Hospice Utilization in Elderly Patients With Brain Metastases

Area of Science:

• Oncology
• Palliative Care
• Health Services Research

Background:

• Brain metastases significantly impact patient morbidity and mortality.
• Hospice integration improves quality of life and symptom management for elderly patients, especially those unable to tolerate brain-directed therapies.
• Limited population-level data exist on hospice utilization among elderly patients with brain metastases.

Purpose of the Study:

• To investigate the incidence, timing, and predictors of hospice enrollment among elderly patients diagnosed with brain metastases.
• To identify sociodemographic disparities in hospice utilization for this population.

Main Methods:

• Utilized the Surveillance, Epidemiology and End Results-Medicare database.
• Identified 50,148 patients aged 66 years and older with brain metastases (2005-2016).
• Employed descriptive statistics and multivariable logistic regression to analyze hospice enrollment patterns.

Main Results:

• Hospice enrollment occurred in 71.4% of patients and increased over the study period.
• Black, Hispanic, and Asian patients, as well as men, had significantly lower odds of hospice enrollment compared to white patients and women, respectively.
• Over 32% of hospice enrollees were admitted less than 7 days before death, a rate consistent throughout the study.

Conclusions:

• While hospice is widely used, a substantial proportion of elderly patients with brain metastases do not receive hospice services.
• Significant sociodemographic disparities in hospice utilization were identified, highlighting inequities in end-of-life care.
• Targeted interventions are necessary to address these disparities and improve equitable access to hospice care for all patients with brain metastases.