Use of hospice care for men with prostate cancer has increased significantly over the past 2 decades, but most wait too long to enroll, when they cannot take full advantage of the palliative care services offered, researchers at UCLA's Jonsson Comprehensive Cancer Center have found.
For hospice care to be most effective, patients should be enrolled for several weeks prior to their deaths, explained Mark Litwin, MD, the study's senior author. The study showed, however, that most men enrolled just 1 or 2 weeks before they died. "Most men are being referred to hospice too late, and that timing hasn't changed in the last 20 years, which is unfortunate, Litwin said. The findings are reported in the October 11 online edition of Archives of Internal Medicine.
Litwin and his colleagues identified 14,521 Medicare beneficiaries 66 years of age or older who died of prostate cancer between 1992 and 2005; 7646 (53%) received hospice care. The median hospice stay was 24 days. About 22 percent of patients in the study enrolled within 7 days of their death.
Multivariable modeling showed that men who had a spouse or partner and those with a more recent date of death were more likely than others to use hospice care. In contrast, African American men and those with a more comorbidities were less likely to enroll.
The researchers also found that men who received hospice care were less likely to receive high-intensity end-of-life care, including intensive care unit admissions, inpatient stays, and multiple emergency department visits.
"Hospice stays shorter than seven days are too brief to maximize the benefit of enrollment, and individuals making shorter stays receive fewer services and benefit less from the input of the full interdisciplinary team," the researchers state. "Increasing appropriate hospice use may improve the quality of death for men at the end of life while rationalizing health care expenditures during this high-cost period."