Hospice use and end-of-life care among older patients with esophageal cancer.

backgroundHospice and end-of-life health care utilization among patients with esophageal cancer are understudied. We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to analyze hospice use and end-of-life treatment patterns.

methodsWe included patients diagnosed with esophageal adenocarcinoma or squamous cell carcinoma between 2000 and 2011 and who had died by December 31, 2013. We evaluated patterns of hospice enrollment, chemotherapy receipt, radiation receipt, acute care hospitalizations, and intensive care unit (ICU) admissions at end of life. We used multivariate logistic regression to evaluate possible associations with hospice use, late ICU admission, and late chemotherapy receipt.

resultsOur study included 6449 patients; 3597 (55.8%) enrolled in hospice. Among hospice enrolled patients, 31.4% enrolled in the last 7 days of life. Hospice enrollment increased over time, from 43.2% in 2000 to 59.6% in 2013. Patients who were older, female, with stage IV disease, or those with higher socioeconomic status were more likely to enroll in hospice. Among all patients, 19.1% had an ICU admission within the last 30 days and 4.6% received chemotherapy within the last 14 days of life. Those who were Black or Asian (compared to White), married, or had a comorbidity score >1 were more likely to have a late ICU admission. Males and younger patients were more likely to receive chemotherapy at end of life.

conclusionHospice enrollment rates among patients with esophageal cancer have increased over time; however, a significant percentage of patients enrolls near the end of life. Further research is needed to improve understanding of how end-of-life care decisions for these patients are made.