Comfort-Focused Care: What It Means

This page explains what "comfort-focused care" means and what it includes day to day. It is for people with serious cancer and the families caring for them.

"Comfort-focused care" is a description of a goal, not a single service. It means the plan is now built around how a person feels and what they can still do. It is no longer built around shrinking a tumor.

It is active care. Symptoms are checked, medicines are adjusted, equipment is ordered, and someone is on call. What changes is the question asked at every decision: will this make the person feel better?

The National Cancer Institute speaks directly to the fear behind the phrase: "Choosing hospice care doesn't mean that you've given up hope."

Palliative care is "care meant to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer." It is given by palliative care specialists who have training or certification in it, usually in a team. It happens in hospitals, outpatient clinics, long-term care facilities, and at home.

It "may be provided at any point during cancer care, from diagnosis to the end of life." Crucially: "When a person receives palliative care, they may continue to receive cancer treatment."

Hospice care is a Medicare benefit with rules attached. It begins "when curative treatment is no longer the goal of care and the sole focus is quality of life." To enroll, your hospice doctor and your regular doctor, if you have one, certify that you are terminally ill. This means a life expectancy of 6 months or less. You also sign a statement choosing hospice instead of Medicare-covered treatment for that illness.

Comfort care is the everyday phrase for the goal both of those serve. It is what a hospital team means when they write "comfort measures" in the chart.

You can have palliative care for years while still on chemotherapy. Hospice is a narrower, later, more structured version.

The National Cancer Institute lists four areas.

• Physical: pain, fatigue, loss of appetite, nausea, vomiting, shortness of breath, and insomnia.
• Emotional: depression, anxiety, and fear.
• Spiritual: help exploring beliefs and values in order to find a sense of peace.
• Practical: financial and legal worries, insurance questions, and employment concerns.

This is the part families most want spelled out. NCI's guide to the last days of life suggests these measures.

Breathing. Shortness of breath is common near the end of life. Have the person sit up and aim a cool fan toward their face.

Mouth, lips, and eyes. Offer ice chips, or swab the mouth and lips to keep them moist.

Position and skin. Changing the person's position can ease symptoms. Ask your care team how often to turn them and how to protect the skin.

Digestion. Nausea, vomiting, constipation, and loss of appetite are all common. Medicines can help with nausea and constipation. Offer small amounts of favorite foods if the person wants to eat. Do not force food.

Temperature. Hands, arms, feet, or legs may feel cool. Use blankets to keep the person warm. Do not use electric blankets or heating pads.

Fatigue. Energy runs low. Keep things simple, and ask your team about medicines or help that save energy.

Two worries come up in almost every family conversation, and both have clear answers.

On addiction: the National Cancer Institute distinguishes tolerance from addiction. "Tolerance of an opioid is a physical dependence on it. This is not the same as addiction (psychological dependence)."

On safety: NCI says most people who are prescribed opioids for cancer pain use them safely. Give pain medicine as your care team prescribes, and ask them about any worry.

Here are the practical details.

• Breakthrough pain is pain that comes between scheduled doses. Doctors can prescribe extra doses for it.
• Morphine is the most common opioid for cancer pain.
• Adjuvant drugs add to pain relief. NCI lists antidepressants, anticonvulsants, local anesthetics, corticosteroids, bisphosphonates, and denosumab.
• Nerve blocks, which use local anesthetic around nerves, are an option when drugs are not enough.

Constipation is the side effect that ruins comfort fastest. Opioids slow the gut. Ask your care team about a plan to prevent it from the start, rather than a rescue plan later.

Pain is easier to prevent than to relieve. That single sentence changes how families use the medicine.

These get bundled together, and they should not be.

• A DNR order is about whether CPR is attempted.
• Other orders and advance directives record wider wishes. Ask your team which forms apply where you live.

You can choose comfort-focused care and still want to be hospitalized for a fixable problem. You can have a DNR and still be pursuing active treatment. Tell your care team which combination you want, and get it written down.

Hospice care is usually given at home. It can also be given in an inpatient hospice facility when medically needed. Ask the hospice who is on call after hours.

Medicare pays for four levels of care:

• Routine home care, the standard day-to-day level at home.
• Continuous home care, mainly nursing care at home, used only during brief periods of crisis to keep someone at home.
• Inpatient respite care, up to 5 consecutive days in an approved facility to give the caregiver a rest.
• General inpatient care, in a facility, for pain control or acute symptom management.

With a Medicare-approved hospice provider, here is what you pay:

• Nothing for hospice care.
• Up to a $5 copay per prescription for pain drugs.
• 5 percent coinsurance for respite care.

Medicare does not cover treatment meant to cure the illness. Contact your hospice team before getting other services. The benefit runs in two 90-day periods and then unlimited 60-day periods, with recertification each time.

You can stop hospice at any time. You can change hospice providers once in each benefit period.

Call your care team right away, day or night, if either of these happens:

• Breathlessness frightens the person, and a fan and a raised bed head are not easing it.
• The person cannot be woken as usual after a dose change.

Either can mean a medicine needs adjusting urgently. Hospice and palliative teams keep an on-call line open for exactly this, so there is no need to wait for morning.

Call your care team the same day if pain is no longer held between scheduled doses.

Call your care team within a day or two if any of these happen:

• Several days pass with no bowel movement while opioids are being taken.
• Vomiting keeps medicines from staying down.
• The skin over a pressure point turns red or breaks open.

• Palliative Care in Cancer — National Cancer Institute
• Care Choices in Advanced Cancer — National Cancer Institute
• End-of-Life Care for People Who Have Cancer — National Cancer Institute
• Cancer Pain (PDQ) Patient Version — National Cancer Institute
• Last Days of Life (PDQ) Patient Version — National Cancer Institute
• Hospice care coverage — Medicare.gov
• Medicare Hospice Benefits booklet — Medicare.gov
• Hospice levels of care — Centers for Medicare and Medicaid Services