severely malnourished patients before major gastrointestinal surgery. In patients with less severe malnutrition, preoperative oral immunonutrition is associated with a 50% decrease in postoperative complications. The benefit of immune-enhancing diets in severely malnourished patients remains to be proven. Dietary counselling should be offered to all patients undergoing radiochemotherapy. In cases of severely malnourished patients, or if dietary counselling is ineffective, enteral nutrition is recommended. Parenteral nutrition should be reserved for patients with severe digestive intolerance when enteral nutrition is not possible. In conclusion, it is essential to provide individualized nutritional support at every step in a multimodal treatment programme for gastrointestinal cancer. These recommendations should be used in daily practice but should also be included in all clinical research protocols.     

Predicting the need for end-of-life care for elderly cancer patients: findings from a Dutch regional cancer registry database

Over 80% of all deaths in the Netherlands concern people aged 65 years and older. Elderly patients who have been diagnosed with a life-limiting illness have many unmet healthcare needs in the last phase of their life. For this exploratory population-based study, data from the Eindhoven Cancer Registry were retrospectively analysed to determine possible trends in the number, patient characteristics, treatment and survival of patients aged 65 years and older newly diagnosed with stage IV cancer (n= 9028), a group of elderly in the palliative phase of cancer. During 1996-2006 a substantial increase of 81% in the number of elderly patients newly diagnosed with cancer stage IV was found. Over 70% of these patients received primary cancer treatment, irrespective of serious comorbidity (in 61% of them) and a short life expectancy (most died within 12 months except for those with cancer of the prostate). The vast increase in the number of the elderly who need palliative care contributes to awareness among healthcare professionals about future demand. They enable anticipation and planning sufficient end-of-life care capacity, but also to develop care planning programmes for these older palliative cancer patients. Research needs to be done on aspects of the symptom burden, role of palliative treatment, psychological, social and spiritual needs and end-of-life decision-making. Registration of additional data on these aspects of (palliative) care is suggested.     

Making Difficult Discussions Easier: Using Prognosis to Facilitate Transitions to Hospice

Patients with advanced cancer face difficult decisions regarding their treatment, and many will need to make difficult choices about end‐of‐life care because although cancer‐directed therapies are increasingly available, few provide a cure. High‐quality cancer care includes access to palliative care throughout the cancer care continuum, and increasing evidence suggests that timely enrollment in hospice can increase quality of life for patients dying from cancer. Therefore, clinicians must learn to recognize patients who are hospice‐eligible and to develop prognostication and communication skills that enable honest provider‐patient dialogue about end‐of‐life options. In this article, the authors review available tools for prognostication in advanced cancer and present a method for discussing prognosis by using the SPIKES acronym. In addition, by using patient‐identified goals and service needs, the authors recommend a method for making a hospice referral after disclosure of poor prognosis. CA Cancer J Clin 2009;59:250‐263. ? 2009 American Cancer Society, Inc.