Hospice Care Has No Effect on Terminal Ovarian Cancer Treatment

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Findings among older patients with terminal ovarian cancer receiving hospice care.
Findings among older patients with terminal ovarian cancer receiving hospice care.

Increasing use of hospice in the final days of ovarian cancer does not offset intensive end-of-life care in older women, according to a study published in the Journal of Clinical Oncology.

Alexi A. Wright, M.D., from the Dana-Farber Cancer Institute in Boston, and colleagues examined changes in medical care during the last month of life over time for 6,956 individuals (aged ≥66 years) enrolled in fee-for-service Medicare. Patients were diagnosed with epithelial ovarian cancer between 1997 and 2007, and died as a result of ovarian cancer by December 2007.

The researchers found that between 1997 and 2007, hospice use increased significantly, and terminal hospitalizations decreased (both P < 0.001). There was, however, a simultaneous, statistically significant increase in intensive care unit admissions, hospitalizations, repeated emergency department visits, and health care transitions (all P ≤ 0.01).

RELATED: For Patients with Ovarian Cancer at End of Life, Paradoxical Increase in Use of Intensive Medical Services and Hospice

Over time the proportion of patients referred to hospice from inpatient settings rose (P = 0.001). Compared to outpatients, inpatients referred to hospice were more likely to enroll in hospice within three days of death (adjusted odds ratio, 1.36).

"Use of hospital-based services increased over time, and patients underwent more transitions among health care settings near death, suggesting that the increasing use of hospice did not offset intensive end-of-life care," the authors write.

Reference

  1. Wright, Alexi A., MD, MPH, et al. "End-of-Life Care for Older Patients With Ovarian Cancer Is Intensive Despite High Rates of Hospice Use." Journal of Clinical Oncology. doi: 10.1200/JCO.2014.55.5383. October 6, 2014.

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