Despite More Use of Hospice, Intensive Medical Services Increase for Ovarian Cancer Patients at End of Life

Alexi Wright, MD, MPH

A new study has shown that although patients with ovarian cancer were more likely to enter hospice care, the cost of hospital-based services actually increased, dispelling the hope that the cost of hospital services would decline if more patients opted for hospice care.

The study, published in the October issue of the Journal of Clinical Oncology and conducted by researchers at the Dana-Farber Cancer Institute, tracked nearly 7000 patients over the age of 66 with ovarian cancer.

Researchers found that many patients received aggressive treatments while in the hospital, and resorted to hospice care as an “add-on” when those treatments fail, the authors wrote.

“There’s a growing awareness that the use of aggressive, expensive medical interventions at the end of life often doesn’t improve patients’ quality of life and may even make it worse,” Alexi Wright, MD, MPH, the lead author of the study and medical oncologist at Dana-Farber, said in a statement.

“Hospice care, which focuses on intensive symptom management at home, is an attractive option for many people. But unless people make an end-of-life care plan while they’re healthy—spelling out their preferences in advance—these important decisions are often made for them, or occur in a crisis atmosphere. That may explain why, in this study, we saw an increased use of hospital-based services even as hospice enrollment increased.”

The study analyzed the Medicare records of 6956 women aged 66 or older who were diagnosed with ovarian cancer between 1997 and 2007, and who died of the disease by the end of 2007. The researchers found that hospice use increased significantly during that period, whereas hospitalized deaths fell. But they also found significant increases in intensive care unit admissions, hospitalizations, repeated emergency department visits, and transitions from one healthcare facility to another.

During the same timeframe, the proportion of patients who were referred to hospice from a hospital inpatient clinic rose. Also, 70% of patients were transferred between medical facilities at least once in the last month of life—with 20% experiencing major transitions between care settings within the final 3 days of life.

Researchers said the findings show that elderly, terminally ill patients experience multiple, stressful medical interventions when undergoing transfers between facilities—all before arriving at a hospice, where their stay may be very brief.

“The earlier people can make plans—with their families and physicians—the better they can control the kind of care they receive at the end of life,” Wright remarked. “Many people want their final days to be a time of legacy building, a time when they can share or build memories with their loved ones, instead of time spent in hospitals or receiving potentially futile medical interventions. Our study points to the extent to which such planning is still needed.”