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Comparative Study
. 2006 Aug;54(8):1206-11.
doi: 10.1111/j.1532-5415.2006.00833.x.

Patterns and predictors of home health and hospice use by older adults with cancer

Julie L Locher  1 , Meredith L Kilgore, Michael A Morrisey, Christine S Ritchie
Affiliations
Comparative Study

Patterns and predictors of home health and hospice use by older adults with cancer

Julie L Locher et al. J Am Geriatr Soc. 2006 Aug.

Abstract

Objectives: To describe patterns of home health and hospice use by older cancer patients and a comparison group of older persons without cancer. To identify predictors of home care and hospice utilization.

Design: Retrospective analysis using the Surveillance, Epidemiology and End Results (SEER)-Medicare Database, a linkage of the SEER Program of the National Cancer Institute (an epidemiological surveillance system of population-based tumor registries) and Medicare Claims.

Setting: The SEER data used in this paper cover a service area that includes approximately 14% of the U.S. population, including the states of Connecticut, Hawaii, Iowa, and New Mexico and the metropolitan areas of Detroit, San Francisco-Oakland, Atlanta, Seattle-Puget Sound, Los Angeles County, and San Jose-Monterey.

Participants: Five analytical samples were drawn. The first consisted of all cases with a diagnosis of cancer in 1997 to 1999 who were eligible for services in calendar year 1999 (n=120,072). The second and third were subsamples of these and consisted of cases with a new cancer diagnosis in 1999 (n=46,373) and cases who died in 1999 (n=41,483). The fourth consisted of a comparison sample without cancer (n=160,707). The fifth was a subsample of this and consisted of those who died in 1999 (n=6,639).

Measurements: Utilization rates of home health and hospice services.

Results: Twenty-nine percent of cancer patients used home health services, and 10.7% used hospice services, compared with 7.8% of noncancer patients who used home health and less than 1% who used hospice. Half (51.4%) of cancer patients who used home health did not have cancer listed as an admitting diagnosis for the use of those services. Home health utilization was lowest for unmarried men.

Conclusion: This is the first study to evaluate community-based home health and hospice utilization by older cancer patients. Future studies must begin to address what constitutes appropriate utilization.

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Figures

Figure 1
Figure 1
Home health and hospice utilization by cancer site (full sample).
Figure 2
Figure 2
Utilization within 6 months of cancer diagnosis.
Figure 3
Figure 3
Utilization within 6 months before death.
Figure 4
Figure 4
Expected utilization among all cancer patients 1999.
Figure 5
Figure 5
Expected utilization for cancer patients.
See this image and copyright information in PMC

References

    1. Federal Interagency Forum on Aging-Related Statistics. Older Americans 2000: Key Indicators of Well-Being. Washington, DC: U.S. Government Printing Office; 2000.
    1. U.S. Cancer Statistics, 1999 Incidence. National Cancer Institute Surveillance, Epidemiology, and End Results. [Accessed December 1, 2005]. Available at http://www.seer.cancer.gov.
    1. Anderson RN. Deaths: Leading causes for 2000. Natl Vital Stat Rep. 2002;50:1–85. - PubMed
    1. Edwards BK, Howe HL, Ries LAG, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden. Cancer. 2002;94:2766–2792. - PubMed
    1. Center for Medicare and Medicaid Services. Medicare and You. 2006. [Accessed December 1, 2005]. [on-line] Available at www.medicare.gov/publications/pubs/pdf/10050.pdf.

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