Authors: Mehanna EK, Catalano PJ, Cagney DN, Haas-Kogan DA, Alexander BM, Tulsky JA, Aizer AA
Title: Hospice utilization in elderly patients with brain metastases.
Journal: J Natl Cancer Inst :-
Date: 2020 Mar 12
PubMed ID: 32163145
Abstract: BACKGROUND: Brain metastases are associated with considerable morbidity and mortality. Integration of hospice at the end of life offers patients symptom relief and improves quality of life, particularly for elderly patients who are less able to tolerate brain-directed therapy. Population-level investigations of hospice utilization among elderly patients with brain metastases are limited. METHODS: Using the Surveillance, Epidemiology and End Results (SEER)-Medicare database for primary cancer sites that commonly metastasize to the brain, we identified 50,148 patients (age ≥66 years) diagnosed with brain metastases between 2005-2016. We calculated the incidence, timing, and predictors of hospice enrollment using descriptive techniques and multivariable logistic regression. All statistical tests were two-sided. RESULTS: The incidence of hospice enrollment was 71.4% (95%CI 71.0-71.9, p < 0.001), a rate which increased over the study period (p < 0.001). The odds of enrollment for black (OR 0.76, 95%CI 0.71-0.82, p < 0.001), Hispanic (OR 0.80, 95%CI 0.72-0.87, p < 0.001) and Asian patients (OR 0.52, 95%CI 0.48-0.57, p < 0.001) were substantially lower than white patients; males were less likely to be enrolled in hospice than females (OR 0.78, 95%CI 0.74-0.81, p < 0.001). Among patients enrolled in hospice, 32.6% (95%CI 32.1-33.1, p < 0.001) were enrolled less than7 days prior to death, a rate which was stable over the study period. CONCLUSION: Hospice is utilized for a majority of elderly patients with brain metastases although a considerable percentage of patients die without hospice services. Many patients enroll in hospice late and concerningly, statistically significant sociodemographic disparities exist in hospice utilization. Further investigations to facilitate targeted interventions addressing such disparities are warranted.