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Research Letter
April 30, 2020

Trends in Provision of Palliative Radiotherapy and Chemotherapy Among Hospices in the United States, 2011-2018

Author Affiliations
  • 1Schulich School of Business, York University, Toronto, Ontario, Canada
  • 2Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
  • 3Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut
JAMA Oncol. Published online April 30, 2020. doi:10.1001/jamaoncol.2020.0923

Hospice is central to end-of-life care. Yet to receive hospice services, Medicare beneficiaries need to forgo treatments related to their terminal conditions.1 Thus, patients with cancer cannot receive radiotherapy or chemotherapy, such as single-fraction radiotherapy for painful bone metastasis, for palliative purposes. To alleviate this constraint, some hospices have developed open-access programs that allow patients to receive care for their terminal conditions.2 These hospices, however, encounter an increase in costs without an accompanying increase in reimbursement. In 2016, the Centers for Medicare & Medicaid Services initiated the Medicare Care Choices Model (MCCM), which allows participating hospices to provide care for beneficiaries’ terminal conditions and receive a higher payment rate.3 Despite this, very few hospices participate in the MCCM. To date, little is known about trends in hospices providing palliative radiotherapy and chemotherapy. This topic is particularly important now, as hospices may be reluctant to provide new, expensive immunotherapies.

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