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February 14, 2011

Hospice Use and High-Intensity Care in Men Dying of Prostate Cancer

Author Affiliations

Author Affiliations: Departments of Urology (Drs Bergman, Saigal, Gore, and Litwin) and Health Services (Drs Saigal and Litwin) and Jonsson Comprehensive Cancer Center (Drs Saigal and Litwin), University of California, Los Angeles; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Drs Saigal, Lorenz, and Gore); RAND Corporation, Santa Monica, California (Ms Hanley); Departments of Urology and Epidemiology, University of Michigan, Ann Arbor (Dr Miller); and the UCLA Robert Wood Johnson Clinical Scholars Program (Dr Gore). Group Information: For more information on the Urologic Diseases in America Project, see http://www.udaonline.net.

Arch Intern Med. 2011;171(3):204-210. doi:10.1001/archinternmed.2010.394

Background  Hospice programs improve the quality of life and quality of death for men dying of cancer. We sought to characterize hospice use by men dying of prostate cancer and to compare the use of high-intensity care between those who did or did not enroll in hospice.

Methods  We used linked Surveillance, Epidemiology, and End Results–Medicare data to identify a cohort of Medicare beneficiaries who died of prostate cancer between 1992 and 2005. We created 2 multivariable logistic regression models, one to identify factors associated with hospice use and one to determine the association of hospice use with the receipt of diagnostic and interventional procedures and physician visits at the end of life.

Results  Of 14 521 men dying of prostate cancer, 7646 (53%) used hospice for a median of 24 days. Multivariable modeling demonstrated that African American ethnicity (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.68-0.88) and higher Charlson comorbidity index (OR, 0.49; 95% CI, 0.44-0.55) were associated with lower odds of hospice use, while having a partner (OR, 1.23; 95% CI, 1.14-1.32) and more recent year of death (OR, 1.12; 95% CI, 1.11-1.14) were associated with higher odds of hospice use. Men dying of prostate cancer who enrolled in hospice were less likely (OR, 0.82; 95% CI, 0.74-0.91) to receive high-intensity care, including intensive care unit admissions, inpatient stays, and multiple emergency department visits.

Conclusions  The proportion of individuals using hospice is increasing, but the timing of hospice referral remains poor. Those who enroll in hospice are less likely to receive high-intensity end-of-life care.