THE PROVISION OF PALLIATIVE CHEMOTHERAPY IN HOSPICE: A NATIONAL COHORT STUDY OF HOSPICES AND HOSPICE PATIENTS

2.50
Hdl Handle:
http://hdl.handle.net/10755/165061
Category:
Abstract
Type:
Presentation
Title:
THE PROVISION OF PALLIATIVE CHEMOTHERAPY IN HOSPICE: A NATIONAL COHORT STUDY OF HOSPICES AND HOSPICE PATIENTS
Author(s):
Maxwell, Terri L.; Bain, Kevin T.; Sochalski, Julie A.
Author Details:
Terri L. Maxwell, PhD APRN BC-PCM, Vice President of Research, ExcelleRx Inc., Philadelphia, Pennsylvania, USA, email: tmaxwell@excelleRx.com; Kevin T. Bain, PharmD, BCPS, CBP, FASCP; Julie A. Sochalski, PhD, RN, FAAN, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
Abstract:
The design of the Hospice Benefit in 1982 reflected the reality of cancer treatment at that time; treatments were usually very toxic and few palliative therapies were available. Recently, a broad range of palliative chemotherapy agents have become available, challenging hospice requirements related to discontinuation of therapies prior to enrollment. Some hospices are now admitting patients receiving chemotherapy to improve access and increase hospice length of stay (LOS) for these patients. Purpose: To identify hospice organizational factors associated with the provision of oral palliative chemotherapy, to characterize patients who received oral chemotherapy in hospice, and to examine differences in hospice LOS among patients that did and did not receive these therapies. This study provides insights into ONS research priorities such as decision-making in advanced disease, palliative, and hospice care. Exploratory, descriptive correlational design using secondary analysis of data from a national pharmacy provider of patients admitted to hospice with a diagnosis of brain, breast or lung cancers between 1/01/03 and discharged or expired as of 6/30/05. Sample was comprised of 58,154 patients enrolled in 544 hospices. 43.6% of hospices provided chemotherapy to 1,140 patients. Hospice size, profit status and geographical region were statistically associated with providing chemotherapy, but after including these factors in a logistic regression model only hospice size and profit status were significant, with large-sized and not-for profit hospices most likely to provide chemotherapy. Non-profit hospices were 5 times more likely to provide chemotherapy, independent of hospice size. Chemotherapy patients were 4 years younger compared to non- chemotherapy patients. Receiving chemotherapy was not associated with gender, race, diagnosis, or discharge status. Chemotherapy patients were in hospice approximately 2 weeks longer compared to non-chemotherapy patients (p <.001) and had on average, a 9-day increase in median length of stay, with both breast and brain cancer patients increasing their median length of stay by 2 weeks. A change in MedicareÆs payment system that explicitly recognizes palliative chemotherapy may increase access to hospice services. However, the removal of financial barriers may increase access at the organizational level, but the demand from patients may be lacking. Future research should focus on outcomes of providing chemotherapy in hospice.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2007
Conference Name:
32nd Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
Las Vegas, Nevada, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleTHE PROVISION OF PALLIATIVE CHEMOTHERAPY IN HOSPICE: A NATIONAL COHORT STUDY OF HOSPICES AND HOSPICE PATIENTSen_GB
dc.contributor.authorMaxwell, Terri L.en_US
dc.contributor.authorBain, Kevin T.en_US
dc.contributor.authorSochalski, Julie A.en_US
dc.author.detailsTerri L. Maxwell, PhD APRN BC-PCM, Vice President of Research, ExcelleRx Inc., Philadelphia, Pennsylvania, USA, email: tmaxwell@excelleRx.com; Kevin T. Bain, PharmD, BCPS, CBP, FASCP; Julie A. Sochalski, PhD, RN, FAAN, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvaniaen_US
dc.identifier.urihttp://hdl.handle.net/10755/165061-
dc.description.abstractThe design of the Hospice Benefit in 1982 reflected the reality of cancer treatment at that time; treatments were usually very toxic and few palliative therapies were available. Recently, a broad range of palliative chemotherapy agents have become available, challenging hospice requirements related to discontinuation of therapies prior to enrollment. Some hospices are now admitting patients receiving chemotherapy to improve access and increase hospice length of stay (LOS) for these patients. Purpose: To identify hospice organizational factors associated with the provision of oral palliative chemotherapy, to characterize patients who received oral chemotherapy in hospice, and to examine differences in hospice LOS among patients that did and did not receive these therapies. This study provides insights into ONS research priorities such as decision-making in advanced disease, palliative, and hospice care. Exploratory, descriptive correlational design using secondary analysis of data from a national pharmacy provider of patients admitted to hospice with a diagnosis of brain, breast or lung cancers between 1/01/03 and discharged or expired as of 6/30/05. Sample was comprised of 58,154 patients enrolled in 544 hospices. 43.6% of hospices provided chemotherapy to 1,140 patients. Hospice size, profit status and geographical region were statistically associated with providing chemotherapy, but after including these factors in a logistic regression model only hospice size and profit status were significant, with large-sized and not-for profit hospices most likely to provide chemotherapy. Non-profit hospices were 5 times more likely to provide chemotherapy, independent of hospice size. Chemotherapy patients were 4 years younger compared to non- chemotherapy patients. Receiving chemotherapy was not associated with gender, race, diagnosis, or discharge status. Chemotherapy patients were in hospice approximately 2 weeks longer compared to non-chemotherapy patients (p &lt;.001) and had on average, a 9-day increase in median length of stay, with both breast and brain cancer patients increasing their median length of stay by 2 weeks. A change in Medicare&AElig;s payment system that explicitly recognizes palliative chemotherapy may increase access to hospice services. However, the removal of financial barriers may increase access at the organizational level, but the demand from patients may be lacking. Future research should focus on outcomes of providing chemotherapy in hospice.en_GB
dc.date.available2011-10-27T12:11:50Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:11:50Z-
dc.conference.date2007en_US
dc.conference.name32nd Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationLas Vegas, Nevada, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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