title: Hospice enrollment for terminally ill patients with gynecologic malignancies: impact on outcomes and interventions.
abstract: OBJECTIVE
  To determine survival and interventions for patients with non-curative gynecologic malignancies based on supportive care enrollment.
  
  
  METHODS
  An IRB approved retrospective review identified patients with recurrent/persistent gynecologic cancers from 2002 to 2008. Demographics, therapy, clinicopathologic data, hospice utilization, surgical/invasive procedures and survival were collected. Patients were considered hospice enrollees if they enrolled following recommendation from their provider (HOSPICE); however, patients that declined hospice when recommended were considered (NO HOSPICE), regardless if they ultimately received supportive care. Standard statistical tests including: t-test and Kaplan-Meier with Log Rank were used.
  
  
  RESULTS
  Eighty-one patients were identified: 29 patients (36%) NO HOSPICE and 52 (64%) HOSPICE. Mean age was 61. Most patients had ovarian cancer (54.3%), were white (61.7%) and had disease recurrence (72%). Patients utilized a median of 3 anti-neoplastic therapies (range 0-10) for recurrent or progressive/persistent disease. Median time receiving hospice care was 1week for NO HOSPICE patients versus 8weeks HOSPICE patients (p<0.0005). In a subset of patients with recurrent disease, median overall survival for NO HOSPICE patients was 9months (95% CI 5.9-12.1months) versus 17months (95% CI 11.1-22.9months) for HOSPICE patients (p=0.002). NO HOSPICE patients were more likely to have a procedure performed (55% vs. 31%) within 4weeks of their death, including the administration of chemotherapy OR 2.4 (95% CI 1.1-7.1, p=0.036).
  
  
  CONCLUSIONS
  While retrospective reviews evaluating hospice are challenging, our data suggest no detrimental impact on survival for hospice patients. Continued evaluation for patients at the end-of-life is necessary in order to optimize resource utilization.
authors.affiliation: Division of Gynecologic Oncology, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Keyser
authors.forename: Beverly G
authors.initials: BG
authors.lastname: Reed
authors.forename: William J
authors.initials: WJ
authors.lastname: Lowery
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sundborg
authors.forename: William E
authors.initials: WE
authors.lastname: Winter
authors.forename: John A
authors.initials: JA
authors.lastname: Ward
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000628:therapy*; D017051:Hospice Care / Q000706:statistics & numerical data*; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D010166:Palliative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome