Heart failure patients significantly less likely than cancer patients to use hospice care

April 15, 2013 – Soko Setoguchi, MD, and Lesley Curtis, PhD, and others found several key differences for hospice care use between heart failure and cancer patients.

Advances in health care help many patients with heart failure and cancer live longer, but quality of life for both the patients and their caregivers can decline near the end of the patient’s life as symptoms and suffering increase. Studies have shown that hospice services can minimize the physical and psychological distress of terminal cancer patients and their families, but less is known about hospice use for end-of-life heart failure care. A new study sought to examine the differences in hospice use between cancer patients and heart failure patients.

The results of the study were published in the March issue of the Journal of Pain and Symptom Management. The DCRI’s Soko Setoguchi, MD, was the senior author, and Lesley Curtis, PhD, was an author.

For the study, the researchers linked Medicare data with data from the Pennsylvania cancer registry and the state’s Pharmaceutical Assistance Contract for the Elderly (PACE) program. PACE is the largest state prescription benefits program in the country for low- to middle-income elderly people. To be eligible for the study, patients must have used hospice care at least once after being hospitalized for heart failure or receiving a cancer diagnosis. Of the patients identified between 1997 and 2004, 20 percent of heart failure patients were admitted to hospice care, compared with 51 percent of cancer patients.

Heart failure patients admitted to hospice care were typically older than cancer patients and more likely to be female. Heart failure patients were frequently referred for hospice care from hospitals or nursing facilities, compared with cancer patients, who were more likely to be referred for hospice care from home. Overall, cancer patients were admitted to hospice care earlier than heart failure patients. Approximately 40 percent of heart failure patients were enrolled in hospice care a week or less before their death, whereas 24 percent of cancer patients were enrolled a week or less before their death.

The researchers suggest that it might be harder to recognize end-stage heart failure because the disease is more unpredictable than end-stage cancer, and there is the possibility that clinicians and patients dealing with heart failure are more reluctant to discuss end-of-life care. Studies have shown that hospice care and palliative care are accepted and common aspects of cancer care planning. The researchers suggest that future studies could provide better understanding of the low hospice use among heart failure patients. They also recommend development of educational programs to emphasize the benefits of hospice care for patients with heart failure who need end-of-life care.