A Hospice Nurse’s Account of “Tidal Wave of Cancer”

I joined the hospice service in 2022 so do not have a perspective from pre-covid. But my more experienced colleagues do and it is clear to all of us that our unit in a smallish city is experiencing a tidal wave of cancer since after the time I started. It was a really quiet unit to start with, in fact I was reassured that way when I took the job. But with a good rep for being able to offer what was needed when required. 

But now we are always full, with waiting lists. Patients have more complex needs, heavy going, and a lot more young people, most evident since about mid 2024. Based on my prior life in nursing, I never imagined I would have to care for so many younger palliative patients, mostly cancer. But also neuro conditions. In the first few years we had 1 motor neurone disease patient only. I’d never nursed any in hospitals. In the last 18 months we have now a handful on our books in their 50s and 60s, and a significant increase in severe Parkinson’s disease in the same time frame, some are comorbid with cancer. Again, 60s  and 70s seems young. 

The most obvious  increase is young people, everyone’s noticed,  with breast cancers, bowel, sarcomas, including at the injection site (I wonder why), spreading everywhere. More with higher needs, progressing more rapidly. I guess that is the most shocking thing, the rate of deterioration, and often at first presentation they are already widespread. It might be 2 to 4 weeks after first oncology appointment for a biopsy by which time it could be running rampant. It is a tough job anyway but we have patients who are sent to us to start end of life care and they haven’t been told they are reaching terminal, they still think they are awaiting a biopsy and treatment planning! 

More bladder cancers, ovarian, patients with nephrostomies and colostomies to manage, patients with brain cancers. 

The community hospice service is very busy and not able to respond quickly enough to the new normal trajectory.  And more of their work is end of life in the home. 

Now patients often come directly from their first admission to hospital for end of life care! They are shell shocked. Our poor counsellors are flat-tack with referrals, and we all have to support these traumatised families. 

We have more young children spending precious time with their sick parents, often broken families, it can be really messy emotionally. Also more lawyers coming in to take wills, do Powers of Attorney etc.

Staff are always off sick, it always seems to be infections, starts as a typical cold and they can’t get better. Yes, loads of covid of course. We’re always down so casuals are usually working and if none available we have to refuse patients. Sometimes we have 4 or even 6 empty beds we could fill except for low staff. But no shortage of managers!

So people with high palliative needs sometimes have to go to local rest homes who may not have the time required. They do their best but the feedback from families is very mixed. 

At conferences and professional development, the grapevine says this is the same everwhere. I can see the multidisciplinary teams doing their absolute best, dedicated people just struggling with the caseload. Clearly some staff now understand what is causing all this, but fear still rules the day. I sense that changing though. 

Kiwis just need to wake up to whats happening. It might not be them right now but at this rate it might be.