If you have stage 4 breast cancer, you may consider palliative care or hospice care so you’re the most comfortable you can be as you near end of life. Here’s how to decide which option is best for you.

Stage 4 breast cancer, or advanced breast cancer, is a condition in which the cancer has metastasized, or spread from the breast to one or more other areas of the body.

There’s no current cure for stage 4 breast cancer, but in many cases, options are available to enhance quality of life and extend life. Options for end-of-life care include palliative and hospice care.

Many misconceptions exist about these types of care. Here’s what you need to know to better understand these options.

Palliative care involves treating unpleasant symptoms of cancer, both physical and emotional, that may stem from systematic treatments like chemotherapy or radiation. Some examples of palliative care include:

The goal of palliative care is to help a person feel better rather than to cure or treat the cancer itself. It can be used alone or along with any standard cancer treatment options.

When palliative care is appropriate

Palliative care is always appropriate — right from the first diagnosis. Though this type of care can and should be used along with end-of-life care, palliative care is certainly not used exclusively in those situations.

It can be used alongside any recommended treatments that target the cancer itself. It can also help treat any unwanted side effects of the cancer treatment.

How palliative care helps

Palliative care is about helping a person live as fully as possible. While cancer treatment works to prolong life, palliative care works to improve the quality of that life.

The physical and emotional support of palliative care can be an incredible comfort during an incredibly difficult period.

Hospice care is end-of-life care for people with an end stage cancer diagnosis who either have no treatment options or choose not to prolong their life with standard treatments.

This type of care involves medications and other treatments to:

  • manage symptoms
  • manage side effects
  • keep a person as comfortable as possible during the last days of their life

Hospice care can be administered in the following settings:

  • one’s own home
  • a hospital
  • a nursing home
  • a hospice facility

When hospice care is appropriate

Hospice is appropriate when the patient is no longer pursuing cancer treatment and has a life expectancy of less than 6 months if the illness is left untreated. As per CMS guidelines for payment, this time period also matters.

It can be a difficult decision, but the earlier hospice care begins, the more benefit a person receives. It’s important not to wait too late to begin hospice care if it’s needed.

When hospice workers have longer to get to know a person and their unique situation, they can create a better, individualized plan for care.

How hospice care helps

Hospice care helps ease a person’s transition from actively treating the cancer to focusing on staying as comfortable as possible and preparing for their death.

When no treatment options remain, it can be a great relief for a person to know that professional hospice workers will be there to make their remaining time more comfortable.

Hospice care is also a big help to family members, as they don’t have to handle the responsibility of end-of-life care for their loved one all alone. Knowing a loved one isn’t in pain can also help make this challenging time more bearable for family and friends.

Deciding between palliative or hospice care — and deciding whether to utilize these options at all — can be difficult. Here’s how to decide which is best for you or your loved one.

Questions to ask yourself

Consider these questions when determining the best care for your current situation:

Where am I on my cancer journey?

Palliative care is appropriate at any step of a metastatic breast cancer diagnosis.

Most people choose hospice care when their doctor has indicated that they have 6 months or less to live. The timing can help you determine which approach may be best.

Am I ready to stop some treatment?

Palliative care focuses on keeping a person comfortable. They may still receive treatments to shrink tumors or limit the growth of cancer cells.

However, hospice care usually involves stopping antitumor treatments. It focuses solely on comfort and finishing your life on your own terms.

It may take time to conclude that you’ve reached an endpoint in your treatment and life. If you’re not ready for that yet, palliative care may be the way to go.

Where do I wish to receive care?

While this isn’t always the case, palliative care programs are often offered at a hospital or short-term care facility, such as an extended-care facility.

But location depends on your insurance coverage and cost considerations, availability of geographic resources, and personal preference.

Hospice inpatient facilities (free-standing facilities) exist all over the country, whereas others may have in-hospital hospice programs. Hospice can also be offered at home.

Questions to ask your doctor

There are also questions you may want to ask your doctor that can help ease the decision making process. Examples of these questions include:

  • In your experience, how long do you think I have left to live?
  • What services do you think could benefit me most at this point in my treatment?
  • What are some ways you’ve seen others benefit from palliative or hospice care that I may not be thinking about right now?

Discussing these questions with a doctor who’s advised others under similar circumstances can be very helpful.

Unlike hospice or palliative care, end-of-life care isn’t a particular type of service. Instead, it’s a shift in approach and mindset.

End-of-life care is appropriate when a person or their family knows the end of life is nearing and time is limited. At this difficult time, there are actions a person may want to take to ensure their final wishes are known.

Here are some examples:

  • Seek out a religious or spiritual counselor to answer questions about death and dying.
  • Talk with family members about thoughts, feelings, and final wishes for them.
  • Speak with a lawyer about updating or writing a will, as well as completing any advance directives.
  • Discuss treatments focused on managing symptoms and enhancing your life, such as taking pain or nausea medications.
  • Speak with your doctor about what you can expect in the last few months to days of life, given your overall diagnosis. Your doctor may also want to speak with your family members to help them prepare.
  • Utilize at-home nursing staff who can provide care when you may be unable to do some things for yourself.

These are just some of the ways a person can make their wishes known and live their life most fully.

Both palliative and hospice care are important parts of caring for someone with stage 4 breast cancer. These types of care have nothing to do with giving up and everything to do with helping people feel more comfortable while living the best life possible.

The palliative or hospice care process will usually begin with a referral from your oncologist. It may also come from a caseworker or social worker in your oncologist’s office.

These referrals are often needed for insurance purposes. Each individual palliative or hospital care organization will likely have its own requirements regarding the paperwork or information needed following this referral.

Communication in all aspects is so important when deciding on hospice or palliative care. This includes communication with your doctor, family, and loved ones so you can live out your life on your terms.