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The impact of hospice services in the care of patients with advanced stage non-small cell lung cancer.

104 Background: Prior research has shown that early incorporation of palliative care alongside standard oncological care in metastatic non-small cell lung cancer (NSCLC) patients results in longer survival and less aggressive treatment at the end of life. The purpose of our study was to profile the continuum of care of stage IV NSCLC patients, comparing it to quality indicators for excellence in end-of-life (EOL) cancer care, as defined by the Quality Oncology Practice Initiative and other published studies. Specifically, our aim was to explore the connection between hospice enrollment and end-of-life quality measures.


METHODS
197 deceased stage IV NSCLC patients diagnosed between 2008 and 2010 at two separate tertiary care centers within the same county were identified. A retrospective review was conducted, collecting data from electronic medical records regarding antitumor treatment services received, post-diagnosis hospital admissions, palliative care consultations, hospice referrals and enrollments, and circumstances surrounding the patient's death. The patients were separated into two groups depending on their status of hospice enrollment, and the remainder of the measures compared accordingly.


RESULTS
There was no significant difference in number of lines of chemotherapy received and total number of post-diagnosis hospital admissions between the patients who were enrolled in hospice and those who were not. However, the group who received hospice services had a significantly lower number of hospitalizations in the last 30 days of life (p<0.001), emergency department admissions in the last 30 days of life (p<0.01), and intensive care unit admissions in the last 30 days of life (p<0.001). Median survival, measured by the length of time between diagnosis and death, did not differ between the two groups.


CONCLUSIONS
This study demonstrates that, among patients with metastatic NSCLC, hospice enrollment was associated with optimized end-of-life oncological care, as seen with fewer hospital admissions in the last 30 days of life, without incurring a lower median survival.