title: Retrospective evaluation of palliative care and hospice utilization in hospitalized patients with metastatic breast cancer.
abstract: Hospitalizations in patients with metastatic cancer occur commonly at the end of life but have not been well-described in individuals with metastatic breast cancer.
  
  
  
  To describe the reasons for admission and frequency of palliative care and hospice utilization in hospitalized patients with metastatic breast cancer.
  
  
  
  This was a retrospective chart review of patients who had their first hospitalization with a diagnosis of metastatic breast cancer between 1 January 2009 and 31 December 2010. To standardize follow-up time, we collected data for 3 years post the index hospitalization.
  
  
  
  We identified 123 consecutive patients who were hospitalized for the first time with a diagnosis of metastatic breast cancer at a single, tertiary care center.
  
  
  
  Uncontrolled symptoms accounted for half (50%, 62/123) of index admissions. The majority of patients died during the follow-up period (76%, 94/123), and the median time from index admission to death was 6 months (range: 0-34 months). Approximately half (53%, 50/94) died in the hospital or within 14 days of last hospital discharge, and less than one-third (29%, 27/94) were referred to hospice after their last hospitalization. The inpatient palliative care team evaluated 57% (54/94) of those who died at least once during an admission, but only 17% (16/94) of patients attended an outpatient palliative care appointment.
  
  
  
  Hospitalized patients with metastatic breast cancer are commonly admitted for uncontrolled symptoms and have a poor prognosis. However, only a minority receive outpatient palliative care or are referred to hospice during their last hospitalization prior to death.
authors.affiliation: Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA jashin@partners.org.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Shin
authors.affiliation: MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Parkes
authors.affiliation: Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Areej
authors.initials: A
authors.lastname: El-Jawahri
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Lara
authors.initials: L
authors.lastname: Traeger
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Knight
authors.affiliation: Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Gallagher
authors.affiliation: Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
mesh_terms: D001943:Breast Neoplasms; D005260:Female; D017051:Hospice Care; D006738:Hospices; D006760:Hospitalization; D006801:Humans; D010166:Palliative Care; D012189:Retrospective Studies; D013727:Terminal Care
keywords: Breast neoplasms; hospices; hospitalization; neoplasm metastasis; palliative care