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Hospice improves end-of-life care for patients with lung, colorectal cancers
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Families of patients with lung cancer or colorectal cancer reported that their family member had improved end-of-life care and better symptom relief before death while in hospice care, according to published findings in the Journal of Clinical Oncology.
Through propensity-score matching, Alexi A. Wright, MD, MPH, assistant professor of medical oncology at Dana-Farber Cancer Institute, and colleagues extracted data from the Cancer Care Outcomes Research and Surveillance Consortium and compared family-reported outcomes of patients who received hospice care (n = 1,257) and who did not (n = 985).
All patients included died by 2011 and had a family member or close friend who had participated in a post-death interview. From these interviews, the researchers looked specifically at whether hospice was associated with family members’ perceptions of the patients’ various symptoms and their burden — such as pain and dyspnea — as well as patient-goal attainment and overall quality of end-of-life care.
In separate analyses, researchers also measured any associations between hospice length-of-stay and outcomes among hospice enrollees.
Overall, a greater proportion of families of patients enrolled in hospice reported pain in their patient or use of pain medication compared with patients not enrolled in hospice (91% vs. 81%). However, families of patients enrolled in hospice were more likely to report that the patients received the right amount of pain medication (80% vs. 73%; difference, 7 percentage points; 95% CI, 1-12) and the right amount of assistance with breathing (78% vs. 70%; difference, 8; 95% CI, 2-13).
Families of patients enrolled in hospice also reported more often that patients’ end-of-life wishes were followed (80% vs. 74%; difference, 6; 95% CI, 2-11) and that the quality of end-of-life care was “excellent” (57% vs. 42%; difference, 15; 95% CI, 11-20). Decedents who received hospice care were also more likely to die in their preferred place (68% vs. 39%; difference, 29; 95% CI, 23-34).
The median length of hospice stay was 21 days (interquartile range, 7-56). Longer stays were associated with family member’s perception that the patient received the right amount of pain medication, higher patient-goal attainment and higher rates of family-reported end-of-life care compared with shorter stays.
Families of patients who were in hospice care for more than 30 days reported the highest quality end-of-life outcomes (85% vs. 76%; difference, 9; 95% CI, 2-16) compared with patients who stayed in hospice for 3 or fewer days.
“Despite a higher symptom burden among patients enrolled in hospice, hospice care was associated with better symptom management, patient-goal attainment and quality end-of-life care,” the researchers wrote. “Future studies should examine whether multifaceted approaches might result in the provision of more preference-sensitive, high-quality and value-based end-of-life care for patients with cancer.” – by Melinda Stevens
Disclosures: Wright reports no relevant financial disclosures. One researcher reports research funding for their institution from Pfizer.
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