Length of Survival of Patients with Cancer in Hospice: A Retrospective Analysis of Patients Treated at a Major Cancer Center Versus Other Practice Settings

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Abstract
This is a retrospective study of the length of survival (LOS) in hospice of patients with cancer treated at a major cancer center compared to other treatment sites. Of 670 patients, the 185 (28%) treated at a major cancer center had unique characteristics, including higher median Palliative Performance Score (PPS) at the time of hospice enrollment (45 versus 40, p = 0.009), and longer median LOS in hospice (35 versus 21 days, p = 0.02: log rank test). Additional variables that predicted longer LOS were higher PPS, Medicare or Medicaid, self-referral, unmarried status, and non-executed advance directives. After adjusting survival for PPS with a Cox proportional hazard model, the hazard ratio for PPS remained statistically significant (95% confidence interval [CI]: 0.95–0.97] while that for the treatment site was not (95% CI: 0.73–1.04]. The performance status, and not the treatment site, was the dominant predictor of the LOS of patients with cancer in hospice.