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

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According to a new study published in the Journal of Clinical Oncology, researchers at Dana-Farber Cancer Institute in Boston, Massachusetts, have found that despite an increase in the use of hospice, the use of intensive and costly hospital services for patients with ovarian cancer also increased.

For the study, researchers followed nearly 7,000 older women with ovarian cancer. They found that between 1997 and 2007, patients were more likely to enter a hospice program and less likely to die while in a hospital, while also using intensive medical services more frequently. Intensive medical services include treatment in intensive care units, hospitalizations, repeated emergency department visits, and health care facility transitions. The findings suggest that many patients received aggressive cancer therapy while in the hospital, but when treatment failed, entered hospice care as an "add-on."

In addition, the number of patients referred to hospice care from a hospital inpatient clinic increased, and 70% of patients were transferred between health care facilities at least once during the last month before death. Of those, 20% experienced a major transition during the final 3 days of life. The researchers recommend that patients make plans with their families and physicians to have improved control of the kind of end-of-life care.

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Despite an increase in hospice, the use of costly services for ovarian cancer also increased.

There have been widespread efforts to improve the quality of life of terminally ill patients. As more patients choose to spend their final days and weeks in hospice care rather than a hospital, the hope is the use of intensive and costly hospital services would decline. A new study by Dana-Farber Cancer Institute researchers shows for one group of terminally ill cancer patients, that is not what is happening. The study, which tracked nearly 7,000 older patients with ovarian cancer, found that between 1997 and 2007, patients were more likely to enter a hospice and less likely to die in a hospital.

However their use of hospital-based services actually increased. These seemingly paradoxical findings, published in the October issue of the Journal of Clinical Oncology, suggest that many patients received aggressive treatments while in the hospital, and resorted to hospice care as an “add-on” when those treatments fail, the authors write.

READ FULL ARTICLE From Dana-farber

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