Prognoses Of Cancer Diagnoses – Determining Hospice Eligibility

Today I’m reviewing the CMS Disease Specific Guidelines for Cancer admission to hospice.

The reasonable determination of a patient’s medical prognosis is critical for the patient with a chronic or terminal condition. Only then can the patient make treatment decisions that are consistent with his or her values.

The hospice admission criteria provide a reasonable place to start. If the hospice criteria are met then the patient is considered to have a six month prognosis and hence is eligible for hospice care.

All that follows is from Resource (1) below:

CMS Disease Specific Guidelines (LCDs)

A patient is eligible for hospice services if he
meets these three criteria:
1) has a Palliative Performance Scale [Resource 2 below] of less than 70%
2) is dependent on at least two Activities of Daily Living Resource below , and
3) meets the Disease Specific Guidelines [Links to individual Disease Specific Criteria from my blog post.]

Cancer Diagnoses

A. Disease with metastases at presentation OR
B. Progression from an earlier stage of disease to
metastatic disease with either:
1. A continued decline in spite of therapy; or
2. Patient declines further disease directed therapy.
Note: Certain cancers with poor prognoses (e.g., small
cell lung cancer, brain cancer and pancreatic cancer) may
be hospice eligible without fulfilling the other criteria in
this section.



1. Determining Hospice Eligibility In Terminally Ill Patients Hospice by The Bay – An Affiliate Of USCF Health, Updated 3-2014

2. The Palliative Performance Scale For Determination Of Hospice Eligibility
Posted on March 29, 2018 by Tom Wade MD

3. Instruments For The Assessment Of The Activities Of Daily Living [ADLs]
Posted on March 30, 2018 by Tom Wade MD

This entry was posted in 2018 Blog Posts, Family Medicine, Geriatrics, Health Monitoring Forms + Questionnaires, Hospice Care, Internal Medicine, Medical Decision Making, Oncology, Palliative Care, Prognosis. Bookmark the permalink.