Abstract
Background/Aims Colorectal cancer is the third most common cancer diagnosis in the US, with a lifetime risk of 5.1%. It is the second leading cause of cancer death, and is predicted to cause approximately 50,000 deaths in 2011. With a five year survival rate of less than 25%, the majority of patients diagnosed with metastatic colorectal cancer face decisions about end of life care. This study seeks to understand what influences hospice utilization among metastatic colorectal cancer patients who are part of the Comparative Effectiveness in Genomics and Personalized Medicine for Colon Cancer (CERGEN) population.
Methods Electronic medical record (EMR) data was collected, through database queries and manual chart review, for 1220 subjects diagnosed with stage III or stage IV colorectal cancer progressing to metastatic disease between 2006 and 2009, at seven Managed Care Organizations (MCOs) from the Cancer Research Network (CRN). Hospice use is defined as a binary outcome indicating whether there was at least one hospice referral or admission recorded in the subject’s EMR. Descriptive statistics (mean, median, variance) and logistic modeling were used to summarize the demographic, health status, and system factors that influenced hospice use.
Results Overall, 59% of subjects utilized hospice services. Patients utilizing hospice care were significantly older (69 vs. 63, p < 0.0001), with a lower average family income (63% for family income <$60,000 vs. 56% for family income = $60,000, p = 0.01), and with longer follow up time after colorectal cancer diagnosis (follow up interval of 639 days vs. 499 days, p = 0.01) than those not utilizing hospice care. We also saw significant variation by site across the seven MCOs studied (p = 0.01, range = 47% to 65%). Race, ethnicity, gender, stage at diagnosis, year of diagnosis, Medicare status, alcohol and/or tobacco use, use of chemotherapy and use of KRAS testing were not significantly associated with hospice utilization.
Discussion Health status, demographic and system characteristics all influence the use of hospice services by metastatic colorectal cancer subjects in the CERGEN population.
