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Hospice care provides patients with terminal illness with care that lessens the burden of illness and improves quality of life. Approximately 1.5 million Medicare recipients receive hospice care each year. Numbers have steadily increased over the last several years. Of these cases, about 98% involve routine home care services.

There is concern as to why so many patients are receiving hospice care late in the course of illness. Around 54% of Medicare recipients who utilize hospice services do so for fewer than 30 days before their death. Moreover, around 28% receive hospice services for fewer than 7 days before their death [1].

Researchers from Baylor College of Medicine sought to determine how patient race related to hospice care length of stay for patients with non-small cell lung cancer (NSCLC). Medicare data were used that included 53,626 deceased patients with NSCLC who were 66 years old or older.

Ultimately, it was found that the majority of patients, 64.1%, spent fewer than 30 days in hospice care. Of these, 30.2% spent fewer than 7 days. The length of stay in hospice care revealed a 38% increased incidence rate ratio for Black patients and an almost three-fold increased incidence rate ratio for Hispanic patients compared to white patients with stage I and stage II NSCLC. For stage III and stage IV NSCLC, Black patients had a slight decrease in utilization of hospice services.

The researchers concluded that Black and Hispanic patients had a greater length of stay in hospice care in early disease stages of NSCLC, indicating that racial disparities in this area of hospice care have improved. However, a disparity still remains in utilization of hospice care in later disease stages of NSCLC among Blacks. A call to action is made for oncologists to continue engaging and educating minority groups with NSCLC, especially Black patients, on hospice care to further improve hospice care disparities [2].

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[1] National Hospice and Palliative Care Organization. (2020, August). NHPCO Facts and Figures. https://www.nhpco.org/hospice-facts-figures/#:~:text=Representative%20data%20shared%20in%20the,at%20the%20time%20of%20death.&text=Routine%20Home%20Care%20accounted%20for%2098.2%20percent%20of%20care%20provided

 

[2] Hardy, D., Chan, W., Liu, C. C., Cormier, J. N., Xia, R., Bruera, E., & Du, X. L. (2011). Racial disparities in length of stay in hospice care by tumor stage in a large elderly cohort with non-small cell lung cancer. Palliative Medicine, 26(1), 61–71. https://doi.org/10.1177/0269216311407693

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