BACKGROUND: Nonmalignant comorbid medical conditions, such as heart failure and emphysema, may complicate cancer treatment. METHODS: Guidelines from the National Hospice Organization for cancer and selected nonmalignant diseases are outlined, and treatment principles for end-stage heart failure and emphysema are reviewed. RESULTS: Estimates by clinicians of survivability in advanced cancer and nonmalignant disease are important in order to allow patients and family members to begin realistic advance planning. As disease progresses through its end stages to death, optimal management may include both disease-modifying and symptom-relieving interventions. CONCLUSIONS: A well-managed end of life is an important therapeutic option in informed consent discussions with seriously ill patients and their families.