Optimal Timing for Hospice-shared Care in Terminal Cancer Patients

Abstract

The optimal timing for initiating palliative care in cancer patients varied widely. This retrospective population-based study aimed to determine the optimal initiation timing of hospice-shared care (HSC), which maximizes the beneficial effects of quality of care (QOC) and medical expenses among terminal cancer patients. We extracted cancer patients who were in their last year of lives during 1 January 2010 to 31 December 2013 from a nationwide database. After the selection and matching process, 1,714 patients (67.7±13.2 years, 62.7% male) were enrolled and categorized into the HSC group and usual care (UC) group (n=857 in each group). By suing the generalized linear mixed-effects model for comparisons between groups, we found that the HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8-60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15-90 days before death. In conclusion, HSC initiation before the last eight days and 15 days of lives were found to effectively improve QOC and save medical expenses, respectively, among patients with terminal cancer.