Length of survival (LOS) of cancer patients in hospice and prior enrollment in phase I studies

Abstract

8158 Background: Short LOS in hospice might be an important measure of poor quality of life for terminally ill cancer patients. It is unknown whether enrollment of cancer patients in phase I studies at the end of life delays their referral to hospice and adversely affects their LOS in hospice. Methods: 180 adult cancer patients treated at Roswell Park Cancer Institute and admitted to a community hospice program between 1/1/02–6/30/02 were included in this exploratory analysis. We retrospectively examined the possible variables associated with short LOS of cancer patients in hospice at a major cancer center, including prior enrollment in phase I studies. Survival analysis was performed with Kaplan-Meier estimation, log-rank comparison, and univariate and multivariate Cox models. Results: The median LOS in hospice was 35 days for all patients and 49 days for the 7% of patients who were previously enrolled in phase I studies. Of all patients, 27% died within two weeks and 8% lived longer than 6 months. Variables associated with short LOS were male gender [p=0.06], executed advance directives [p=0.06], insurance other than Medicare/Medicaid [p=0.07], and poor performance status at the time of hospice enrollment, as assessed by Karnofsky Performance Scale [p= 0.02] or Palliative Performance Scale (PPS) [p< 0.001]. Prior enrollment in phase I studies was not associated with short LOS in hospice [Hazard Ratio: 1.00 & p= 0.99]. In a multivariate Cox model, low PPS and male gender predicted a short LOS in hospice [p<0.001 & p=0.01, respectively]. The PPS and gender separated patients into four risk groups with different LOS in hospice [p<0.001]: males with low PPS had the shortest LOS, while females with high PPS had the longest one. Conclusions: The performance status of cancer patients at the time of hospice enrollment is a strong predictor of the LOS in hospice. The association between male gender and short LOS in hospice, as seen in other studies, needs to be explored further. Prior enrollment of cancer patients in phase I studies did not adversely affect their LOS in hospice. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration State University of New York at Buffalo