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

Abstract

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 N12 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 b 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.

Perception about palliative care and factors influencing the likelihood of palliative care service utilisation among adult cancer patients in Ethiopia

“…In line with our study, a study conducted in Canada (Wales et al, 2018) and Texas (Taylor et al, 2019) found that higher socioeconomic status was associated with a higher likelihood of palliative care service utilisation; this helps the patient to have better health and healthcare understanding, a higher capacity for advocacy, a more stable home environment and more caregiver support. Similarly, a study conducted in Addis Abba found that almost 30% (Worku et al, 2017) patients face a higher cost of palliative care service, and around half of the patients were not able to access the service.…”

Hispanics and Hospice: A Systematic Literature Review

“…Four studies used data from the same large non-profit hospice agency in New York City 48-51 and 2 used data from the Texas Cancer Registry. 31,52 In a national sample of Medicare decedents, African Americans (13%), Hispanics (11.1%), and Asian Americans (10.9%) were more likely to disenroll from hospice than Whites (8.1%). 34 Being Hispanic and Black/African American was associated with greater odds of live discharge compared to Whites.…”

“…49,50 Relative to Whites, Hispanics also had greater odds of transferring to another hospice facility 49,50 or becoming ineligibility for hospice due to extended prognosis. 50 2 studies of ovarian cancer patients showed no significant differences in live discharge rates between Whites, Hispanics, Blacks, and other ethnic/racial backgrounds, 31,52 and no difference in rate of multiple disenrollment from hospice by race/ethnicity. 52 Site of Death.…”

“…50 2 studies of ovarian cancer patients showed no significant differences in live discharge rates between Whites, Hispanics, Blacks, and other ethnic/racial backgrounds, 31,52 and no difference in rate of multiple disenrollment from hospice by race/ethnicity. 52 Site of Death. Four studies examined site of death (ie, location of patient death) among Hispanics.…”

“…Only 1 study was based in California, 26 the state with the largest Hispanic population; and 6 studies were based in Texas, 28,30,31,45,52,55 the state with the second largest Hispanic population. No study included states with the third (Arizona) and fourth (New Mexico) largest Hispanic populations.…”