Improvements in hospice utilization among patients with advanced‐stage lung cancer in an integrated health care system

• Published in: Cancer 2018-01, Vol.124 (2), p.426-433
• Main Authors: Sullivan, Donald R., Ganzini, Linda, Lapidus, Jodi A., Hansen, Lissi, Carney, Patricia A., Osborne, Molly L., Fromme, Erik K., Izumi, Seiko, Slatore, Christopher G.
• Format: Article
• Language: English
• Subjects: Cancer; Enrollments; epidemiology; Hazards; Health care; Health care networks; Health risk assessment; health services research; Life expectancy; Life span; Lung cancer; Oncology; Palliative care; Patients; Quality of life; supportive and palliative car; Trends; Variability
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.31047

BACKGROUND Hospice, a patient‐centered care system for those with limited life expectancy, is important for enhancing quality of life and is understudied in integrated health care systems. METHODS This was a retrospective cohort study of 21,860 decedents with advanced‐stage lung cancer diagnosed from January 2007 to June 2013 in the national US Veterans Affairs Health Care System. Trends over time, geographic regional variability, and patient and tumor characteristics associated with hospice use and the timing of enrollment were examined. Multivariable logistic regression and Cox proportional hazards modeling were used. RESULTS From 2007 to 2013, 70.3% of decedents with advanced‐stage lung cancer were enrolled in hospice. Among patients in hospice, 52.9% were enrolled in the last month of life, and 14.7% were enrolled in the last 3 days of life. Hospice enrollment increased (adjusted odds ratio [AOR], 1.07; P < .001), whereas the mean time from the cancer diagnosis to hospice enrollment decreased by 65 days (relative decrease, 32%; adjusted hazard ratio, 1.04; P < .001). Relative decreases in late hospice enrollment were observed in the last month (7%; AOR, 0.98; P = .04) and last 3 days of life (26%; AOR, 0.95; P < .001). The Southeast region of the United States had both the highest rate of hospice enrollment and the lowest rate of late enrollment. Patient sociodemographic and lung cancer characteristics were associated with hospice enrollment. CONCLUSIONS Among patients with advanced‐stage lung cancer in the Veterans Affairs Health Care System, overall and earlier hospice enrollment increased over time. Considerable regional variability in hospice enrollment and the persistence of late enrollment suggests opportunities for improvement in end‐of‐life care. Cancer 2018;124:426‐33. © 2017 American Cancer Society. Within an integrated health care system, overall and earlier hospice enrollment increased over time among lung cancer patients; however, significant regional variability in enrollment suggests opportunities for improvement. The extrapolation of discrete elements of integrated health care systems, that contribute to improved end‐of‐life care, to settings with decreased or delayed hospice use is essential for reversing the current dismal trends in end‐of‐life care in the United States.