Hospice and Emergency Room Use by Disadvantaged Men Dying
of Prostate Cancer
Jonathan Bergman,* Lorna Kwan, Arlene Fink, Sarah E. Connor and Mark S. Litwin
From the Departments of Urology (JB, SEC, MSL), Medicine (AF) and Health Services (AF, MSL), and Jonsson Comprehensive Cancer
Center (LK, MSL), University of California-Los Angeles, Los Angeles, California
Abbreviations
and Acronyms
IMPACT Improving Access,
Counseling and Treatment for
Californians with Prostate Cancer
PSA prostate specific antigen
Submitted for publication September 10,
2008.
Study received approval from the UCLA Office
for Protection of Research Subjects.
The analyses, interpretations and conclusions
in this manuscript are those of the authors and
not the State of California.
* Correspondence: Department of Urology,
University of California-Los Angeles, Box 951738,
Los Angeles, California 90095-1738 (telephone:
310-206-0473 and 310-251-4804; FAX: 310-206-
5343; e-mail: jbergman@mednet.ucla.edu).
Purpose: Hospice care has been found to improve symptom management, quality
of death and quality of life at the end of life. We describe hospice use by a cohort
of low income, uninsured men with prostate cancer enrolled in a public assistance
program. We ascertained whether hospice enrollment was associated with a
decrease in the number of prostate cancer related emergency room visits made
before death.
Materials and Methods: We studied all 57 low income, uninsured men in a
public assistance program who had died since its inception in 2001. The associ-
ation between sociodemographic and clinical data, and hospice enrollment data
were evaluated.
Results: The overall rate of hospice use was 28% (16 of 57 patients). The mean
SD duration of hospice enrollment before death was 44 43 days (median 34,
range 2 to 143). Two patients (12%) were enrolled fewer than 7 days and none
were enrolled more than 180 days. Prostate cancer related emergency room
visits, adjuvant chemotherapy treatment, evidence of metastasis at initial pre-
sentation and death from prostate cancer were significantly associated with
hospice use (p 0.05). We noted a trend toward fewer mean emergency room
visits made by men enrolled in hospice care than by those not enrolled (0.7 1.3
vs 1.1 0.9, p 0.15).
Conclusions: Hospice use and the duration of enrollment by low income, uninsured
men dying of prostate cancer was comparable to previously reported hospice use by
insured individuals. Hospice enrollment was associated with fewer prostate cancer
related emergency room visits.
Key Words: prostate, prostatic neoplasms, emergency treatment,
hospice care, terminal care
APPROXIMATELY 30,000 men die of pros-
tate cancer in the United States each
year.
1
For those enrolling in hospice
specific attention is given to palliation,
patient autonomy and decision making.
Hospice care has been found to improve
symptom management, quality of
death and quality of life at the end of
life.
2
Reported rates of the use of hos-
pice resources by men dying of prostate
cancer vary widely from 18% to 43%. In
the United States the term hospice ser-
vices encompasses inpatient and outpa-
tient care with approximately 90% of
hospice services delivered on an outpa-
tient basis.
2,3
Hospice enrollment also
appears to lower the cost of caring for
men dying of cancer, although the pre-
cise treatments, hospital admissions
and emergency room visits that lead to
the higher cost of caring for those not
enrolled in hospice have yet to be delin-
eated.
2–6
However, these data are
gleaned from retrospective cohort anal-
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THE JOURNAL OF UROLOGY
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Copyright © 2009 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/j.juro.2009.01.030