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Costs spike when terminally ill leave hospice-study

* After leaving hospice, many patients wind up in ERs

* Total end-of-life costs spike in patients leave hospice

* Other studies show dying in hospital, ICUs traumatizing

BOSTON, Sept 28 (Reuters) - The cost of care for terminally ill cancer patients who stopped hospice care was nearly five times higher than for patients who stayed with it, according to a study.

Researchers at the Yale School of Public Health in New Haven, Connecticut, and Mount Sinai School of Medicine in New York found that patients who stopped hospice care were far more likely to end up needing emergency department care, stays in intensive care units (ICUs) and hospitalization.

The study will be published in the Oct. 1 issue of the Journal of Clinical Oncology.

“This is particularly important given the latest evidence that patients who die in ICUs and hospitals experience far more physical and emotional distress than patients who die at home with hospice,” said Elizabeth Bradley, professor of public health at Yale.

“For decades, we have seen better outcomes for patients and families who use hospice, but here we also find clear evidence that leaving hospice is also costly financially.”

The research team evaluated data from more than 90,000 patients with cancer who were served by 1,384 hospices between 1998 and 2002.

Some 34 percent of the patients who opted out of hospice wound up being admitted to an emergency department, compared to only 3.1 percent of those who remained in hospice care until death.

Additionally, 40 percent of former hospice patients were admitted to the hospital as inpatients, but only 1.6 percent of enrolled hospice patients were.

Former hospice patients spent an average of 19.3 days in the hospital, whereas patients who continued with hospice spent an average of 6.7 days.

Patients who stayed with hospice incurred an average $6,537 in expenses from the time of hospice enrollment to death, while those who stopped hospice care incurred an average $30,848 in expenses.

The Medicare expenditures that the researchers evaluated included hospice care, hospitalizations, physician visits, outpatient care, medical equipment and supplies and home health care services.

A recent study by the Dana-Farber Cancer Institute found that patients with cancer who died in ICUs or hospitals experienced more physical and emotional distress at the end of life. Their caregivers also suffered more emotional trauma from the experience. (Reporting by Ros Krasny; Editing by Jonathan Oatis and Vicki Allen)

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