More Hospice Care Meant Longer Survival, Lower End-of-Life Costs for Metastatic Melanoma Patients

A study of patients with metastatic melanoma found that those who spent more time in hospice care lived almost four months longer than similar patients who had little or no hospice care, and that end-of-life costs dropped for those with more time in hospice.

The

study

, led by Jinhai Huo, PhD, MD, MPH, examined data involving 862 Medicare patients who died between 2000 and 2009 of metastatic melanoma, which has a 5-year survival rate of only 15 percent (compared with 95 percent for melanoma caught at early stages). Until the recent introduction of new therapies for late-stage metastatic melanoma, prospects for long-term survival for these patients were grim, even after following steps including radiation, surgery and chemotherapy.

Thus, end-stage metastatic melanoma patients offered a window into one of the most difficult but essential debates in healthcare today: Does it make sense to continue invasive, expensive treatments that offer little hope, or are patients and the healthcare system better off if palliative care is pursued earlier?

The authors used the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database to cull results involving 862 patients over age 65, and divided data into three groups: those with no hospice care, those with one to three days, and those with at least four days of hospice care. Among the findings:

• Patients with at least four days of hospice lived an average of 10.2 months (114 patients), while those with no care lived 6.5 months (225 patients) and those who received up to three days of hospice lived 6.1 months (523 patients).
• Patients with at least four hospice days had lower healthcare costs in their final three months, with the cost dropping between $9576 and $14,680, depending on the calculation method used. Besides the amount of hospice care, only the patient’s age made a significant difference in healthcare costs.

“Our study has current policy relevance given that the proportion of Medicare expenditures during the last year of life has been stable for 20 years, with 26.9 percent to 30.6 percent of all Medicare expenditures occurring during that interval,” the authors write.

The article notes that the data used reflects a period before the arrival of game-changing therapies such as ipilimumab and vemurafenib, which have been shown to dramatically extend survival for patients with metastatic melanoma.