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Average length of stay in hospice for five cancers.

6593 Background: Factors which influence average length of stay (ALOS) for terminally ill cancer patients who choose hospice include patient and family preferences, availability of services, demographics, specialty, and experience of referring physician, advances in treatment options, and especially type of cancer. In this paper, we examined differences in ALOS for the top five cancers in patients who utilized a large, national hospice provider between 2000 and 2007.


METHODS
We reviewed the records of 73,263 patients with prostate, colorectal, breast, lung, or pancreatic cancer who were admitted to one of 45 hospice programs and died on service between January 2000 and December 2007. The top five cancers accounted for 58% of all cancer deaths in the hospice programs. The effect of type of cancer and year on ALOS was evaluated using analysis of variance. Pair-wise differences were compared using the Bonferroni correction.


RESULTS
Overall ALOS was 40.0 days (yearly range 37.8-41.1). ALOS for prostate, colorectal, breast, lung, and pancreas was 46.8, 44.9, 44.2, 37.3, and 31.4 days, respectively. Prostate, colorectal, and breast ALOS were not significantly different from one other; lung ALOS was less than the top three but greater than pancreas ALOS (p < 0.001); and pancreas ALOS was significantly lower than all others (p < 0.001). The interaction between year and type of cancer was not significant (p > 0.05).


CONCLUSIONS
The longer ALOS for patients with prostate, colorectal and breast cancer may be related to differences in natural history and effectiveness of anti-neoplastic therapies when compared to cancers of the lung and pancreas. Given the remarkable stability of ALOS over the last eight years and the lack of a statistical interaction between year and type of cancer, ALOS differences also suggest a steeper rate of decline for patients with cancers of the lung and pancreas following admission to hospice. No significant financial relationships to disclose.