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Gynecol Oncol. 2019 Mar;152(3):452-458. doi: 10.1016/j.ygyno.2018.10.041.

How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients.

Author information

1
The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, United States of America.
2
The University of Texas MD Anderson Cancer Center, Department of Health Services Research, United States of America.
3
The University of Texas School of Public Health, Department of Management, Policy Sciences & Community Health, United States of America.
4
The University of Texas MD Anderson Cancer Center, Department of Health Services Research, United States of America. Electronic address: sgiordan@mdanderson.org.

Abstract

OBJECTIVE:

To describe disparities in patterns of hospice use and end-of-life costs among ovarian cancer patients.

METHODS:

Using Texas Cancer Registry-Medicare data, ovarian cancer patients deceased 2005-2012 with >12 months of continuous Medicare coverage before death were included. Descriptive statistics and multivariable logistic regressions were used to evaluate patterns of hospice use. Cost and resource utilization was obtained from Medicare claims and analyzed using a non-parametric Mann-Whitney test.

RESULTS:

2331 patients were assessed: 1788 (77%) white, 359 (15%) Hispanic, 158 (7%) black and 26 (1%) other. 1756 (75%) enrolled in hospice prior to death but only 1580 (68%) died with hospice. 176 (10%) of 1756 patients unenrolled and died without hospice. 346 (20%) unenrolled from hospice multiple times. From 2008 to 2012, patients were less likely to unenroll from hospice prior to death. Black patients were more likely to unenroll from hospice prior to death (OR 2.07 [1.15-3.73]; p = 0.02) compared to white patients. The median amount paid by Medicare during the last six months of life was $38,530 for those in hospice compared to $49,942 if never enrolled in hospice (p < 0.0001) and was higher for black and Hispanic patients compared to white patients. 30% hospice unenrolled patients and 40% multiply enrolled hospice patients received at least one life extending or invasive care procedure following unenrollment from hospice.

CONCLUSION:

Recently, more patients remain enrolled in hospice, but black patients have a higher risk of unenrollment. Hospice enrollment was associated with lower costs as long as a patient did not unenroll from hospice.

KEYWORDS:

Cancer care disparities; Hospice; Ovarian cancer

PMID:
30876488
DOI:
10.1016/j.ygyno.2018.10.041
[Indexed for MEDLINE]

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