Publication Abstract

Authors: Forst D, Adams E, Nipp R, Martin A, El-Jawahri A, Aizer A, Jordan JT

Title: Hospice Utilization in Patients with Malignant Gliomas.

Journal: Neuro Oncol :-

Date: 2017 Oct 16

Abstract: BACKGROUND: Despite recommendations from professional organizations supporting early hospice enrollment for patients with cancer, little research exists regarding end-of-life (EOL) practices for patients with malignant gliomas (MG). We evaluated rates and correlates of hospice enrollment and hospice length-of-stay (LOS) among patients with MG. METHODS: Using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, we identified adult patients who were diagnosed with MG from January 1, 2002 to December 31, 2011 and who died before December 31, 2012. We extracted sociodemographic and clinical data, and used univariate logistic regression analyses to compare characteristics of hospice recipients versus non-recipients. We performed multivariable logistic regression analyses to examine predictors of hospice enrollment >3 or >7-days prior to death. RESULTS: We identified 12,437 eligible patients (46% female), of whom 7,849 (63%) were enrolled in hospice before death. On multivariable regression analysis, older age, female sex, higher level of education, white race, and lower median household income predicted hospice enrollment. Of those enrolled in hospice, 6,996 (89%) were enrolled for >3 days, and 6,047 (77%) were enrolled for >7 days. Older age, female sex, and urban residence were predictors of longer LOS (3- or 7-day minimum) on multivariable analysis. Median LOS on hospice for all enrolled patients was 21 days (IQR 8-45 days). CONCLUSIONS: We identified important disparities in hospice utilization among patients with MG, with differences by race, gender, age, level of education and rural versus urban residence. Further investigation of these barriers to earlier and more widespread hospice utilization is needed.