Characteristics Associated with In-Hospital Death among Commercially Insured Decedents with Cancer.
A majority of patients with poor-prognosis cancer express a preference for in-home death; however, in-hospital deaths are common.



We sought to identify characteristics associated with in-hospital death.



Case series.



Commercially insured patients with cancer who died between July 2010 and December 2013 and who had at least two outpatient visits at a tertiary cancer center during the last six months of life.



Patient characteristics, healthcare utilization, and in-hospital death (primary outcome) were ascertained from institutional records and healthcare claims. Bivariate and multivariable analyses were used to evaluate the association of in-hospital death with patient characteristics and end-of-life outcome measures.



We identified 904 decedents, with a median age of 59 years at death. In-hospital death was observed in 254 patients (28%), including 110 (12%) who died in an intensive care unit. Hematologic malignancy was associated with a 2.57 times increased risk of in-hospital death (95% confidence interval [CI] 1.91-3.45, p < 0.001), and nonenrollment in hospice was associated with a 14.5 times increased risk of in-hospital death (95% CI 9.81-21.4, p < 0.001). Time from cancer diagnosis to death was also associated with in-hospital death (p = 0.003), with the greatest risk among patients dying within six months of cancer diagnosis. All significant associations persisted in multivariable analyses that were adjusted for baseline characteristics.



In-hospital deaths are common among commercially insured cancer patients. Patients with hematologic malignancy and patients who die without receiving hospice services have a substantially higher incidence of in-hospital death.
1 Dartmouth-Hitchcock Medical Center, Lebanon , New Hampshire.
Gabriel A
GA
Brooks
2 Dana-Farber Cancer Institute , Boston, Massachusetts.
Sherri O
SO
Stuver
2 Dana-Farber Cancer Institute , Boston, Massachusetts.
Yichen
Y
Zhang
2 Dana-Farber Cancer Institute , Boston, Massachusetts.
Stephanie
S
Gottsch
2 Dana-Farber Cancer Institute , Boston, Massachusetts.
Belen
B
Fraile
2 Dana-Farber Cancer Institute , Boston, Massachusetts.
Kristen
K
McNiff
3 Blue Cross/Blue Shield of Massachusetts , Boston, Massachusetts.
Anton
A
Dodek
2 Dana-Farber Cancer Institute , Boston, Massachusetts.
Joseph O
JO
Jacobson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054598:Blue Cross Blue Shield Insurance Plans / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D014481:United States; D055815:Young Adult