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Disparities in hospice care among older women dying with ovarian cancer.
Gynecol Oncol. 2012 Apr; 125(1):14-8.GO

Abstract

BACKGROUND

Timely hospice referral is an essential component of quality end-of-life care, although a growing body of research suggests that for patients with various types of cancer, hospice referrals often occur very late in the course of care, and are marked by sociodemographic disparities. However, little is known about the ovarian cancer patient population specifically. We examined the extent and timing of hospice referrals in ovarian cancer patients over age 65, and the factors associated with these outcomes.

METHODS

We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 8211 women aged 66+ with ovarian cancer who were diagnosed between 2001 and 2005 and died by December 31, 2007. We excluded women who were not eligible for Medicare A continuously during the 6 months prior to death. Outcomes studied included overall hospice use in the last 6 months of life and late hospice enrollment, defined as within 3 days of death. We examined variations in these two measures based on year of diagnosis and sociodemographic characteristics (age, race, marital status, rural residence, income, education) and type of Medicare received (fee-for-service vs. managed care).

RESULTS

Among 8211 women in the cohort who died from ovarian cancer, 39.7% never received hospice care (3257/8211). Overall hospice care increased over the period of observation, from 49.7% in 2001 to 63.6% [corrected] in 2005, but the proportion of women receiving hospice care within 3 days of death did not improve. Among those who received hospice care, 11.2% (556/4954) and 26.2% (1299/4954) received such care within 3 and 7 days of death, respectively. A higher proportion of black women (46.5% vs. 38.4% among whites), women in the lowest income group (42.8% vs. 37.0% in the highest income group), and those receiving fee-for-service Medicare (41.3% vs.33.5% for women in managed care) never received hospice care. In multivariable models, factors associated with lack of hospice care included age younger than 80 years (OR 1.27, 95% CI 1.15-1.40), non-white race (OR 1.44, 95% CI 1.26-1.65), low income (OR 1.17, 95% CI 1.04-1.32) and enrollment in fee-for-service Medicare compared with managed care (OR 1.39, 95% CI 1.24-1.56).

CONCLUSION

More older women with ovarian cancer are receiving hospice care over time, however, a substantial proportion receive such care very near death, and sociodemographic disparities in hospice care exist. Our data also support the need to target lower-income and minority women in efforts to increase optimally timed hospice referrals in this population. Our finding that ovarian cancer patients enrolled in managed care plans were more likely to receive hospice care suggests the importance of health care system factors in the utilization of hospice services.

Authors+Show Affiliations

Center of Outcomes Research and Evaluation, Maine Medical Center Research Institute, ME, USA. fairfk@mmc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22138230

Citation

Fairfield, Kathleen M., et al. "Disparities in Hospice Care Among Older Women Dying With Ovarian Cancer." Gynecologic Oncology, vol. 125, no. 1, 2012, pp. 14-8.
Fairfield KM, Murray KM, Wierman HR, et al. Disparities in hospice care among older women dying with ovarian cancer. Gynecol Oncol. 2012;125(1):14-8.
Fairfield, K. M., Murray, K. M., Wierman, H. R., Han, P. K., Hallen, S., Miesfeldt, S., Trimble, E. L., Warren, J. L., & Earle, C. C. (2012). Disparities in hospice care among older women dying with ovarian cancer. Gynecologic Oncology, 125(1), 14-8. https://doi.org/10.1016/j.ygyno.2011.11.041
Fairfield KM, et al. Disparities in Hospice Care Among Older Women Dying With Ovarian Cancer. Gynecol Oncol. 2012;125(1):14-8. PubMed PMID: 22138230.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disparities in hospice care among older women dying with ovarian cancer. AU - Fairfield,Kathleen M, AU - Murray,Kimberly M, AU - Wierman,Heidi R, AU - Han,Paul K J, AU - Hallen,Sarah, AU - Miesfeldt,Susan, AU - Trimble,Edward L, AU - Warren,Joan L, AU - Earle,Craig C, Y1 - 2011/12/01/ PY - 2011/09/07/received PY - 2011/11/17/revised PY - 2011/11/21/accepted PY - 2011/12/6/entrez PY - 2011/12/6/pubmed PY - 2012/7/14/medline SP - 14 EP - 8 JF - Gynecologic oncology JO - Gynecol Oncol VL - 125 IS - 1 N2 - BACKGROUND: Timely hospice referral is an essential component of quality end-of-life care, although a growing body of research suggests that for patients with various types of cancer, hospice referrals often occur very late in the course of care, and are marked by sociodemographic disparities. However, little is known about the ovarian cancer patient population specifically. We examined the extent and timing of hospice referrals in ovarian cancer patients over age 65, and the factors associated with these outcomes. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 8211 women aged 66+ with ovarian cancer who were diagnosed between 2001 and 2005 and died by December 31, 2007. We excluded women who were not eligible for Medicare A continuously during the 6 months prior to death. Outcomes studied included overall hospice use in the last 6 months of life and late hospice enrollment, defined as within 3 days of death. We examined variations in these two measures based on year of diagnosis and sociodemographic characteristics (age, race, marital status, rural residence, income, education) and type of Medicare received (fee-for-service vs. managed care). RESULTS: Among 8211 women in the cohort who died from ovarian cancer, 39.7% never received hospice care (3257/8211). Overall hospice care increased over the period of observation, from 49.7% in 2001 to 63.6% [corrected] in 2005, but the proportion of women receiving hospice care within 3 days of death did not improve. Among those who received hospice care, 11.2% (556/4954) and 26.2% (1299/4954) received such care within 3 and 7 days of death, respectively. A higher proportion of black women (46.5% vs. 38.4% among whites), women in the lowest income group (42.8% vs. 37.0% in the highest income group), and those receiving fee-for-service Medicare (41.3% vs.33.5% for women in managed care) never received hospice care. In multivariable models, factors associated with lack of hospice care included age younger than 80 years (OR 1.27, 95% CI 1.15-1.40), non-white race (OR 1.44, 95% CI 1.26-1.65), low income (OR 1.17, 95% CI 1.04-1.32) and enrollment in fee-for-service Medicare compared with managed care (OR 1.39, 95% CI 1.24-1.56). CONCLUSION: More older women with ovarian cancer are receiving hospice care over time, however, a substantial proportion receive such care very near death, and sociodemographic disparities in hospice care exist. Our data also support the need to target lower-income and minority women in efforts to increase optimally timed hospice referrals in this population. Our finding that ovarian cancer patients enrolled in managed care plans were more likely to receive hospice care suggests the importance of health care system factors in the utilization of hospice services. SN - 1095-6859 UR - https://www.unboundmedicine.com/medline/citation/22138230/Disparities_in_hospice_care_among_older_women_dying_with_ovarian_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-8258(11)00959-0 DB - PRIME DP - Unbound Medicine ER -