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Hospice care beneficial for patients with head and neck cancers
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Hospice care at the end of life improved quality of life and reduced health care costs among terminally ill patients with oral cavity and pharyngeal cancers, according to results of a retrospective cohort analysis.
“People have the intuitive sense that hospice and end-of-life care have economic benefits, but there is not a lot of data about this in the literature,” Christopher S. Hollenbeak, PhD, faculty member in the department of health policy and administration at Penn State University in Hershey, told HemOnc Today. “Even less has been written about costs and end of life for oral and pharyngeal cancers, which tend to get less attention than other cancers.”
Christopher S. Hollenbeak
Hollenbeak and colleagues sought to estimate the monthly cost of all services used during the last months of life by patients with oral cavity or pharyngeal cancers using data from the SEER–Medicare linked database. Further, they assessed whether hospice care reduced costs.
The analysis included data from 4,205 patients with oral cavity cancer and 3,178 patients with pharyngeal cancer who were aged 65 years or older. Patients were diagnosed between 1995 and 2005 and subsequently died between 1995 and 2007.
At the time of death, 1,605 patients (38.2%) with oral cavity cancer and 1,114 patients (35.1%) with pharyngeal cancer had received hospice care. Most patients enrolled into hospice did so within 30 days of death (oral cavity cancer, 63.4%; pharyngeal cancer, 57.8%).
Compared with patients who did not receive hospice care, these services were associated with a reduction in health care costs in the final month of life of $7,035 (95% CI, 6,040-8,160) among patients with oral cavity cancer and $7,430 (95% CI, $6,340-$9,100) among patients with pharyngeal cancer.
The savings increased in the final month of life when patients enrolled into hospice care more than 30 days before death. Enrollment into hospice care 31 to 90 days before death increased savings to $11,200 (95% CI, $10,090-$12,330) among patients with oral cavity cancer and to $12,410 (95% CI, $11,270-$13,650) among patients with pharyngeal cancer. Savings appeared comparable among patients who enrolled into hospice care more than 90 days before death.
Study limitations include a lack of generalizability to other diseases outside of cancer, cohort differences not captured by the database, and failure to measure other health outcomes like quality of life, patient satisfaction or other clinical details. Additionally, unpaid caregiving provided by family could not be measured and may have contributed to cost differences.
“We found it particularly striking how much costs increase at end of life for both oral and pharyngeal cancers,” Hollenbeak said. “We also found it striking how obvious the costs savings were when these patients enrolled in hospice. The ‘Holy Grail’ for a health economist is to find interventions that are both less costly and more effective. This is exactly what we found in this study. Hospice care in terminally ill patients with oral and pharyngeal cancers lowers costs and provides more compassionate and dignified care.
“Our future plans for research are to apply these methods in other cancers to explore in a more robust fashion how cost savings differ and how length of enrollment in hospice matters,” Hollenbeak added. – by Anthony SanFilippo
For more information:
Christopher S. Hollenbeak, PhD, can be reached at chollenbeak@hmc.psu.edu
Disclosure: The researchers report no relevant financial disclosures.
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