The Light Before the End of the Tunnel

My grandpa was a very stern man who loved his grandchild enough to stop smoking, but

hated the noise and unpredictability that comes with children. We used to see my grandparents

every two weeks, and every time we came over, my grandpa would be sitting at the old desktop

playing solitaire, reading a newspaper or arguing with my grandma over some mundane issue on

the news. When I saw him last in person, he was bedridden, with a frail frame, swollen feet, and

had to call for assistance every time he needed something. Pancreatic cancer had destroyed his

body, causing so much pain that my grandpa wanted a DNR. A DNR stands for Do Not

Resuscitate, meaning that the patient does not want to have CPR performed if their heart stops

beating. My grandpa would rather die than live in any more agony. Thankfully, home hospice

made his life much easier, helping to let him transfer into death peacefully with his family by his

side. This was my first experience with death in the family with two more to come, all of which

came from cancer. Years after his passing, I think regularly about the fact that both sides of my

family contain an extensive history with cancer. This means that I have a high chance of

receiving a cancer diagnosis in my future. Because of this possibility, I’ve also thought about

hospice and palliative care, and how it aided my grandfather before his passing. Hospice and

palliative care are often mistaken for each other, which can create misgivings. Hospice is end of

life care, focusing on care, comfort and quality of life. Palliative care on the other hand

combines both treatment and quality of life care. Both fields work closely with each other to

ensure patient comfort and that quality of life is maintained. In the end however, death itself is a

very sensitive topic, and although I myself am very welcome to the idea of hospice and palliative

care, I understand that many people do not have the same experience as me. I came to the

realization that I wanted to do some research into palliative care and hospice and make it

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personal. Thus, my research question: How does hospice and palliative care benefit cancer

patients?

Cancer has long been a plague upon humanity, one that even modern medicine with all its

advanced technology fails to put down. Due to its prevalence, cancer is often used in media, one

example being the book, The Fault In Our Stars by John Green, telling the story of a girl with

lung cancer who finds love through a support group. Another example, the wildly popular

television series, Breaking Bad, depicts a struggling chemistry teacher with lung cancer trying to

support his family through a life of drug making and crime. Despite their differences, the media

all have one thing in common, portraying the devastating effect that cancer can put on families.

Money is a major factor in Breaking Bad, the main motivator for the characters, who struggle to

deal with the cost of cancer treatments, as well as what will happen after the teacher passes.

Monetary issues can arise, causing major shifts in how the family may spend or save. Massive

changes are expected to occur during this time, “The diagnosis of cancer is a family experience

that changes the lives of all its members, bringing an immense amount of stress and many

challenging situations. The daily routine, common activities and distribution of duties all have to

change. Family members follow the phases of the disease, very often suffering comparable or

greater distress than the patient”(Wozniak). Cancer patients require care, often administered by

their spouses or other family members which can be an around the clock job. There can be

negative effects of assuming on a caregiver role, “Family members and friends are an important

part of cancer care. Like the patient, they have changing needs. It’s common for many caregivers

to become overwhelmed by the extra responsibilities placed upon them. Many find it hard to care

for their loved one who is sick while trying to handle other obligations, such as work, household

duties, and taking care of their family. Uncertainty about how to help their loved one with

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medical situations, inadequate social support, and emotions such as worry and fear can also add

to caregiver stress”(Palliative Care in Cancer). The constant support for the patient, as well as

the major change in couple dynamics can stress the relationship. This can be further stressed if

children enter the equation regardless of age. The negative effects of cancer can impact children

emotionally, mentally, socially and physically. The effect of cancer has an extreme negative

impact on the family of the cancer patient, but the one who pays the greatest price is the patient

themself.

In their fight against cancer, individual patients often have to deal with tough fast changes

to their daily life. They can experience severe life changes such as medication with hard side

effects like chemotherapy. In addition, their roles can change, such as going from providers to

having to rely on others, which can be a tough mental barrier to break. To gain a better

understanding, I consulted my mentor Tracy Murray. Tracy Murray is an acute care nurse

practitioner in Bone Marrow Transplant (BMT) and Cellular Therapy (CCT) at Stanford Health

Care. She has ample firsthand experience in treating cancer patients and guiding the patients and

their families. Her daily work as an acute care nurse practitioner involves performing physical

assessments, symptoms follow-ups, review labs & medications, ordering diagnostic work ups as

needed, and providing education to the patients and their caregiver. Recently, I asked Murray in

an interview about how a diagnosis can affect the individual,

“It depends, some relapses require just additional work up so the patient can go on to

another therapy with a different transplant or CAR-T treatment. In this case, the patient

undergoes more chemotherapy and loses another couple months of their lives recovering.

Other relapses are terminal and we cannot offer anything else. In this case, the patient can

decide to go home and seek palliative therapy with their local oncologist (to provide

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 comfort and buy a small amount of time only) or transition to end of life hospice/

palliative care”

As shown, cancer can have many different impacts on people’s lives, forcing changes upon them.

There are physical ailments, emotional and psychological problems. Many cancer patients

encounter this issue, “The impact of cancer and its treatment is undeniably stressful. And

although many people recover well, about 25% of cancer survivors have persistent problems,

including anxiety, depression, and other psychological and social (psychosocial)

distress”(Meeting Psychosocial Health Needs). Other physical ailments include anemia, bone

loss, bruising and bleeding problems, diabetes, fatigue and possible recurrence of cancer. These

effects are devastating, but it is vital to remember during treatment to stay strong mentally and

emotionally. To combat these issues, there are coping strategies that can help such as accepting

the reality of the situation, facing your mortality, reaching out for support, expressing your

emotions and feelings, and finally, to stay positive and maintain optimism. While cancer can

have disastrous effects on everyone from the patient to their families and friends, it is a must to

remain hopeful and optimistic in the face of such difficult times.

Due to the effects of life altering diseases and illnesses like cancer, there was a vision to

provide care, comfort and provide the best rest of life care. Hospice was born from that vision,

providing patients a comforting end. Palliative care was created to provide patients treatment

and comfort care, while hospice provides comfort care without treatment. I talked to Donna

Durant, a nurse practitioner at University of Pittsburgh Medical Center Presbyterian hospital.

She specializes in palliative medicine, helping patients manage their pain and making sure that

their treatment aligns with their beliefs. I asked her about how palliative care can impact

families. Her response was, “When patients feel their pain is relieved, or feel better with talking,

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or when our team discusses an intervention, or families feel at peace when a loved one dies,

knowing we gave the best care possible motivates me”. The role of palliative care is to provide

the best quality of life and treatment for the person. There are palliative treatments meant to

relieve pain rather than combat disease or illnesses. For example, “palliative radiation can shrink

a tumor pressing on nerves. Palliative chemotherapy has been shown to decrease pain and other

symptoms of advanced pancreatic, prostate, and lung cancers”(Smith). Due to the ample

benefits provided by palliative care, palliative care is often recommended by professionals.

There are many benefits such as, “Many of the same methods that are used to treat cancer, such

as medicines and certain treatments, can also be used to reduce pain or other symptoms and help

a patient feel more comfortable. In advanced cancer, palliative treatment may be given to help a

person feel better, even if it isn't intended to cure the cancer”(Choices for Care). Palliative care

allows patients to experience quality care and comfort while they wait to see how their condition

progresses.

When a patient's conditions worsen as they go through palliative care, they are often

recommended to go into hospice. Hospice normally occurs when the patient is expected to live

no longer than six months, although it can be provided if the patient’s physician and hospice

team agree that the condition is life limiting. While the objective for palliative care is to provide

comfort as well as treatment for the disease or illness, hospice’s goal is to, “help you feel better

when a cure is not possible…Hospice care can help people achieve their personal goals, such as

spending less time at the doctor’s office and more time with loved ones”(Hospice Care).

Hospice can be beneficial to not just individuals, but families as well. Caregivers who have been

burnt out can be helped by the hospice team, allowing for a better management of care given.

The effects of caregiver roles without hospice could strain relationships because of the possible

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time scheduling changes, as well as a change in power in the relationship. Hospice can help

alleviate these changes, “Hospice care decreases the burden on family, decreases the family's

likelihood of having a complicated grief and prepares family members for their loved one's

death. Hospice also allows a patient to be cared for at a facility for a period of time, not because

the patient needs it, but because the family caregiver needs a break”(Hospice Care: Comforting

the Terminally Ill). These changes allow caregivers to take breaks and help them have breaks

wherever necessary. However, there are many misconceptions about hospice and palliative care.

Many times, it is shown that hospice was not started early enough. According to the American

Cancer Society, “Sometimes the doctor, patient, or family member will resist hospice because

they think it means “giving up” or that there’s no hope. It's important to know that you can leave

hospice and go into active cancer treatment any time you want. But the hope that hospice brings

is a quality life, making the best of each day during the last stages of advanced illness”. Feeling

that hospice is a place where people have given up is a common misconception. Hospice

happens when the condition has progressed to the point where it would be more harmful to

continue treatment than it would be to stop. Rather than continue to treat the condition, hospice

decides to focus on patient care and quality of life before death, helping patients and their

families with their services.

Hospice’s services provided are what make it special, and they come together to give a

dying patient comfort and quality of care. For example, when caregivers such as spouses or

children are tired out, hospice care staff can come and help assume the duties for a while,

allowing for caregivers to take a break to avoid caregiver fatigue. Some other examples include,

“nursing care, drugs for symptom management, homemaker services, chaplain services,

physical therapy and counseling. Luxuries such as back rubs, foot massages, favorite

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 foods or music are offered as well. Hospice care includes a number of services for the

patient's family and home caregivers as well. Members of the hospice staff make regular

visits to assess the patient and provide care. If no caregiver is available at home, the

hospice team can help arrange for another comfortable setting in a freestanding hospice

facility, hospital or nursing home”(UCSF Health).

By providing such services, hospice can help patients alleviate pain from their condition, while

aiding caretakers by providing support if necessary. These benefits allow patients to spend their

final days in comfort, simultaneously allowing their family to cope and grieve. According to the

UMN(University of Minnesota), “Most of those who do receive hospice care report that they

wished they would have started hospice services earlier”. Hospice services allow patients to

bypass unnecessary suffering, and enables an easier transition to death. However, some people

understandably do not feel that hospice is the best place, and insist on continuing treatment.

“Research has shown that patients and families who use hospice services report a higher quality

of life than those who don’t. Yet, almost half of the people with advanced cancer keep getting

chemotherapy even when it has almost no chance of helping them. They end up suffering when

they didn’t have to”(Cancer & Hospice). Due to the heavy side effects of chemotherapy,

advanced cancer patients who decide to go through may suffer for longer than necessary for

futile treatment. I asked my mentor what she thought about preparing patients for hospice,

“There is no best way to prepare someone for hospice. The only options are to really listen to the

patient and family’s wishes, get them the most accurate information through people who know

the topic best (social workers and hospice team), and let them know that this option is not a

“death sentence” and no one is “giving up on them””. Families can be desperate to save their

loved one, which may prolong potential suffering. Furthermore, hospice teams provide

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bereavement support for those grieving as they say goodbye to a loved one. Hospice teams help

grieving families by providing support such as counseling, support groups and educational

classes. Hospice is not just devoted to comfort before death, it is extended to Although there are

many benefits to hospice, there are still many myths and misconceptions about it. It is important

to educate people on the realities of hospice and palliative care so that they can make the best

decision possible with the amount of information they have.

Earlier in the paper, I discussed many practical aspects of hospice, but I haven’t gone into

much depth into the emotional and empathetic side of hospice. Hospice is designed first and

foremost with empathy and care in mind. While the illness may deteriorate the patient

physically, the person is still left. We can be called football players, chefs, accountants,

anything that we want, but despite all that, they are just titles. Above any titles, we are all still

human, meaning that we are very much mortal. Mortality is not a subject handled very well, and

it’s completely understandable why we make mistakes as we grieve and mourn our losses. One

tool that we can use to overcome and move forward from tragic events such as cancer diagnoses,

is showing our empathy. Empathy during hospice allows the patients to feel a sense of happiness

and comfort in their final day. In fact, empathy can help boost the experience during hospice,

“The experience of an empathic relationship meant being acknowledged as an individual, a

person of value. The outcome of the empathic relationships between hospice nurses and their

patients was the improvement and maintenance of patients' physical and emotional

well-being”(Raudonis). I hope to one day become a nurse, and share that empathy with others

who may be going through difficult times. In nursing, empathy is a required tool for the job as

nurses have to console patients as they experience pain or loss, as well as to give mental, and

emotional support for both patients and families alike. Hospice nurses are a necessary part of

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hospice, where they play an indispensable role in physical, mental and emotional comfort and

care. Hospice nurses often build relationships between them and their patients, which help out in

patient satisfaction and happiness, “Such relationships not only improve patients' physical and

emotional state, but also facilitate their adjustment to their illness, ease pain and can ultimately

lead to a good death experience. It is nurses' personal qualities and skills, which are embedded in

these relationships, that constitute excellence in nursing care”(Mok). Nurses perform a majority

of the emotional care that comes with the job, meaning that empathy is vital in their job.

Another important part would be trust, which is built upon empathy. Trust and faith in

healthcare is necessary, otherwise, healthcare would cease to function. In hospice, patients put

their trust and faith in hospice staff, that they will be taken care of to the best ability of the

hospice staff. In return, the staff receive the trust and derive satisfaction from building

relationships with their patients. Although hospice is often associated with sadness and death, it

doesn’t necessarily have to be. After all, hospice is intended to enable patients to experience

completion, that they have lived out their lives the way they wanted even if they did not expect

their life to turn out that way.

Looking back during my time as a child, I feel happy that although my grandfather

experienced so much pain with his cancer, he lived a full life, concluding it surrounded by his

family in comfort in his own home. Without hospice, I do not think that my grandfather would

have been happy to see his pain prolonged if we had delayed his hospice to try and continue to

treat him. He was a man who understood his own mortality, and decided to spend his last few

months in hospice in comfort where his grandchildren, children and spouse took care of him until

he passed. Fast forward to today, I ask the question of how palliative care and hospice can

benefit cancer patients. My answer to this question is that palliative care and hospice provide a

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way to relieve cancer patients of pain caused by the cancer. While modern medicines attempt to

overcome cancer, hospice and palliative care stand as a way to help patients enjoy their lives

while they can. Hospice and palliative care provide ways that can help families through a tough

situation whether that be assuming caretaker roles, sharing memories, or comforting the family.

Hospice and palliative care are a symbol of hope, a symbol that can help guide families through

tough times providing patients a way out of needless suffering. The hospice and palliative care

industry may seem morbid, but in reality, they supply a way for cancer patients and their families

to have a sense of hope in dark times. I often think about the industry as a kinder pathway into

death, enabling cancer patients to spend their last moments in comfort and happiness surrounded

by the people they love.

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 Works Cited

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https://samaritannj.org/hospice-care/what-is-hospice-care/cancer-hospice/.

“Choices for Care with Advanced Cancer.” National Cancer Institute,

https://www.cancer.gov/about-cancer/advanced-cancer/care-choices.

Durant, Donna. Personal Interview. 28 February 2023

“End of Life and Hospice Care.” Taking Charge of Your Health & Wellbeing,

https://www.takingcharge.csh.umn.edu/end-life-and-hospice-care.

“Hospice Care.” Cancer.Net, 4 Nov. 2019,

https://www.cancer.net/navigating-cancer-care/advanced-cancer/hospice-care.

“Hospice Care: Comforting the Terminally Ill.” Mayo Clinic, Mayo Foundation for Medical

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“Meeting Psychosocial Health Needs of Cancer Survivors.” National Cancer Institute, January

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psychosocial)%20distress.

Mok, Esther, and Pui Chi Chiu. “Nurse-patient relationships in palliative care.” Journal of

advanced nursing vol. 48,5 (2004): 475-83. doi:10.1111/j.1365-2648.2004.03230.x

Murray, Tracy. Personal Interview. 27 February 2023

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“Palliative Care in Cancer.” National Cancer Institute,

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