Hospice discussion rates low among patients with stage IV lung cancer

Nearly half of patients diagnosed with metastatic lung cancer did not have a discussion about hospice with their physician within four to seven months of their diagnosis. In addition, black, Hispanic and non-English–speaking patients, along with those enrolled in Medicaid, were less likely to have discussed hospice compared with white or Asian patients or those with private insurance.

“These findings could explain lower rates of hospice enrollment observed for these groups in other studies,” researchers wrote.

Using data from a multiregional study, the researchers identified 1,517 patients diagnosed with stage IV lung cancer. Logistic regression models were estimated on the probability that patients had discussed hospice with a physician or other health care provider prior to a computer-assisted telephone interview four to seven months after diagnosis. The median time from diagnosis to interview was five months. Medical records were collected for patients who consented.

Fifty-three percent of patients reported discussing hospice with a physician prior to their interview. Seventy-two percent of patients who discussed hospice reported that a physician or health care provider recommended hospice. Patients who discussed hospice before the interview were more likely to enroll in hospice within a year of diagnosis compared with those who did not discuss hospice (70% vs. 26%; P<.001).

Black and Hispanic patients were less likely to have discussed hospice (49% and 43%) compared with white or Asian patients (53% and 57%; P<.001). Forty-one percent of non-English–speaking patients and 50% of Medicaid enrollees had not discussed hospice compared with English-speaking patients (54%) and those with private (52%) or other insurance (69%). Patients who were assigned to chemotherapy were also less likely to have discussed hospice (51% vs. 57%; P=.004).

Fifty-three percent of patients who died two months after the interview had discussed hospice; rates were lower among patients who lived longer. Pain and symptom severity were not associated with a difference in hospice discussion rates.

Huskamp HA. Arch Intern Med. 2009;169:954-962.