Hospice use before death: Variability across cancer diagnoses

BACKGROUND: There is little information available about patterns of hospice use before death for patients with a diagnosis of cancer. OBJECTIVE: To examine whether rates of hospice use before death are different for persons dying of specific cancers or vary across age, sex, or racial groups. METHODS: Information about cause-specific hospice use received by elderly Medicare beneficiaries was obtained from Medicare hospice administrative (claims) data. Information regarding cause-specific numbers of deaths was obtained from the National Center for Health Statistics. Rates of hospice use were calculated using direct standardization adjusted for age, sex, and race. Length of stay in a hospice was calculated as the median number of days between entry into the hospice and death. RESULTS: Rates of hospice use before death ranged from 42.0 hospice users per 100 deaths for breast cancer to 48.1 hospice users per 100 deaths for pancreatic cancer. Across all cancers, blacks received approximately 82% of the hospice use as nonblacks. Men entered hospices at almost the same rate as women (overall male-to-female ratio = 0.97). Median length of stay in a hospice ranged from 21 to 27 days. CONCLUSIONS: A great deal of consistency was observed regarding hospice-use rates across cancer diagnoses. This consistency is greater than might be expected given differences in prognosis across cancers. The results suggest that there may be greater than previously predicted consistency across end-stage cancer patients in the ability to determine prognosis or patient preferences for hospice services.