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Gynecol Oncol. 2010 Sep;118(3):274-7. doi: 10.1016/j.ygyno.2010.05.021. Epub 2010 Jun 12.

Hospice enrollment for terminally ill patients with gynecologic malignancies: impact on outcomes and interventions.

Author information

  • 1Division of Gynecologic Oncology, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA.

Erratum in

  • Gynecol Oncol. 2011 Jun 1;121(3):643.

Abstract

OBJECTIVE:

To determine survival and interventions for patients with non-curative gynecologic malignancies based on supportive care enrollment.

METHODS:

An IRB approved retrospective review identified patients with recurrent/persistent gynecologic cancers from 2002 to 2008. Demographics, therapy, clinicopathologic data, hospice utilization, surgical/invasive procedures and survival were collected. Patients were considered hospice enrollees if they enrolled following recommendation from their provider (HOSPICE); however, patients that declined hospice when recommended were considered (NO HOSPICE), regardless if they ultimately received supportive care. Standard statistical tests including: t-test and Kaplan-Meier with Log Rank were used.

RESULTS:

Eighty-one patients were identified: 29 patients (36%) NO HOSPICE and 52 (64%) HOSPICE. Mean age was 61. Most patients had ovarian cancer (54.3%), were white (61.7%) and had disease recurrence (72%). Patients utilized a median of 3 anti-neoplastic therapies (range 0-10) for recurrent or progressive/persistent disease. Median time receiving hospice care was 1week for NO HOSPICE patients versus 8weeks HOSPICE patients (p<0.0005). In a subset of patients with recurrent disease, median overall survival for NO HOSPICE patients was 9months (95% CI 5.9-12.1months) versus 17months (95% CI 11.1-22.9months) for HOSPICE patients (p=0.002). NO HOSPICE patients were more likely to have a procedure performed (55% vs. 31%) within 4weeks of their death, including the administration of chemotherapy OR 2.4 (95% CI 1.1-7.1, p=0.036).

CONCLUSIONS:

While retrospective reviews evaluating hospice are challenging, our data suggest no detrimental impact on survival for hospice patients. Continued evaluation for patients at the end-of-life is necessary in order to optimize resource utilization.

Published by Elsevier Inc.

PMID:
20542319
[PubMed - indexed for MEDLINE]
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