title: Patterns of hospice use in patients dying from hematologic malignancies.
abstract: BACKGROUND
  Hospice brings substantial clinical benefits to dying patients and families but is underutilized by patients dying of hematologic malignancies (HM); nationwide, only 2% of HM patients use hospice. There are 70,000 deaths among U.S. patients with hematologic malignancies yearly.
  
  
  OBJECTIVE
  We measured the use and length of stay (LOS) in hospice among patients with HMs at a large academic cancer center.
  
  
  METHODS
  This was a single center retrospective review of adult patients (≥18 years) with lymphoma, leukemia, myelodysplastic syndrome, aplastic anemia, and multiple myeloma referred for hospice.
  
  
  METHODS
  Information included demographics, transplant, hospice type, LOS, and use of "expanded access" services.
  
  
  RESULTS
  Fifty-nine patients were referred to hospice, and 53 utilized hospice services, 25% of 209 HM decedents. Thirty-five received home hospice and 18 used inpatient hospice. The median home hospice LOS was nine days (SD 13) and inpatient hospice six days (SD 10). Nine patients with "expanded access" hospice received only a few blood transfusions, and none received radiation.
  
  
  CONCLUSIONS
  HM patients are referred late or never for hospice services. Studies evaluating earlier integration of palliative and hospice care with usual HM care are warranted. We present a one-page negotiation form that we have found useful in negotiations among HM physicians, hospice medical directors, and payers.
authors.affiliation: 1 Oncology Department, Johns Hopkins School of Medicine , Baltimore, Maryland.
authors.forename: Amy
authors.initials: A
authors.lastname: Sexauer
authors.forename: M Jennifer
authors.initials: MJ
authors.lastname: Cheng
authors.forename: Louise
authors.initials: L
authors.lastname: Knight
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Riley
authors.forename: Lauren
authors.initials: L
authors.lastname: King
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013727:Terminal Care; D014481:United States