Understanding palliative and hospice care is essential, as misconceptions about these services can affect the decisions you may need to make if you or a loved one has stage 4 breast cancer.

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

There’s currently no 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 systemic treatments such as chemotherapy and radiation.

Palliative care can involve aspects such as:

The goal of palliative care is to help you feel better rather than to cure or treat the cancer itself. Palliative care 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 palliative care can and should be used along with end-of-life care, it is certainly not used only 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 cancer treatment.

How palliative care helps

Palliative care is about helping you live as fully as possible. While cancer treatment works to prolong your life, palliative care works to improve your quality of life.

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

Hospice care is end-of-life care that’s appropriate if you have an end stage cancer diagnosis and either have no treatment options or choose not to prolong your life with standard treatments.

This type of care involves medications and other treatments to:

  • manage symptoms
  • manage side effects
  • keep you as comfortable as possible during the last days of your life

Hospice care can take place in any of the following settings:

  • your home
  • a hospital
  • a nursing home
  • a hospice facility

When hospice care is appropriate

Hospice is appropriate when you’re no longer pursuing curative treatment and you have a life expectancy of less than 6 months if your cancer is not treated. If you’re enrolled in Medicare, you must meet certain requirements to receive coverage for hospice care, including a life expectancy of 6 months or less.

Starting hospice care can be a difficult decision, but the earlier hospice care begins, the higher the chance may be that you can have the type of quality of life you want when your cancer is no longer curable. It’s important not to wait too long to start hospice care if you need it.

If hospice workers have more time to get to know you and your unique situation, they can create a better, more individualized plan for care.

How hospice care helps

Hospice care helps ease the transition from actively treating cancer to focusing on staying as comfortable as possible and preparing for death. Hospice can come in many forms, such as inpatient hospice and at-home hospice.

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

Hospice care is also a big help to family members, as it means they will not be alone in providing end-of-life care for their loved one. Knowing that their loved one is not in pain can also help make this challenging time more bearable for family and friends.

Deciding between palliative and hospice care — and deciding whether to use 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 option 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 you comfortable. You 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 for you to conclude that you’ve reached an endpoint in your treatment and your 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 a short-term care facility, such as an extended-care facility.

But the location depends on your insurance coverage and cost considerations, the availability of resources in your area, and your preference.

Inpatient hospice facilities (freestanding facilities) exist all over the country, and some hospitals 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 include:

  • 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 has advised others in 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 you or your family knows the end of life is nearing and time is limited. At this difficult time, there are actions you may want to take to ensure that your 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 your thoughts, feelings, and final wishes for them.
  • Talk with a lawyer about updating or writing a will and completing any advance directives.
  • Discuss treatments focused on managing symptoms and enhancing your life, such as taking medications for pain or nausea.
  • Talk 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 talk with your family members to help them prepare.
  • Consider hiring at-home nursing staff who can provide care when you may not be able to do some things for yourself.

These are just some of the ways you can make your wishes known and live your life most fully.

Palliative and hospice care are important parts of managing stage 4 breast cancer.

The palliative or hospice care process will usually start with a referral from your oncologist or from a caseworker or social worker in your oncologist’s office.

A referral is often needed for insurance purposes. Each individual palliative or hospice care organization will likely have its own requirements for the paperwork or information that’s needed after this referral.

Communication is important when you’re 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.