Hospice Care For Advanced Cancer Decreased Aggressive Care and Costs in Last Year of Life

Ziad Obermeyer, MD, MPhil Emergency Medicine, Brigham & Women's Hospital Assistant Professor, Harvard Medical SchoolMedicalResearch.com Interview with:
Ziad Obermeyer, MD, MPhil
Emergency Medicine, Brigham & Women’s Hospital
Assistant Professor, Harvard Medical School

Medical Research: What is the background for this study? What are the main findings?

Dr. Obermeyer: More patients with cancer use hospice today than ever before, but there are indications that care intensity outside of hospice is increasing, and length of hospice stay decreasing. We examined how hospice affects health care utilization and costs and found that, in a sample of elderly Medicare patients with advanced cancer, hospice care was associated with significantly lower rates of both health care utilization and total costs during the last year of life.

Patients who did not enroll in hospice had considerably more aggressive care in their last year of life—most of it related to acute complications like infections and organ failure, and not directly related to cancer-directed treatment. Hospice and non-hospice patients had similar patterns of health care utilization until the week of hospice enrollment, when care began to diverge. Ultimately, non-hospice patients were five times more likely to die in hospitals and nursing homes. These differences in care contributed to a statistically-significant difference in total costs of $8,697 over the last year of life ($71,517 for non-hospice and $62,819 for hospice).

Medical Research: What should clinicians and patients take away from your report?

Dr. Obermeyer: Our results highlight the importance of honest discussions between doctors and patients about our patients’ goals of their care at the end of life, relating to treatment decisions and quality of life. This is of particular importance now, in light of the ongoing policy discussions around reimbursing providers for advance care planning.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Obermeyer: There is an urgent need for more research on interventions to promote earlier and better discussions around end of life care between doctors and patients. Hospice is not for everyone, but patients who want that option—with or without concurrent cancer-directed therapy—should know that it exists.


Association Between the Medicare Hospice Benefit and Health Care Utilization and Costs for Patients With Poor-Prognosis Cancer


Last Updated on November 12, 2014 by Marie Benz MD FAAD