Comparing Hospice and Nonhospice Patient Survival

Comparing Hospice and Nonhospice Patient Survival Among Patients Who Die Within a Three-Year Window

Journal of Pain and Symptom Management
Volume 33 | No. 3 | March 2007


Key Points

• There is a growing body of evidence to counter the argument that the use of opioid and sedative medications for symptom relief hastens death.
• Our findings suggest that hospice may indeed have a positive impact on patients’ longevity or at least not hasten death.
• For the five types of cancer and congestive heart failure (CHF) patient populations combined, the mean survival was 29 days longer for hospice patients than for nonhospice patients.
• CHF patients who eventually chose hospice had a mean survival of 402 days compared with 321 days for those who did not.
• The mean survival was also significantly longer for the hospice patients with lung cancer, pancreatic cancer, and marginally significant for colon cancer
• Patients in an already weakened condition avoid the risks of overtreatment when they make the decision to enter hospice.
• Entering hospice may improve monitoring and treatment patient receive.
• Several studies have suggested that psychosocial supports may tend to prolong life.
• Findings are important in helping dispel the myth that hospice care hastens a patient’s death.


Abstract

There is a widespread belief by some health care providers and the wider community that medications used to alleviate symptoms may hasten death in hospice patients. Conversely, there is a clinical impression among hospice providers that hospice might extend some patients’ lives. We studied the difference of survival periods of terminally ill patients between those using hospice and those not using hospices. We performed retrospective statistical analysis on selected cohorts from large paid claim databases of Medicare beneficiaries for five types of cancer and congestive heart failure (CHF) patients. We analyzed the survival of 4493 patients from a sample of 5% of the entire Medicare beneficiary population for 1998-2002 associated with six narrowly defined indicative markers. For the six patient populations combined, the mean survival was 29 days longer for hospice patients than for nonhospice patients. The mean survival was also significantly longer for the hospice patients with CHF, lung cancer, pancreatic cancer, and marginally significant for colon cancer (P = 0.08). Mean survival was not significantly different (statistically) for hospice vs. nonhospice patients with breast or prostrate cancer. Across groups studied, hospice enrollment is not significantly associated with shorter survival, but for certain terminally ill patients, hospice is associated with longer survival times. The claims-based method used death within three years as a surrogate for a clinical judgment to recommend hospice, which means our findings apply to cases where a clinician is very sure the patient will die within three years, and it points to the need to validate these findings.

J Pain Symptom Manage 2007;33:238-246. © 2007 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.