title: End-of-life care for older patients with ovarian cancer is intensive despite high rates of hospice use.
abstract: OBJECTIVE
  To date, few studies have examined end-of-life care for patients with ovarian cancer. One study documented increased hospice use among older patients with ovarian cancer from 2000 to 2005. We sought to determine whether increased hospice use was associated with less-intensive end-of-life medical care.
  
  
  METHODS
  We identified 6,956 individuals age ≥ 66 years living in SEER areas who were enrolled in fee-for-service Medicare, diagnosed with epithelial ovarian cancer between 1997 and 2007, and died as a result of ovarian cancer by December 2007. We examined changes in medical care during patients' last month of life over time.
  
  
  RESULTS
  Between 1997 and 2007, hospice use increased significantly, and terminal hospitalizations decreased (both P < .001). However, during this time, we also observed statistically significant increases in intensive care unit admissions, hospitalizations, repeated emergency department visits, and health care transitions (all P ≤ .01). In addition, the proportion of patients referred to hospice from inpatient settings rose over time (P = .001). Inpatients referred to hospice were more likely to enroll in hospice within 3 days of death than outpatients (adjusted odds ratio, 1.36; 95% CI, 1.12 to 1.66).
  
  
  CONCLUSIONS
  Older women with ovarian cancer were more likely to receive hospice services near death and less likely to die in a hospital in 2007 compared with earlier years. Despite this, use of hospital-based services increased over time, and patients underwent more transitions among health care settings near death, suggesting that the increasing use of hospice did not offset intensive end-of-life care.
authors.affiliation: Alexi A. Wright, Dana-Farber Cancer Institute; Alexi A. Wright, Laura A. Hatfield, and Nancy L. Keating, Harvard Medical School; Nancy L. Keating, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Cancer Care Ontario and Ontario Institute for Cancer Research, Toronto, Ontario, Canada. alexi_wright@dfci.harvard.edu.
authors.forename: Alexi A
authors.initials: AA
authors.lastname: Wright
authors.affiliation: Alexi A. Wright, Dana-Farber Cancer Institute; Alexi A. Wright, Laura A. Hatfield, and Nancy L. Keating, Harvard Medical School; Nancy L. Keating, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Cancer Care Ontario and Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Hatfield
authors.affiliation: Alexi A. Wright, Dana-Farber Cancer Institute; Alexi A. Wright, Laura A. Hatfield, and Nancy L. Keating, Harvard Medical School; Nancy L. Keating, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Cancer Care Ontario and Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.affiliation: Alexi A. Wright, Dana-Farber Cancer Institute; Alexi A. Wright, Laura A. Hatfield, and Nancy L. Keating, Harvard Medical School; Nancy L. Keating, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Cancer Care Ontario and Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006738:Hospices / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D006278:Medicare; D010051:Ovarian Neoplasms / Q000401:mortality*; D018426:SEER Program; D013727:Terminal Care; D014481:United States / Q000453:epidemiology