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Barriers to Hospice Care Among Older Patients Dying With Lung and Colorectal Cancer

Ellen P. McCarthy, Risa B. Burns, Roger B. Davis, Russell S. Phillips

From the Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, MA.

Address reprint requests to Ellen P. McCarthy, Ph.D., Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rose-139, Boston, MA 02215; email: Ellen_Mccarthy{at}caregroup.harvard.edu.

Purpose: To identify factors associated with hospice enrollment and length of stay in hospice among patients dying with lung or colorectal cancer. Methods: We used the Linked Medicare-Tumor Registry Database to conduct a retrospective analysis of the last year of life among Medicare beneficiaries diagnosed with lung or colorectal cancer at age 66 years between January 1, 1973, and December 31, 1996, in the Surveillance, Epidemiology, and End Results Program who died between January 1, 1988, and December 31, 1998. Our outcomes of interest were time from cancer diagnosis to hospice enrollment and length of stay in hospice care. We used Cox proportional hazards regression to adjust for demographic and clinical information.

Results: We studied elderly patients dying with lung cancer (n = 62,117) or colorectal cancer (n = 57,260). Overall, 27% of patients (n = 16,750) with lung cancer and 20% of patients (n = 11,332) with colorectal cancer received hospice care before death. Median length of stay for hospice patients with lung and colorectal cancer was 25 and 28 days, respectively. Overall, 20% of patients entered hospice within 1 week of death, whereas 6% entered more than 6 months before death. Factors associated with later hospice enrollment include being male; being of nonwhite, nonblack race; having fee-for-service insurance; and residing in a rural community. Many of these factors also were associated with shorter stays in hospice.

Conclusion: Although use of hospice care has increased dramatically over time, specific patient groups, including men, patients residing in rural communities, and patients with fee-for-service insurance continue to experience delays in hospice enrollment.

Ellen P. McCarthy is the recipient of a First Independent Research Support & Transition (FIRST) Award No. 5-R29CA-79052 funded by the National Cancer Institute.

Presented in part at the National Meeting of the Society of General Internal Medicine, San Diego, California, May 2001.

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