What are the recommended approaches for home hospice care in a 74-year-old African-American male with squamous cell carcinoma of the lung after completing one year of chemotherapy and radiation therapy?

From the Guidelines

For home hospice care in a 74-year-old African-American male with squamous cell lung carcinoma who has completed a year of chemotherapy and radiation therapy, a comprehensive approach focusing on symptom management and quality of life is recommended. The care plan should include:

• Pain management with a tiered approach starting with scheduled acetaminophen (1000 mg every 6 hours) and progressing to opioids like morphine (5-15 mg oral immediate-release every 4 hours as needed) or long-acting formulations for persistent pain, as supported by the American College of Physicians guideline 1.
• Respiratory symptoms should be managed with oxygen therapy as needed, nebulized albuterol (2.5 mg every 4-6 hours) for wheezing, and low-dose morphine (2.5-5 mg) for dyspnea, as recommended by the American College of Chest Physicians evidence-based clinical practice guidelines 1.
• Psychological support through counseling and possibly medications like sertraline (50-100 mg daily) for depression or lorazepam (0.5-1 mg) for anxiety should be incorporated, as suggested by the NCCN clinical practice guidelines in oncology: palliative care 1.
• Nutritional support with small, frequent, nutrient-dense meals and cultural considerations in care planning are essential, as emphasized by the integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update 1. The hospice team should include:
• Nurses for regular assessments
• Social workers for family support
• Chaplains for spiritual care
• Home health aides for personal care assistance Regular family meetings to discuss goals of care and advance directives are crucial to ensure care aligns with the patient's wishes and cultural values, providing dignity and comfort in his final stage of life, as highlighted by the American College of Physicians guideline 1.

From the Research

Home Hospice Care Recommendations

For a 74-year-old African-American male with squamous cell carcinoma of the lung after completing one year of chemotherapy and radiation therapy, several considerations can be taken into account for home hospice care:

• The importance of early utilization of palliative services for optimal and quality patient care, as highlighted in 2, should be considered to address disparities and barriers to access that minority patients may face.
• Symptom management, including pain and nausea relief, is crucial, as discussed in 3, where a palliative care consultation was requested to assist with symptom management.
• The patient's values and wishes, such as improving symptoms and extending life expectancy, should be taken into account, as seen in 3, where the patient expressed desires for "aggressive treatment" and continuation of chemotherapy.
• The role of palliative care in optimizing the timing of final chemotherapy administration and transition to hospice services, as shown in 4, can help improve quality end-of-life care.

Treatment Considerations

When considering treatment options for advanced squamous cell carcinoma of the lung:

• Immune checkpoint inhibitors, ramucirumab plus docetaxel, and afatinib may be potential treatment options, as discussed in 5.
• Genomic testing is essential to identify patients who might benefit from existing targeted agents or clinical trials, as highlighted in 5.
• The lack of targeted therapies for squamous cell carcinoma of the lung makes treatment decisions challenging, and further prospective data are needed to assess potential second-line regimens following immunotherapy, as noted in 5.

Palliative Care

Palliative care can play a significant role in improving the quality of life for patients with metastatic non-small-cell lung cancer:

• Early palliative care integrated with standard oncology care can lead to improvements in quality of life, mood, and survival, as shown in 4.
• Palliative care can help optimize the timing of final chemotherapy administration and transition to hospice services, as discussed in 4.
• The importance of addressing disparities and barriers to access to palliative care for minority patients, such as African Americans, is highlighted in 2.