Researchers Find that Cancer Patients who Disenroll from Hospice have Increased Hospitalizations and are less likely to Die at Home

Disenrollment can have a Physical and Financial Toll

(Alexandria, Va) – According to a new study, patients with terminal cancer that disenrolled from hospice care had significantly higher rates of hospitalizations – including admission to the emergency department and intensive care unit – than patients who remained under the care of hospice. Furthermore, patients who disenrolled from hospice were more likely to die in the hospital than patients who remained with hospice until their deaths.

National Hospice and Palliative Care Organization hopes that healthcare professionals and policy makers will take time to look at this and other recent studies that help provide a better understanding of both the cost and quality-of-life benefits associated with the hospice experience, including honoring a patient’s wish to be able to die at home.

The study, which was led by researchers at the Mount Sinai School of Medicine, found that:

• 33.9 percent of the patients who disenrolled from hospice care were admitted to an emergency department, in contrast with only 3.1 percent of hospice patients.
• 39.8 percent of disenrolled patients were admitted to the hospital as an inpatient, in contrast with only 1.6 percent of hospice patients.
• Disenrolled patients spent an average of 19.3 days in the hospital, whereas hospice patients spent an average of 6.7 days.
• 9.6 percent of disenrolled patients died in the hospital, compared to only 0.2 percent of hospice patients.
• Costs of care for patients with cancer who disenrolled from hospice were nearly five times higher than for patients who remained with hospice.

“Impact of Hospice Disenrollment on Healthcare Use and Medical Expenditures for Patients with Cancer” is published in the October 1, 2010 issue of Journal of Clinical Oncology.

“This study illustrates the tangible value of hospice care to patients who want to die at home, with the support of the hospice interdisciplinary team, surrounded by family rather than in a hospital connected to machines. There are significant emotional and financial benefits to the patient, family and healthcare system when hospices are caring for people,” said J. Donald Schumacher, NHPCO president and CEO. “In my 30 years running a hospice, I heard time and time again from families that wanted to keep their dying loved one at home.”

“There are numerous reasons why a patient may disenroll from hospice, and while those factors were not part of this study, we are reminded of the importance of advising patients and families as to the potential toll that might accompany leaving hospice care prematurely. A toll that may be physical, emotional, and financial,” added Schumacher.

Wrote the study authors, “Policy makers have called for tightening eligibility restrictions for the MHB (Medicare Hospice Benefit) as part of a wider effort to reduce high Medicare expenditures; our results suggest that addressing hospice disenrollment may be an effective means of reducing Medicare expenditures for hospice users without restriction access to the MHB.”

Further recommendations suggest that oncologists explore outpatient palliative care services that offer multidisciplinary care, symptom control, and end-of-life planning expertise in a context that enables a patient and family to maintain contact with the oncology clinic.

In his plenary address at NHPCO’s “Developing the Continuum of Care” conference held in Boston on August 5, Dr. Schumacher encouraged all hospice providers to explore ways that they can offer “pre-hospice” palliative care services in their communities and work with other providers to ensure patients and families have the right care at the right time from diagnosis on through bereavement for family.

More than 1.5 million patients with life-limiting illness receive care every year from the nation’s hospices.

Information about hospice and advance care planning is available from NHPCO’s Caring Connections. Visit caringinfo.org or call the HelpLine at 1-800-658-8898.

Research Shows Patients May Live Longer with Hospice and Palliative Care

NHPCO Reminds People They Can Ask Physicians for Palliative Care

(Alexandria, Va) – A new study released by the New England Journal of Medicine found that among patients with non-small-cell lung cancer, those who received palliative care lived, on average, almost two months longer than those who received standard care. Researchers also found that the patients receiving palliative care reported a higher quality of life through the final course of their illness.

The goals of palliative care are to improve the quality of a seriously ill person’s life and to support that person and their family during and after treatment. Sharing the same philosophy of hospice care which is usually provided in the final months of life, palliative care may be provided at any stage during a serious or life-limiting illness.

Researchers also found that when patients received palliative care services, they were also more likely to elect hospice services.

"With earlier referral to a hospice program, patients may receive care that results in better management of symptoms, leading to stabilization of their condition and prolonged survival," wrote the authors of the study released Wednesday in the New England Journal of Medicine.

This new study adds to the body of evidence showing that many patients live longer with hospice and palliative care.

A 2007 study that looked at Medicare beneficiaries with some of the most common diagnoses leading to death, found that patients who received hospice services lived on average, 29 days longer than those who did not receive hospice care. This study, published in the Journal of Pain and Symptom Management (March 2007) looked at 4,493 terminally ill patients with either congestive heart failure or cancer of the breast, colon, lung, pancreas, or prostate.

In an earlier study looking at patients with 16 of the most common terminal diagnoses, researchers found that hospice patients lived longer. On average, this ranged from 20 days for those with a diagnosis of gallbladder cancer to 69 days for the cohort of breast cancer patients (JPSM, September 2004).

“There’s an inaccurate perception among the American public that hospice means you’ve given up,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. “Those of us who have worked in the field have seen firsthand how hospice and palliative care can improve the quality of and indeed prolong the lives of people receiving care.”

NHPCO encourages all families who are diagnosed with a serious illness to ask their healthcare providers about hospice and palliative care services.

“The time to learn about these services is before a person is in a medical crisis. Patients and families must learn about these options of care as soon as possible,” Schumacher added.

Both hospice and palliative care focus on helping a person with a serious or life-limiting illness by addressing issues causing physical or emotional pain, or suffering. Hospice and other palliative care providers have teams of people working together to provide care.

More information about hospice and palliative care is available online at caringinfo.org or by calling the HelpLine at 800-658-8898.

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Contact:
Jon Radulovic
NHPCO, Vice President of Communications
Ph: 703-837-3139
jradulovic@nhpco.org

Don Schumacher Interviewed on Marketplace

President/CEO Don Schumacher was interviewed on public radio’s Marketplace about current issues in end-of-life care. Produced by American Public Media, Marketplace is broadcast internationally and is available online. Part one, of “End of life care: More or less of it?” was broadcast 07/20/10.

Part two of the story, “Better Training for Better End-of-Life Care,” looks at palliative care and visits San Diego Hospice and Institute for Palliative Medicine. Marketplace links to materials from NHPCO’s Caring Connections as helpful resources.

The story also features a photo slide show.

Costs of Care at EOL

Discussions About End-of-Life Care Reduce Healthcare Costs in Last Week of Life

NHPCO Encourages Dialog between Patients and Physicians

(Alexandria, Va) – Patients with advanced cancer who reported talking about their end-of-life wishes with their physicians had significantly lower healthcare costs in the last week of life. Researchers found that these conversations between patients and physicians led to fewer cases of aggressive care, which saved money and resulted in a far more peaceful death for patients.

The study in the March 9 issue of Archives of Internal Medicine suggests a tangible benefit to advance care planning discussions with physicians – lower costs and reduced utilization of aggressive care, including admission to the Intensive Care Unit.

Thirty percent of Medicare’s annual costs are spent on the five percent of beneficiaries who will die in a given year. Additionally, about one-third of those dollars spent in the last year of life are spent in the last month.

“Discussions about care at the end of life result in a higher quality of life for patients – and cost the healthcare system less money, that is something that hospice and palliative care providers have long known” said J. Donald Schumacher, president and CEO of National Hospice and Palliative Care Organization.

A 2007 study out of Duke University found hospice saves Medicare about $2,300 per beneficiary that receives hospice care.

Researchers in this recent survey looking at costs in the last week of life indicate that if 50 percent of people had a discussion with their physician about end-of-life care preferences, the cost difference in a year could be more than $76 million dollars.

Study participants who discussed end-of-life care preferences were more likely to be referred to hospice sooner than those who did not.

“In fact, patients who received less invasive or aggressive treatments lived as long as patients who did not, indicating that attempts to prolong life in end-stage cancer patients might be futile,” noted Schumacher.

Research published in the Journal of Pain and Symptom Management (March 2007) found that Medicare beneficiaries who opted for hospice care at the end of life lived on average 29 days longer than similar patients who did not take advantage of hospice.

NHPCO has been a longtime advocate for people having frank discussions about the care they would want – primarily to ensure that a person’s wishes are honored and that they experience the highest quality of life possible.

“An important time to talk to your doctor about the kind of care you would want at the end of your life is not when you’re days away from death but much earlier in the course of an illness,” said Schumacher.

“In fact, I cannot stress the importance of advance care planning for all people. Taking time, right now, to have these discussions with family and loved ones can be very important in making sure wishes are honored should a medical crisis come along,” added Schumacher.

Last year, more than 1.4 million Americans with life-limiting illness received the quality care from the nation’s 4,700 hospice care providers.

Information on care at the end of life, starting these important conversations with loved ones and care providers, and state specific advance directive forms, are all available free-of-charge on NHPCO’s Caring Connections Web site, www.caringinfo.org, or from the Helpline at 800-658-8898.

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For more information visit, http://www.nhpco.org