Impact of hospice care on end-of-life hospitalization of elderly patients with lung cancer in Taiwan.
BACKGROUND
This study investigated the impact of hospice care on end-of-life elderly patients with lung cancer in Taiwan.


METHODS
Data were collected from deceased inpatients with lung cancer who were at least 65 years old, using the National Health Insurance Research Database of 2004.


RESULTS
A total of 1282 patients were enrolled, of whom 277 (21.6%) received hospice care (hospice-care group) and the other 1005 (78.4%) received general acute ward care (control group). The patients' age, gender, and institution of hospitalization did not differ significantly between the two groups, and most of the patients had chosen medical centers and their affiliated hospices for terminal care. The hospice-care group had a significantly shorter hospital stay and lower costs of hospitalization than the control group, with patients cared for primarily by family physicians and radiation oncologists (all p<0.05). The hospice-care group had an elevated incidence of co-morbid diabetes mellitus, higher scores on the Charlson Comorbidity Index, fewer acute lower respiratory conditions, and fewer invasive procedures than the control group (all p<0.05). Natural opium alkaloids were the most commonly prescribed drugs in the hospice-care group, whereas parenteral solutions were most frequently requested in the control group.


CONCLUSIONS
Hospice care has provided a humane and cost-efficient pathway for end-of-life elderly patients with lung cancer. Parenteral nutrition/hydration should be limited for terminal care patients. Opioids should be promoted for the relief of pain and dyspnea in acute ward care. Family physicians and radiation oncologists play important roles in hospice care. Compared with the prevalence of hospice care in the United Kingdom and other developed countries, hospice care in Taiwan is in the position to be expanded.
Division of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
Shih-Chao
SC
Kang
Ming-Hwai
MH
Lin
I-Hsuan
IH
Hwang
Ming-Hsien
MH
Lin
Hsiao-Ting
HT
Chang
Shinn-Jang
SJ
Hwang
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D017051:Hospice Care; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D013624:Taiwan