Hospice care rising among prostate cancer patients, but is ‘too brief’
MedWire News: More than half of end-of-life prostate cancer patients enroll in hospices, but these men are often referred too late to receive maximum benefits of care, shows a US study.
In 2004, 61% of dying prostate cancer patients were in the care of a hospice, yet 25% of these died within 7 days of referral. This length of stay is "too brief" for them to profit from the input of the full disciplinary team, say the researchers.
"It's important that we maximize quality of life when quantity of life cannot be changed," said senior author of the study Mark Litwin (University of California, Los Angeles).
The study also found that patients in hospice care were less likely to receive high-intensity and costly care, including emergency department visits during the last months and weeks of life, compared with men who did not enter a hospice.
"In an era when increased attention is being focused on what to do to reign in runaway healthcare costs, there should be a clear focus on limiting therapies that ultimately will fail for these patients," said Litwin.
Using Surveillance, Epidemiology, and End-Results Medicare data for 14,521 men who died of prostate cancer between 1992 and 2005, Litwin and colleagues identified factors associated with hospice use, and looked at the relationship between hospice use and diagnostic and interventional procedures at the end of life.
They found that 53% of men had used hospice care, but that 22% of these had enrolled within 7 days of death. Those who were enrolled for the ideal 7-180-day period received a median 24 days of care before death.
Being of White ethnicity (vs African-American or Hispanic), being treated primarily with surgery or radiotherapy (vs androgen therapy), having a partner, and having a more recent year of death all increased the odds of hospice use.
Of note, patients not enrolled in hospices had undergone more imaging studies (9.70 vs 7.50), electrocardiograms (1.76 vs 1.25), and cardiopulmonary resuscitations (0.20 vs 0.06) in the last 6 months of life than patients who used hospices, but had received less palliative radiotherapy (2.01 vs 2.53).
The researchers, writing in the Archives of Internal Medicine, believe that physicians routinely overestimate their patients' expected survival, "with prognostic accuracy declining the longer the clinician has known the patient."
However Litwin added: "Optimization of life should be our goal…sometimes survival is of such poor quality that it should not be our primary goal."
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By Sarah Guy