Impact of pancreatic cancer treatment on hospice utilization.

Abstract

52 Background: There is an increasing incidence of pancreatic cancer over time, a cancer with a 5-year survival rate of only 7.2%.For patients with poor prognosis cancers, hospice is an important resource, but it is often not utilized or underutilized. Factors influencing hospice use are difficult to determine. We sought to evaluate the impact of pancreatic cancer treatment on hospice utilization. Methods: National Surveillance Epidemiology and End Results (SEER)-Medicare data was utilized to identify all incident cases of pancreatic cancer patients who died (2005-09, with follow up to 2011). Patients were stratified by primary treatment strategy: surgery, chemotherapy, or no treatment. Hospice utilization in the last 6 months of life, including average and median days enrolled in hospice and average time from diagnosis to hospice was evaluated. Results: 17,031 patients were identified, with 68.5% enrolling in hospice in the last 6 months of life. Patients undergoing surgery were less likely to enroll in hospice compared to patients not undergoing surgery (58.7% vs 69.4%, p < 0.0001). Interestingly, surgical patients spent on average 31.2 days in hospice (median 15.0 days) which was comparable to the non-surgical cohort (average 32.7 days, median 16.0 days; p = 0.32). Patients who received any chemotherapy spent an average of 29.2 days in hospice (median 15 days) compared to those who did not undergo chemotherapy, who spent an average of 34.5 days in hospice (median 16 days); p < 0.0001. While total hospice enrollment was equivalent between the chemotherapy and no chemotherapy cohorts (67.5% vs 69.1%), the time spent in hospice was significantly different (p < 0.0001). Patients not receiving any cancer-directed treatment enrolled in hospice at an average of 78.6 days (median 32 days) from diagnosis. Conclusions: Pancreatic cancer patients undergoing surgery enrolled in hospice to a much lesser extent than patients who did not have surgery. Patients not receiving cancer-directed treatment spend a relatively short time in hospice. Overall, hospice appears to be underutilized, and the majority of patients with this poor prognosis cancer are not realizing the full benefits of hospice.