The Effect of Comorbidity Burden on Health Care Utilization for Patients with Cancer Using Hospice

Abstract

Background: The treatment of patients with advanced cancer with multiple comorbid illnesses is complex. Although an increasing number of such patients are being referred to hospice, the comorbidity burden of this patient population is largely unknown but has implications for the complexity of care provided by hospices. This study reports the comorbidity burden in a national sample of hospice users with cancer and estimates the effect of higher comorbidity on health care use and site of death. Methods: Cross-sectional study using Surveillance, Epidemiology and End Results-Medicare data for hospice users who died of cancer in 2002 (N ¼ 27,166). We measured comorbidity burden using the Charlson comorbidity index and used multivariable generalized estimating equations to estimate the association between comorbidity burden and the following outcomes: emergency department and intensive care unit (ICU) admission, hospitalization, hospice disenrollment, and hospital death. Results: Patients with cancer who used hospice had an average Charlson comorbidity index value of 1.24, including 18.8% who suffered from comorbid dementia. In analyses adjusted for patient demographics, site of primary cancer, and number of days with hospice, higher comorbidity burden was associated with higher likelihood of emergency department admission (odds ratio [OR] ¼ 1.69, 95% confidence interval [CI] 1.52, 1.87), ICU admission (OR ¼ 3.28, 95% CI 2.45, 4.38), inpatient hospitalization (OR ¼ 2.14, 95% CI 1.90, 2.42), hospice disenrollment (OR ¼ 1.41, 95% CI 1.29, 1.56) and hospital death (OR ¼ 2.51, 95% CI 2.08, 3.02). Conclusion: These findings underscore the complexity of the hospice patient population and highlight a potential need to risk adjust the per diem hospice reimbursement rates to account for increased resource requirements for hospices serving patients with higher comorbidity burden.

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

“…For instance, women had lower odds of hospitalization and receipt of aggressive care in several EOL care studies, whereas individuals who reported a black race/ethnicity, a lower SES, and comorbidities had higher odds. [28][29][30][31][32] Our finding that increased age was associated with lower rehospitalization rates was consistent with results of a Canadian study on EOL care for advanced pancreatic cancer 33 and a US study of Medicare beneficiaries with poor-prognosis cancers in the last 6 months of life. 28 However, this finding was inconsistent with one study, in which increased age was associated with more aggressive EOL care.…”

Burdens, Needs and Satisfaction of Terminal Cancer Patients and their Caregivers

“…In another previous study, almost 40% of the spouse caregivers reported depressive symptoms in a range that was likely to be clinically significant, a prevalence that was almost two-fold than their ill partners (Rittenberger et al, 2011). Previous studies have demonstrated that caregivers of patients with cancer have increased health problems and psychosocial stress (Bergen-Jackson et al, 2009;Kiely et al, 2010;Zhou et al, 2010;Bell et al, 2011;Gilbertson-White et al, 2011;Legler et al, 2011;Stevens et al, 2011). Therefore, in palliative care, care burden could have a bad impact on caregivers.…”

Commonly Prescribed Medications in a Population of Hospice Patients

“…The process used to compile the IAHPC list of essential medicines in palliative care involved determination of common symptoms at the end of life and evaluation of medications used to treat those symptoms. 1 …”