Hospice and emergency room use by disadvantaged men dying of prostate cancer.
OBJECTIVE
Hospice care has been found to improve symptom management, quality of death and quality of life at the end of life. We describe hospice use by a cohort of low income, uninsured men with prostate cancer enrolled in a public assistance program. We ascertained whether hospice enrollment was associated with a decrease in the number of prostate cancer related emergency room visits made before death.


METHODS
We studied all 57 low income, uninsured men in a public assistance program who had died since its inception in 2001. The association between sociodemographic and clinical data, and hospice enrollment data were evaluated.


RESULTS
The overall rate of hospice use was 28% (16 of 57 patients). The mean +/- SD duration of hospice enrollment before death was 44 +/- 43 days (median 34, range 2 to 143). Two patients (12%) were enrolled fewer than 7 days and none were enrolled more than 180 days. Prostate cancer related emergency room visits, adjuvant chemotherapy treatment, evidence of metastasis at initial presentation and death from prostate cancer were significantly associated with hospice use (p <0.05). We noted a trend toward fewer mean emergency room visits made by men enrolled in hospice care than by those not enrolled (0.7 +/- 1.3 vs 1.1 +/- 0.9, p = 0.15).


CONCLUSIONS
Hospice use and the duration of enrollment by low income, uninsured men dying of prostate cancer was comparable to previously reported hospice use by insured individuals. Hospice enrollment was associated with fewer prostate cancer related emergency room visits.
Bergman
Jonathan
J
Department of Urology, University of California-Los Angeles, Los Angeles, California 90095-1738, USA. jbergman@mednet.ucla.edu
Kwan
Lorna
L
Fink
Arlene
A
Connor
Sarah E
SE
Litwin
Mark S
MS
D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002423:Cause of Death; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D013727:Terminal Care / Q000379:methods; D016896:Treatment Outcome; D035862:Vulnerable Populations / Q000706:statistics & numerical data*