title: Barriers to hospice care among older patients dying with lung and colorectal cancer.
abstract: OBJECTIVE
  To identify factors associated with hospice enrollment and length of stay in hospice among patients dying with lung or colorectal cancer.
  
  
  METHODS
  We used the Linked Medicare-Tumor Registry Database to conduct a retrospective analysis of the last year of life among Medicare beneficiaries diagnosed with lung or colorectal cancer at age > or = 66 years between January 1, 1973, and December 31, 1996, in the Surveillance, Epidemiology, and End Results Program who died between January 1, 1988, and December 31, 1998. Our outcomes of interest were time from cancer diagnosis to hospice enrollment and length of stay in hospice care. We used Cox proportional hazards regression to adjust for demographic and clinical information.
  
  
  RESULTS
  We studied elderly patients dying with lung cancer (n = 62,117) or colorectal cancer (n = 57,260). Overall, 27% of patients (n = 16,750) with lung cancer and 20% of patients (n = 11,332) with colorectal cancer received hospice care before death. Median length of stay for hospice patients with lung and colorectal cancer was 25 and 28 days, respectively. Overall, 20% of patients entered hospice within 1 week of death, whereas 6% entered more than 6 months before death. Factors associated with later hospice enrollment include being male; being of nonwhite, nonblack race; having fee-for-service insurance; and residing in a rural community. Many of these factors also were associated with shorter stays in hospice.
  
  
  CONCLUSIONS
  Although use of hospice care has increased dramatically over time, specific patient groups, including men, patients residing in rural communities, and patients with fee-for-service insurance continue to experience delays in hospice enrollment.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rose-139, Boston, MA 02215, USA. Ellen_Mccarthy@caregroup.harvard.edu
authors.forename: Ellen P
authors.initials: EP
authors.lastname: McCarthy
authors.forename: Risa B
authors.initials: RB
authors.lastname: Burns
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Russell S
authors.initials: RS
authors.lastname: Phillips
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D015179:Colorectal Neoplasms / Q000473:pathology / Q000523:psychology*; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay; D008175:Lung Neoplasms / Q000473:pathology / Q000523:psychology*; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D018426:SEER Program; D013997:Time Factors