University of Pennsylvania, Philadelphia, PA
Pallavi Kumar, Laura Hatfield, Alexi A. Wright, Jennifer S. Temel, Nancy Lynn Keating
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.
Outcomes | Patients with Lung or Colorectal Cancer | p-value | ||
---|---|---|---|---|
Hospice Care | Absolute Difference | |||
No | Yes | |||
Prevalence of pain | 81% | 91% | 10% | < .0001 |
Prevalence of dyspnea | 74% | 71% | -3% | 0.09 |
Prevalence of depression and/or anxiety | 66% | 72% | 6% | 0.03 |
Distress from pain | 75% | 82% | 7% | 0.001 |
Relief of pain | ||||
Just the right amount | 77% | 82% | 5% | 0.047 |
Relief of dyspnea | ||||
Just the right amount | 73% | 81% | 8% | 0.0009 |
Quality of EOL care | ||||
Excellent/Very good | 70% | 82% | 12% | < .0001 |
EOL care concordant w/ EOL wishes | 73% | 82% | 9% | < .0001 |
Death at preferred place | 38% | 68% | 30% | < .0001 |
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