Underuse of Hospice Care for Blood Cancers Linked to Inadequate Services

Hematologic oncologists are hesitant to refer patients to hospice care due to their views of inadequate services offered there, according to study results published in Cancer (published online May 22, 2017; doi:10.1002/cncr.30735).


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Hospice services are an essential aspect of end-of-life care for patients with various types of cancer, and have been shown to improve end-of-life care. Patients with hematologic malignancies, though, have the lowest rates of hospice use when compared with all oncology patients. Limited data exists regarding the cause for this low rate, including whether hematologic oncologists’ views about the utility of hospice care could explain the low rate of referrals.

Oreofe O Odejide, MD, instructor of medicine, Harvard Medical School (Cambridge, MA), and physician, Dana-Farber Cancer Institute (Boston, MA), and colleagues conducted a mailed survey for hematologic oncologists in the United States to evaluate this group’s perspectives on the utilty of hospice care. Researchers randomly selected 667 oncologists to survey, 349 of whom responded (response rate, 57.3%). Simultaneous provi-sion of care for patients with solid malignancies was permitted.

Researchers reported that the majority of respondents (68.1%) strongly agreed that hospice care is helpful for patients with hematologic cancers. They noted that oncologists with practices including higher numbers of solid tumor patients were more likely to strongly agree (odds ratio, 2.10; 95% CI, 1.26-3.52).

Despite the high levels of support for hospice care in general, 46.0% of respondents believed that home hospice is inadequate for their patients’ needs compared with inpatient hospice with round-the-clock care.

Additionally, while 61.7% of respondents reported that they would be more likely to refer patients to hospice care if red cell and platelet infusions were available, an even greater proportion of those who considered hospice care inadequate reported that they would refer more patients if red cell (67.3% vs 55.3%; P = .03) and platelet transfusions (52.9% vs 39.7%; P = .02) were available, and if they could continue to have regular clinic visits (36% vs 19%; P = .0005).

“These data suggest that although hematologic oncologists value hospice, concerns about the adequacy of services for blood cancer patients limit hospice referrals. To increase hospice enrollment for blood cancer patients, interventions tailoring hospice services to their specific needs are warranted,” authors of the study wrote.—Zachary Bessette