@article{ca9c5076a6004608bae5b7d3bb3c6789,
title = "How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients",
abstract = "Objective: To describe disparities in patterns of hospice use and end-of-life costs among ovarian cancer patients. Methods: Using Texas Cancer Registry-Medicare data, ovarian cancer patients deceased 2005–2012 with >12 months of continuous Medicare coverage before death were included. Descriptive statistics and multivariable logistic regressions were used to evaluate patterns of hospice use. Cost and resource utilization was obtained from Medicare claims and analyzed using a non-parametric Mann-Whitney test. Results: 2331 patients were assessed: 1788 (77%) white, 359 (15%) Hispanic, 158 (7%) black and 26 (1%) other. 1756 (75%) enrolled in hospice prior to death but only 1580 (68%) died with hospice. 176 (10%) of 1756 patients unenrolled and died without hospice. 346 (20%) unenrolled from hospice multiple times. From 2008 to 2012, patients were less likely to unenroll from hospice prior to death. Black patients were more likely to unenroll from hospice prior to death (OR 2.07 [1.15–3.73]; p = 0.02) compared to white patients. The median amount paid by Medicare during the last six months of life was $38,530 for those in hospice compared to $49,942 if never enrolled in hospice (p < 0.0001) and was higher for black and Hispanic patients compared to white patients. 30% hospice unenrolled patients and 40% multiply enrolled hospice patients received at least one life extending or invasive care procedure following unenrollment from hospice. Conclusion: Recently, more patients remain enrolled in hospice, but black patients have a higher risk of unenrollment. Hospice enrollment was associated with lower costs as long as a patient did not unenroll from hospice.",
keywords = "Cancer care disparities, Hospice, Ovarian cancer",
author = "Taylor, {Jolyn S.} and Ning Zhang and Rajan, {Suja S.} and Mariana Chavez-MacGregor and Hui Zhao and Jiangong Niu and Meyer, {Larissa A.} and Ramondetta, {Lois M.} and Bodurka, {Diane C.} and Lairson, {David R.} and Giordano, {Sharon H.}",
note = "Funding Information: This research was supported by CPRIT PR140020 and RP160674. This research was also supported in part by the National Institutes of Health through MD Anderson Cancer Center's Support Grant CA016672 . Dr. Meyer was supported by the following grants: NIH K07 CA201013 and CPRIT RP140020. Dr. Taylor's work on this project was supported by a NIH T32 grant, Training of Academic Gynecologic Oncologists, from the National Cancer Institute (5T32-CA101642). Dr. Giordano and Chavez MacGergor are supported by Komen SAC 150061. The funding source had no direct role in preparing or reviewing this study nor this manuscript. The collection of Texas cancer incidence data used in this study was supported by the Texas Department of State Health Services, Texas Health and Human Commission, and Cancer Prevention Research Institute of Texas, as part of the statewide cancer reporting program and the Centers for Disease Control and Prevention's National Program of Cancer Registries Cooperative Agreement #1NU58DP006308. We also acknowledge support from the Duncan Family Institute for this research. Funding Information: This research was supported by CPRIT PR140020 and RP160674. This research was also supported in part by the National Institutes of Health through MD Anderson Cancer Center's Support Grant CA016672. Dr. Meyer was supported by the following grants: NIH K07 CA201013 and CPRIT RP140020. Dr. Taylor's work on this project was supported by a NIH T32 grant, Training of Academic Gynecologic Oncologists, from the National Cancer Institute (5T32-CA101642). Dr. Giordano and Chavez MacGergor are supported by Komen SAC 150061. The funding source had no direct role in preparing or reviewing this study nor this manuscript. The collection of Texas cancer incidence data used in this study was supported by the Texas Department of State Health Services, Texas Health and Human Commission, and Cancer Prevention Research Institute of Texas, as part of the statewide cancer reporting program and the Centers for Disease Control and Prevention's National Program of Cancer Registries Cooperative Agreement #1NU58DP006308. We also acknowledge support from the Duncan Family Institute for this research. Publisher Copyright: {\textcopyright} 2018",
year = "2019",
month = mar,
doi = "10.1016/j.ygyno.2018.10.041",
language = "English (US)",
volume = "152",
pages = "452--458",
journal = "Gynecologic oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "3",
}