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The Prevalence and Impact of Invasive Procedures in Women with Gynecologic Malignancies Referred to Hospice Care

Jessica E. Stine, Kemi M. Doll, Dominic T. Moore, Linda Van Le, Emily Ko, John T. Soper, Daniel Clarke-Pearson, Victoria Bae- Jump Paola A. Gehrig and Kenneth H. Kim

Objective: To determine the prevalence of inpatient invasive procedures performed in patients who had been referred to hospice and to evaluate the impact of the procedures on end of life (EOL) treatments and outcomes.

Study design: A retrospective analysis of gynecologic oncology patients who were discharged from the hospital to hospice care from January 2009 – June 2012, comparing those who had invasive procedures (PRO) to those who did not (NOPRO), was conducted. Clinical data included disease site and stage, course of admission, type of hospice chosen, administration of palliative chemotherapy or radiation, hospital readmissions and number and type of invasive procedures performed. Overall survival was defined as the time from the date of hospice referral to death from any cause.

Results: Eighty-eight patients were identified and the majority (46%) had ovarian cancer.Sixty-five percent (57/88) of patients had invasive procedures (PRO) in the 4 weeks prior to hospice enrollment. There was no difference in PRO vs. NOPRO groups with respect to palliative chemotherapy (91.3% vs. 83%, p=0.48) or radiation treatments (8.7% vs. 16.1%, p=0.31), the proportion of patients choosing inpatient hospice care (21% vs. 22.5%, p=0.87) or hospital readmissions (10.5% vs 9.3%, p = 1.00). Overall survival was not significantly different between the groups (56d vs 54d, p=0.71).

Conclusions: The relationship between PRO and NOPRO during EOL care did not adversely affect palliative treatment delivery, hospital re-admission rate, home vs. inpatient hospice decision or overall survival. Caution should be exercised when determining the need for invasive procedures in the palliative setting.