This article is more than 5 years old. Information may no longer be current.
Hospice care underutilized by men dying of prostate cancer
Click Here to Manage Email Alerts
Men who are dying of prostate cancer do not enroll in hospice care soon enough to take advantage of palliative care methods that can make their deaths easier, according to a study published in the Archives of Internal Medicine.
The proportion of patients dying of prostate cancer using hospice care has increased over time. Between 1992 and 2005, 53% of men dying of prostate cancer used hospice care for a median of 24 days, but researchers from the University of California, Los Angeles, said 24 days is not enough.
“There are many ancillary services that hospice care offers, including support for the family, spiritual support and palliative care,” said Jonathan Bergman, MD, a urology resident at UCLA and one of the study’s researchers. “Patients would benefit more from all the services if they stay longer than 24 days.”
Hospice care was added to Medicare entitlement in 1983, and since then, the proportion of dying Americans who use these services has increased. Care during the last year of life comprises approximately 30% of lifetime Medicare expenditures, a cost that could decrease greatly by using hospice care. Current Medicare rules allow beneficiaries a maximum of 6 months in hospice care.
“End-of-life care is poorly understood,” Bergman told HemOnc Today. “There are many potential avenues to improving the quality and reducing the cost of end-of-life care.”
Bergman and colleagues used the SEER database to identify Medicare beneficiaries who died of prostate cancer between 1992 and 2005. Then, they identified factors associated with hospice use and also determined the association between hospice use and diagnostic and interventional procedures and physician visits at the end of life.
The researchers identified 14,521 men, of whom 53% used hospice care. Among the men who enrolled in hospice, 22% enrolled within 7 days of death and 9% enrolled more than 180 days before death. For patients who used hospice care for 7 to 180 days, the mean number of days spent in hospice care was 47.
The researchers also found that patients of African-American ethnicity and patients with a higher Charlson comorbidity index were less likely to have used hospice care. Men who had a partner and/or a more recent year of death were more likely to have used hospice care. Men enrolled in hospice care were also less likely to receive high-intensity care such as ICU admissions, inpatient stays and trips to the ED.
According to Bergman, hospice care is underutilized for some patients because it is difficult to predict how long a patient will live. Many times, because of the Medicare 6-month rule, health care providers do not have a discussion about end-of-life care with their patients early on in the disease course.
“It is important for health care providers to have this discussion with their patients early on to discuss what hospice care is, what their options are and to understand what the patients’ individual goals are,” Bergman said in the interview. “If we have that conversation and make patients aware, it will not be a shock when they need to start using these resources.”
Although hospice care primarily focuses on palliative care and making patients comfortable at the end of life, there is the option to go back to receiving aggressive treatment to prolong life. Currently, patients need to disenroll from hospice care, have the treatment, then re-enroll. According to Bergman, there is a movement for open hospice care, so that patients do not need to disenroll to receive the aggressive treatment. – by Emily Shafer
For more information:
- Bergman J. Arch Intern Med. 2010;doi:10.1001/archinternmed.2010.394.