LCD Guidelines
Cancer
1. Disease with distant metastases at presentation
OR
2. Progression from an earlier stage of disease to metastatic disease with either:
- continued decline despite therapy
- patient declines further disease directed therapy
NOTE: Certain cancers with poor prognoses (e.g. small cell lung cancer, brain cancer & pancreatic cancer) may be hospice eligible without fulfilling the other criteria in this section.
Comparative Data
Increase in Tumor Size - Tumor was size of golf ball, now is size of softball
Decease in activity - Was able to go out & enjoy activity, now staying in room
Comorbidities - CHF, COPD, etc.
Decrease in intake - Was eating 100% of meals 1 month ago, now eating only 1 meal per day, complains of change in taste, weight change, anorexia
Depression & Anxiety - Was very social interacting with people, now staying in room, not talkative
Medication changes - Needs depression & anxiety medications
Increase in Pain - Change in pain intensity, pain interferes with activity
Change in ADL’s - Needs assistance with bathing & dressing, PPS was 60% 2 months ago from today, PPS 40%, increased weakness
Change in skin - Pallor, lesions, wounds, nonhealing wounds, dusky, bruising
Comorbidities
Anorexia
Ascites
Bleeding
Kidney Failure
Pain
SOB
Skin Issues