Associations between hospice use and end-of-life (EOL) care outcomes in patients with advanced cancer.

Authors

null

Pallavi Kumar

University of Pennsylvania, Philadelphia, PA

Pallavi Kumar, Laura Hatfield, Alexi A. Wright, Jennifer S. Temel, Nancy Lynn Keating

Organizations

University of Pennsylvania, Philadelphia, PA, Department of Healthcare Policy, Harvard Medical School, Boston, MA, Dana-Farber Cancer Institute, Boston, MA, Massachusetts General Hospital Cancer Center, Boston, MA, Harvard Medical School, Boston, MA

Research Funding

No funding sources reported

Background: There are few data examining the association between hospice care (HC) and the quality of advanced cancer patients’ EOL care. We explored associations between HC and family-reported relief of patients’ symptoms, quality of EOL care, and concordance with patients’ previously expressed wishes for EOL care and place of death. Methods: We surveyed 2,307 family members of deceased patients with advanced lung cancer (LC) or colorectal cancer (CRC) who were enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS) study (a national prospective, observational cohort study). We used propensity score matching to compare family-reported outcomes for patients who did or did not receive HC, including prevalence and relief of common symptoms (pain, dyspnea, depression or anxiety), quality of EOL care, and concordance with wishes for EOL care and place of death. Results: In 985 matched pairs, patients with LC or CRC who received HC had higher pain, distress from pain, and depression and/or anxiety, but more appropriate relief of pain and dyspnea (Table). HC was associated with a higher family-reported quality of EOL care, greater concordance with patients’ EOL care wishes, and higher likelihood of death in a preferred place. Conclusions: Patients receiving HC had greater symptoms compared to non-hospice enrollees, but had more appropriate symptom relief. HC for patients with LC or CRC is also associated with higher quality of EOL care, and concordance with wishes for EOL care and place of death as reported by bereaved family members. These data demonstrate the need to improve hospice utilization for advanced cancer patients.

EOL care among propensity score-matched patients (N=985 pairs).

OutcomesPatients with
Lung or Colorectal Cancer
p-value
Hospice CareAbsolute
Difference
NoYes
Prevalence of pain81%91%10%< .0001
Prevalence of dyspnea74%71%-3%0.09
Prevalence of depression and/or anxiety66%72%6%0.03
Distress from pain75%82%7%0.001
Relief of pain
Just the right amount77%82%5%0.047
Relief of dyspnea
Just the right amount73%81%8%0.0009
Quality of EOL care
Excellent/Very good70%82%12%< .0001
EOL care concordant w/ EOL wishes73%82%9%< .0001
Death at preferred place38%68%30%< .0001

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Abstract Details

Meeting

2015 Palliative and Supportive Care in Oncology Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Biologic Basis of Symptoms and Treatment Toxicities,Psycho-oncology,End-of-Life Care,Survivorship,Evaluation and Assessment of Patient Symptoms and Quality of Life,Management/Prevention of Symptoms and Treatment Toxicities,Integration and Delivery of Palliative Care in Cancer Care,Psychosocial and Spiritual Care,Communication in Advanced Cancer

Sub Track

Hospice

Citation

J Clin Oncol 33, 2015 (suppl 29S; abstr 53)

DOI

10.1200/jco.2015.33.29_suppl.53

Abstract #

53

Poster Bd #

C13

Abstract Disclosures

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