Large number of cancer patients in the US experience late hospice care

1. In a retrospective review of patient data from 12 hospices in the US, 16.3% of cancer patients experience late hospice care (length of stay <3 days). 

2. Hematologic malignancies, male sex, age <65 years were risk factors for late hospice admission. 

Evidence Rating Level: 3 (Average) 

Study Rundown: Despite the known benefits associated with hospice care towards the end-of-life, including improved quality of life and reduction in caregiver stress, many cancer patients do not receive this care until very close to death. The purpose of this study was to evaluate the factors that put patients at risk for late hospice admissions through a retrospective review of electronic patient records of 12 hospices in the US. At the conclusion of this retrospective cohort study, the authors found that late admission (defined as length of stay <3 days) occurred in 1 in 6 (16%) cancer patients admitted to hospice care. Risk factors for late admission included being male, married, age <65 years, and a diagnosis of hematologic malignancy. Furthermore, patients with Medicaid or self-insurance were at decreased risk for late admission. Based on these findings, the authors suggested that these factors may be used to identify patients at risk and to develop programs to reduce late admissions. However, the study only analyzed data from not-for-profit hospices, which may reduce the generalizability of the result.

Click to read the study in JCO

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In-Depth [retrospective cohort]: This was a retrospective cohort study that included 64,264 patients admitted to 12 hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness (CHOICE) network. The reviewed demonstrated that 10,460 (16.3%) cancer patients admitted to hospice care had a length of stay <3 days, with significant variation among hospices, ranging from 11.4% to 24.5% late hospice admissions. Using multi-variate analysis, patient factors predicting late admission included hematologic malignancy (OR: 1.52; 95% CI: 1.41-1.64), male gender (OR: 1.22; 95% CI: 1.16-1.28), presence of a spouse (OR: 1.23; 95% CI: 1.17-1.29), and age >65 years (OR: 0.90; 95% CI: 0.82-0.97). Self-insured patients (OR: 0.74; 95% CI: 0.66-0.84) and Medicaid patients (OR: 0.83; 95% CI: 0.76-0.91) were at a decreased risk for late hospice admission compared to Medicare or commercial insurance.

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