BACKGROUND Our goal was to characterize hospice enrollment and aggressiveness of care for pancreatic cancer patients at the end of life. METHODS We used Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims data (1992–2006) to identify patients with pancreatic cancer who had died (n= 22,818). We evaluated hospice use, hospice enrollment ≥4 weeks before death, and aggressiveness of care as measured by receipt of chemotherapy, acute care hospitalization, and intensive care unit (ICU) admission in the last month of life. RESULTS Overall, 56.9% of patients enrolled in hospice, and 35.9% of hospice users enrolled for four weeks or more. Hospice use increased from 36.2% in 1992–1994 to 67.2% in 2004–2006 (P<0.0001). Admission to the ICU and receipt of chemotherapy in the last month of life increased from 15.5% to 19.6% (P<0.0001) and 8.1% to 16.4% (P<0.0001), respectively. Among patients with locoregional disease, those who underwent resection were less likely to enroll in hospice before death and much less likely to enroll early. They were also more likely to receive chemotherapy (14% vs. 9%, P<0.0001), be admitted to an acute care hospital (61% vs. 53%, P<0.0001), and be admitted to an ICU (27% vs. 15%, P<0.0001) in the last month of life. CONCLUSIONS While hospice use increased over time, there was a simultaneous decrease in early enrollment and increase in aggressive care at the end of life for patients with pancreatic cancer. CONDENSED This study examined hospice enrollment and aggressiveness of care for pancreatic cancer patients at the end of life. While hospice use increased over time, there was a simultaneous increase in aggressive care at the end of life for patients with pancreatic cancer.

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