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Questions and Answers

What is a common feature of Acute Leukemia cells?

They are smaller in size

They are transparent

They are non-adherent

They are sticky (correct)

What is a potential complication of hypercalcemia in leukemia patients?

CNS mentation issues

Renal failure

Cardiac enzyme elevation

All of the above (correct)

What is the significance of Auer rods in Acute Promyelocytic Leukemia (APML)?

They are not associated with APML

They are specific for but not diagnostic of APML

They are non-specific for APML

They are specific for and virtually diagnostic of APML (correct)

What is the primary treatment for Acute Leukemia?

Chemotherapy Signup and view all the answers

What is the term for Clonal Hematopoiesis of Indeterminate Significance?

CHIP Signup and view all the answers

What is the name of the type of immunotherapy that is FDA approved for Multiple Myeloma and some cases of B-ALL?

CART Signup and view all the answers

What is the potential consequence of not treating Acute Promyelocytic Leukemia (APML) promptly?

Bleeding complications Signup and view all the answers

What is the term for a sudden change in the WBC count that may indicate leukemia?

Leukocytosis Signup and view all the answers

What is the definition of cancer?

Uncontrolled cell growth with loss of apoptosis Signup and view all the answers

What type of cancer originates from plasma cells, a type of B cell?

Myeloma Signup and view all the answers

What is the most common presentation of Acute Leukemia?

Severe fatigue associated with anemia Signup and view all the answers

What is the characteristic of blasts in the peripheral blood?

Blasts are never present in the peripheral blood Signup and view all the answers

What is the complication of high white cell count in Acute Leukemia?

Leukostasis Signup and view all the answers

What is the rare presentation of Acute Leukemia?

All of the above Signup and view all the answers

What is the characteristic of Acute Leukemia in terms of patient demographics?

A disease of older people, non-Hispanics white Signup and view all the answers

What is the consequence of not treating Acute Leukemia?

Death is inevitable, sometimes in a matter of hours, days, or weeks Signup and view all the answers

What is the primary diagnostic tool for Pylori infection (MALT tumors)?

EXCISIONAL biopsy of the LN Signup and view all the answers

What is a common symptom of Multiple Myeloma?

Mild back pain that is not alleviated when lying down Signup and view all the answers

What is a risk factor for developing Multiple Myeloma?

Agent orange exposure Signup and view all the answers

What is the term for the condition where the blood is full of cancerous plasma cells and proteins?

Multiple Myeloma Signup and view all the answers

When should a patient with Multiple Myeloma be referred to an oncologist?

All of the above Signup and view all the answers

What is the goal of treatment for Multiple Myeloma?

Prolong survival and improve quality of life Signup and view all the answers

What is a potential complication of hypercalcemia in Multiple Myeloma?

Confusion and increased thirst Signup and view all the answers

What is the definition of Myelodysplastic Syndrome (MDS)?

A premalignant disorder of the bone marrow Signup and view all the answers

What is the increased risk of developing lymphoma in relatives of probands?

3.5x higher Signup and view all the answers

Which of the following is a known risk factor for Chronic Leukemias?

Exposure to ionizing radiation Signup and view all the answers

What is the characteristic of the Philadelphia chromosome in Chronic Myeloid Leukemia (CML)?

BCR-ABL t(9;22) translocation Signup and view all the answers

What is the most common acute leukemia in children?

Acute Lymphoid Leukemia (ALL) Signup and view all the answers

What is the characteristic of the blasts in Acute Myeloid Leukemia (AML)?

>20% blasts Signup and view all the answers

What is the presentation of Chronic Lymphoid Leukemia (CLL)?

Lymphadenopathy and very elevated WBC count Signup and view all the answers

What is the treatment for Hodgkin's Lymphoma?

Complex chemotherapy and radiation therapy Signup and view all the answers

What is the characteristic of Reed-Sternberg cells in Hodgkin's Lymphoma?

Owl eye cells Signup and view all the answers

What is the primary mechanism by which tumors produce paraneoplastic syndromes?

Aberrant production of hormones, peptides, or cytokines Signup and view all the answers

Which of the following is a treatment-related complication of cancer?

Neutropenia Signup and view all the answers

What is the primary characteristic of paraneoplastic syndromes?

Remote effects of cancer that cannot be attributed to direct invasion or metastasis Signup and view all the answers

Which type of cancer is most likely to be associated with paraneoplastic syndromes?

Small cell lung cancer Signup and view all the answers

What is the primary mechanism by which cancer can cause urinary obstruction?

Direct invasion of the urinary tract Signup and view all the answers

What is the primary complication of cancer in the liver?

3rd spacing into the belly Signup and view all the answers

What is the primary mechanism by which cancer can cause malignant effusions?

Direct invasion of the pleural space Signup and view all the answers

What is the primary take-home point for patients with cancer?

Patients with cancer can have emergent complications Signup and view all the answers

What is the primary goal of treating hypercalcemia in patients with cancer?

To alleviate symptoms and improve quality of life Signup and view all the answers

What is the primary mechanism of reversible myelosuppression in patients with cancer?

Direct bone marrow toxicity Signup and view all the answers

What is the primary indication for bisphosphonate therapy in patients with hypercalcemia?

Moderate or severe hypercalcemia Signup and view all the answers

What is the primary consideration when treating hypercalcemia in patients with cancer who have a poor prognosis?

Judicious treatment to balance symptom relief and quality of life Signup and view all the answers

What is the primary complication of untreated hypercalcemia in patients with cancer?

Mild sedation and decreased cognitive function Signup and view all the answers

What is the primary reason why calcium levels are not a reliable indicator of cancer prognosis?

Albumin levels are often low in cancer patients due to malnutrition or liver dysfunction Signup and view all the answers

What is the primary mechanism of hypercalcemia in cancer patients?

All of the above Signup and view all the answers

What is the most common site of malignant spinal cord compression?

Thoracic spine Signup and view all the answers

What is the characteristic physical finding in patients with Superior Vena Cava Syndrome?

All of the above Signup and view all the answers

What is the primary treatment for Superior Vena Cava Syndrome caused by non-small-cell lung cancer?

Radiation therapy Signup and view all the answers

What is the most common cancer causing hypercalcemia?

All of the above Signup and view all the answers

What is the significance of Lhermitte's sign in patients with malignant spinal cord compression?

It is an early sign of cord compression Signup and view all the answers

What is the goal of treatment for malignant spinal cord compression?

All of the above Signup and view all the answers

What is the initial treatment of choice for most patients with malignant spinal cord compression?

Radiation therapy plus glucocorticoids Signup and view all the answers

What is the significance of a corrected calcium level above 12 mg/dL in patients with hypercalcemia?

It may cause cardiac arrhythmia Signup and view all the answers

What is the primary diagnostic tool for evaluating patients with suspected malignant spinal cord compression?

MRI Signup and view all the answers

What term describes abnormal tissue that grows more rapidly than normal and continues to grow and proliferate in the absence of the originating growth signal?

Neoplasm Signup and view all the answers

What is the primary difference between solid tumors and liquid malignancies?

Solid tumors are composed of abnormal organ cells, while liquid malignancies are a disease of the bone marrow Signup and view all the answers

What is the second leading cause of death in the US, according to the provided information?

Cancer Signup and view all the answers

What is the most common cause of cancer deaths in the US?

Lung and bronchus cancer Signup and view all the answers

What is the term for a disease of the bone marrow that can become diseased, leading to abnormal cell growth?

Hematologic malignancy Signup and view all the answers

What is the percentage of US cancer deaths related to tobacco use?

30% Signup and view all the answers

What is the current rate of adult tobacco use in the US?

14% Signup and view all the answers

What is the term for the process by which cell growth becomes dysregulated, leading to cancer?

Hits to the gene Signup and view all the answers

What is the primary goal of staging in cancer treatment?

To determine the best treatment option Signup and view all the answers

What is the term for the spread of cancer to distant sites in the body?

Metastasis Signup and view all the answers

What is the primary function of the TNM staging system?

To classify cancer into different stages Signup and view all the answers

What is the name of the type of radiation therapy that uses many precisely focused radiation beams to treat tumors?

Stereotactic radiation therapy Signup and view all the answers

What is the term for the absence or presence and extent of nodal metastases in the TNM staging system?

N Signup and view all the answers

What is the primary mechanism of hypercalcemia in cancer patients?

Cancer cells producing osteoclast-activating factors Signup and view all the answers

What is the term for the treatment of tumors using radiation therapy?

Radiation therapy Signup and view all the answers

What is the primary goal of cancer treatment?

To cure the patient Signup and view all the answers

What is the term for the process by which cancer cells spread to distant sites in the body?

Metastasis Signup and view all the answers

What is the primary reason for staging cancer?

To develop a treatment plan Signup and view all the answers

What is the primary goal of hospice care?

To provide comfort and support to the patient and their loved ones Signup and view all the answers

What is the significance of the phrase 'there is much to be done' in the context of hospice care?

It signals a shift from curative to palliative care Signup and view all the answers

What percentage of hospice patients die within 7 days of being admitted?

⅓ Signup and view all the answers

What is the primary requirement for a patient to be eligible for hospice care?

A terminal illness with a life expectancy of 6 months or less Signup and view all the answers

What is the purpose of respite care in hospice?

To give caregivers a break and allow them to rest Signup and view all the answers

What is the significance of the 'circle of care' in hospice?

It refers to the hospice team's expertise and compassion in caring for dying patients Signup and view all the answers

What is the primary way that hospice care is typically paid for?

Medicare Part A or Medicaid Signup and view all the answers

What is the purpose of bereavement care in hospice?

To provide comfort and support to the patient's loved ones after they pass away Signup and view all the answers

What is the primary goal of Palliative Care?

To focus on quality of life for anyone dealing with serious illness Signup and view all the answers

What is a unique feature of hospices in North Carolina?

There are over a dozen hospices operating in the state Signup and view all the answers

What is the purpose of bereavement counseling?

To offer grief support to anyone in the community grieving the loss of a loved one Signup and view all the answers

What is the focus of Concurrent Care?

To allow patients under 18 to receive chemo and other treatments Signup and view all the answers

What is the primary difference between hospice and palliative care?

Hospice care is only for patients with a short life expectancy, while palliative care is for anyone with serious illness Signup and view all the answers

What is the goal of Advanced Illness Care Continuum?

To establish a continuum of care for patients with serious illness Signup and view all the answers

What is the purpose of CAP-C case management?

To require shifts of care in the home Signup and view all the answers

What is the primary difference between Palliative Care programs?

Program variations, team make-up, services provided, and location of services provided Signup and view all the answers

Study Notes

Cancer Generalities

Cancer is characterized by uncontrolled cell growth with loss of apoptosis (programmed cell death)
Can occur in any cell in the body

Types of Cancer

Leukemia: originates from a blood cell (either myeloid or lymphoid)
Lymphoma: originates from lymphoid tissue (either in bone marrow or peripheral)
Myeloma: originates from plasma cells, a type of B cell

Marrow Components

Neutrophils: can lead to Acute Myeloid Leukemia
Lymphocytes: can lead to Acute Lymphocytic Leukemia
Monocytes: can lead to Acute Myeloid Leukemia
Eosinophils: can lead to Hypereosinophilic Syndrome
Basophils: can lead to Acute Myeloid Leukemia (seen in CML, also in HD)
RBCs: can lead to Acute Erythroid Leukemia (rare)
Platelets: can lead to Acute Megakaryoblastic Leukemia (rare)

Normal Maturation of Neutrophil

Myeloblast → Promyelocyte → Myelocyte → Metamyelocyte → Band → Neutrophil

Acute Leukemia

Epidemiology: generally a disease of older people, non-Hispanics, and whites
Genetic disorders: Down syndrome, Ataxia telangiectasia, Fanconi Anemia, Li Fraumeni
Radiation exposure and chemical exposure increase risk
Without treatment, death is inevitable within hours, days, or weeks
Must be able to identify findings quickly for referral

Signs and Symptoms of Acute Leukemia

CBC with "BLAST" in the differential (blasts are never normal in peripheral blood)
Severe fatigue associated with anemia and possible signs of symptomatic anemia
High white cell count (can be >50-100K, requiring leukapheresis to reduce leukostasis)
Anemia, fevers, bleeding/bruising, or DIC
Bone/Joint pains, skin manifestations, pallor, petechiae, and ecchymosis
Rare: gingival hyperplasia (monocytic), oral candida, herpetic lesions, and CNS involvement

Metabolic/Electrolyte Abnormalities

Hyperphosphatemia
Hypocalcemia
High uric acid
Hyperkalemia
High LDH

Why is Acute Leukemia so Dangerous?

ACUTE Leukemia cells are "sticky"
Acute leukemia is a MEDICAL EMERGENCY

Treatment of Acute Leukemia

Always involves chemotherapy (unless palliative care)
Special case: Acute Promyelocytic Leukemia (APML) aka M3
Requires immediate treatment with ATRA if suspected
Auer Rods are specific for and virtually diagnostic of APML

Advanced Treatments

Bone Marrow Transplant
Chimeric Antigen Receptor T cell (CART) therapy
Type of immunotherapy
FDA approved for: Multiple Myeloma and some B-ALL cases
Major side effects: fever, Cytokine Release Syndrome (CRS), and long-term B cell aplasia

Leukemias

Relatives of probands have a 3.5x higher chance of developing lymphoma
Higher incidence in RA, hemolytic anemia, psoriasis, SLE, Systemic sclerosis, Polyarteritis nodosa, sarcoidosis, Crohn Disease, motor and Celiac disease
Immunosuppression and viral infections (HIV, HTLV, EBV) are risk factors

Myeloid Leukemias

Acute: AML (acute myeloid leukemia)
- Sudden onset
- >20% blasts
- Severe symptoms
- Most common acute leukemia in adults
Chronic: CML (chronic myeloid leukemia)
- Philadelphia chromosome translocation BCR-ABL t(9;22)
- Elevated WBC and platelet count
- Often normal hemoglobin
- Always has splenomegaly
- Can progress to accelerated phase (30% blasts)
- Treatment: Tyrosine kinases (e.g. imatinib)

Lymphoid Leukemias

Acute: ALL (acute lymphoid leukemia)
- Most common in children
Chronic: CLL (chronic lymphoid leukemia)
- Affects older people
- Smudge cells present
- VERY elevated WBC count (hundreds of thousands)
- New drugs available in pill form
- Can have normal life expectancy
- Increased risk of infections → may benefit from monthly IVIG infusions

Lymphomas

Hodgkin's Lymphoma
- Peak incidence at young (20-24) and old (80-84) ages
- "Owl Eye cells" (Reed-Sternberg cells)
- Presentation: lymphadenopathy, fatigue, pruritus
- Treatment: complex chemotherapy, radiation, or combination therapy, BMT, CART
Non-Hodgkin's Lymphoma
- Affects all ages, races, and socioeconomic statuses
- Splenomegaly and implants associated with increased risk
- Presentation: lymphadenopathy, fever of unknown origin
- Can be associated with immunodeficiencies and H. pylori infection (MALT tumors)

Plasma Cell Dyscrasias - Multiple Myeloma

Mild back pain, especially mid-thoracic and when lying down
Middle-aged individuals affected
Epidemiology:
- Higher incidence in African Americans
- Association with agent orange exposure and family history
- Increased risk with Body Mass Index
CRAB criteria:
- Calcium deviation
- Renal insufficiency
- Anemia
- Bone disease
Symptoms: throughout the body, blood with cancerous plasma cells and proteins
Pitfalls:
- Worsening hypercalcemia (beware dental work 6 weeks before or after)
- Increased thirst and urination frequency
- Confusion and bone lesions with pathological fractures
Referral criteria:
- Anemia with renal insufficiency +/- hypercalcemia
- Lytic lesions on imaging
- Oncologist will risk stratify; consider autologous transplant
Treatment:
- Induction chemotherapy followed by maintenance therapy (if ineligible for transplant)
- Autologous transplant prolongs time to first relapse, but MM is not curable

Myelodysplastic Syndrome (MDS)

Premalignant disorder that can become cancer if left untreated
Defined as a pre-malignancy of the bone marrow

Oncologic Emergencies

Classified into 3 groups:
- Pressure or obstruction caused by a space-occupying lesion
- Metabolic or hormonal problems (paraneoplastic syndromes)
- Treatment-related complications

Mechanical/Obstructive Emergencies

SVCS (Superior Vena Cava Syndrome)
MSCC (Metastatic Spinal Cord Compression)
Pulmonary Embolism
Urinary Obstruction
Malignant Effusions

Metabolic or Hormonal Emergencies

Paraneoplastic Syndromes
- Due to aberrant tumor production of hormones, peptides, or cytokines
- Or due to the body's immune attack on normal tissues
Tumor Lysis Syndrome
- Tumor bursts due to chemotherapy, leading to metabolic damage
Hypercalcemia
SIADH (Syndrome of Inappropriate Antidiuretic Hormone)

Neutropenia
Anemia
Thrombocytopenia
Bleeding Disorders
Clotting disorders

Cancer in the Liver

Usually metastatic from other organs (e.g. Colon cancer)
Liver stops making albumin and clots, leading to 3rd spacing into the belly

Paraneoplastic Syndromes

General problems observed in many patients with advanced or widespread metastatic cancer
Symptoms resemble those of primary endocrine, dermatologic, rheumatologic, hematologic, or neuromuscular disorders
Small cell lung cancer (SCLC) is most likely to be associated with paraneoplastic syndromes

Take Home Points

Patients with cancer can have emergent complications from their disease or treatment
If a patient presents with a common condition, they have cancer until proven otherwise

Oncologic Emergencies

Superior Vena Cava Syndrome (SVCS)

SVCS is the clinical manifestation of superior vena cava (SVC) obstruction
SVC obstruction results in severe reduction in venous return from the head, neck, and upper extremities
Malignant tumors (lung cancer, lymphoma, metastatic tumors) are responsible for the majority of SVCS cases

Presentation

Patients with SVCS usually present with neck and facial swelling, dyspnea, and cough
Other symptoms include hoarseness, tongue swelling, headaches, nasal congestion, epistaxis, hemoptysis, dysphagia, pain, dizziness, syncope, and lethargy
Bending forward or lying down may aggravate the symptoms
Characteristic physical findings are dilated neck veins, increased collateral veins, cyanosis, and edema of the face, arms, and chest

Diagnosis and Treatment

Diagnosis is a clinical one, with a chest radiograph (CXR) as the first step
CXR findings include widening of the superior mediastinum, usually on the right side
CT provides the most reliable view of the mediastinal anatomy
Chemotherapy is effective for small-cell carcinoma of the lung, lymphoma, or germ cell tumor
Radiation therapy is the primary treatment for SVCS caused by non-small-cell lung cancer and other metastatic solid tumors

Malignant Spinal Cord Compression (MSCC)

MSCC is defined as compression of the spinal cord and/or cauda equina by an extradural tumor mass
Thoracic spine is the most common site (70%), followed by lumbosacral spine (20%), and cervical spine (10%)
Lung cancer is the most common cause
Most common initial symptom is localized back pain and tenderness
Pain is exacerbated by movement and coughing or sneezing
Radicular pain is less common than localized back pain and usually develops later
Lhermitte's sign may be an early sign of cord compression

Treatment

Treatment is aimed at relief of pain and restoration/preservation of neurologic function
Management requires a multidisciplinary approach
Radiation therapy plus glucocorticoids is the initial treatment of choice for most patients
The management decision of SCC involves assessment of neurologic (N), oncologic (O), mechanical (M), and systemic factors (S) (NOMS)

Hypercalcemia

Elevated levels of calcium in the blood (>/10.5 mg/dL)
Affects 20-30% of patients with cancer at some point during their illness
Most common cancers causing hypercalcemia are myeloma, breast carcinoma, and NSCLC
Hypercalcemia is caused by one of three mechanisms: systemic effects of tumor-released proteins, direct osteolysis of bone by tumor, and vitamin D-mediated osteoabsorption

Presentation

Symptoms and signs can be subtle; more severe symptoms occur with higher levels of hypercalcemia and rapidly rising calcium levels
Early symptoms include anorexia, nausea, fatigue, constipation, and polyuria
Later findings may include muscular weakness, hyporeflexia, confusion, psychosis, tremor, and lethargy

Diagnostic Workup

Calcium level corrected for albumin
Corrected calcium = measured calcium – measured albumin + 4
Ionized calcium level is more specific, sensitive, and expensive
ECG in hypercalcemia often shows a shortening of the QT interval
Initial workup includes obtaining serum PTH, PTHrP, and calcitriol levels

Treatment

Emergency management begins with IV 0.9% saline to ensure rehydration with brisk urinary output
For moderate or severe hypercalcemia, treatment with bisphosphonate is indicated
Treatment is then directed to control of tumor; reduction of tumor mass usually corrects hypercalcemia

(Febrile) Neutropenia

Cytotoxic chemotherapeutic agents affect bone marrow function
The nadir count of each cell type in response to classes of agents is characteristic
Complications of myelosuppression result from the predictable sequelae of the missing cells' function
Febrile neutropenia refers to the clinical presentation of fever and

Cancer Definition

Cancer refers to a wide array of disorders characterized by unregulated cell growth
Medical and biological term: neoplasm (abnormal tissue that grows rapidly and continues to grow in the absence of the originating growth signal)

Types of Cancer

Solid tumors: pieces of organ where cells grow out of control and can compress other organs
Liquid/Hematologic: a disease of the bone marrow, affecting any of the three cell lines (RBC, WBC, Platelets)

Common Cancers

Top 10 cancers by rates of new cases:
- Female breast cancer
- Prostate
- Lung and bronchus
- Colon and rectum
- Corpus and uterus, NOS
- Melanomas of the skin
- Urinary bladder
- Non-Hodgkin lymphoma
- Kidney and renal pelvis
- Pancreas
Top 10 cancers by rates of cancer death:
- Lung and bronchus
- Female breast
- Prostate
- Colon and rectum
- Pancreas
- Liver and intrahepatic bile duct
- Ovary
- Leukemias
- Corpus and uterus, NOS
- Non-Hodgkin lymphoma

Risk Factors for Cancer

Tobacco Use:
- 30% of US cancer deaths related to tobacco use
- Tobacco risk linked to at least 12 types of cancer
- 81% of lung cancer deaths attributed to smoking
- Current rate of adult tobacco use: 14%
Vaping:
- Electronic cigarette aerosol can contain harmful substances (nicotine, heavy metals, volatile organic compounds, carcinogenic substances)
- Vaping among high school students increased from 1.5% in 2011 to 21% in 2018
Nutrition & Physical Activity:
- Prudent recommendations to reduce cancer risk:
  - Be physically active
  - Maintain a healthy weight
  - Consume a diet rich in fruits, vegetables, and whole grains
  - Lower consumption of saturated and trans dietary fats
  - Limit alcohol use
  - Avoid excess sun exposure
  - Utilize SPF every day
Radiation:
- Individuals exposed to significant radiation doses may increase their lifetime risk of cancer
- Standardization of CT radiation doses and limiting testing have been important steps in minimizing this risk

Staging

Staging refers to where a cancer is located and if it has spread from its original source
TNM system:
- T: tumor location, size, and level of invasion
- N: absence or presence and extent of nodal metastases
- M: absence or presence of systemic metastases
Cancer spreads to the biggest organ near it
Once the TNM designations have been determined, an overall “clinical stage” (I, II, III, or IV) is assigned
IV: metastasis of disease

Oncology Treatment

Surgery:
- Tumor removal
- Debulking surgery
- Palliative surgery
Chemotherapy:
- Systemic chemotherapy
- Localized chemotherapy
- Biologic agents
- Hormonal agents
- Palliative chemotherapy
Radiation Therapy:
- Radiation therapy
- Stereotactic radiation therapy (Stereotactic radiosurgery)
- Brachytherapy
- Palliative radiation therapy

Hospice Care

Designed to create a 'holding space' for dying persons and their loved ones
Focuses on providing comfort and support to patients with a terminal illness and a life expectancy of six months or less
⅓ of patients die within 7 days of being in hospice
Challenges a death-denying culture, shifting the medical mindset from "there's nothing more we can do" to "there is much to be done"

Hospice Team and Services

A circle of care offering expertise and compassion in the service of dying persons' comfort and support of their loved ones
Plan of care is established and constantly updated to reflect the goals for today
Services include medical equipment and supplies, related medications, 24-hour on-call, bereavement care, physical therapy, nutritionist, horticultural therapist, music, and respite care

Eligibility and Payment

Eligibility requires a terminal illness and a life expectancy of six months or less, or choosing comfort care over curative care
2 physicians certify that a patient is eligible for hospice care
Almost 98% of the time, hospice is provided under Medicare Part A or Medicaid, and private insurances often provide a hospice benefit as well

Signs it might be Time for Hospice Care

Decreased energy
Less capacity to do daily activities
Weight loss
Frequent infections
More hospitalizations
More pain
Failure to thrive

Starting Hospice Care

Hospice is started by contacting the hospice organization, and they complete the communication with all parties and deem eligibility
Doctor writes an order for hospice care, and admission visit is set up
Patient or family signs consents for care, and then it's official

Bereavement Counseling

Grief support for hospice bereaved and anyone in the community grieving the loss of a loved one
Services include individual counseling, loss-specific groups, literature, workshops, and memorial services

Other Services

Kids Path: hospice care, home health, perinatal care, and bereavement services
CAP-C case management: require shifts of care in home
Concurrent care: anyone under 18 can still receive chemo, etc.
Advanced Illness Care Continuum: focuses on quality of life for anyone dealing with serious illness

Palliative Care

= Comfort Care, focuses on quality of life for anyone dealing with serious illness, at any time, regardless of diagnosis, prognosis, or treatment
Establishes goals of care, assists with completion of advance directives, and helps navigate complex medical decisions
Relieves suffering associated with serious illness, and provides timely transfer to hospice when appropriate
Any diagnosis, any age, and any time in the course of disease can be eligible for palliative care

Centers for Medicare and Medicaid Services Innovation Center

Building an Improved Dementia Experience (GUIDE) Model: a program variation with a unique team make-up, services, and location

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Description

Learn about the basics of cancer, including characteristics, types, and how it affects different cells in the body. Explore leukemia, lymphoma, and myeloma, and how they relate to marrow components.