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Patients With Cancer Referred to Hospice Versus a Bridge Program: Patient Characteristics, Needs for Care, and Survival

From the Philadelphia Veterans Affairs Medical Center, The University of Pennsylvania Department of Medicine Division of Geriatrics and Division of Hematology Oncology, and the Institute on Aging and the Center for Bioethics, Philadelphia, PA.

Supported by a Career Development Award from the Department of Veterans Affairs (D.C.).Address reprint requests to David Casarett, MD, MA, Institute on Aging, Center for Bioethics, University of Pennsylvania, 3615 Chestnut St, Philadelphia, PA 19104; email: casarett{at}mail.med.upenn.edu

PURPOSE: The purpose of this study was to compare the characteristics and needs of patients with advanced cancer who were referred to hospice with those referred to a prehospice "bridge" program that is staffed by hospice nurses.

PATIENTS AND METHODS: Data were gathered through retrospective review of computerized clinical records using precoded data fields of 284 patients with cancer enrolled in a bridge program and 1,000 who enrolled in a hospice program. Patient characteristics, needs for supportive care at the time of enrollment, and survival were assessed.

RESULTS: Bridge patients were less likely to have Medicare or Medicaid (43% v 72%; odds ratio, 0.30; P < .001) and were younger (69 v 73 years, rank sum test; P < .001), more likely to be married (59% v 43%; odds ratio, 1.90; P < .001), and more likely to be in the highest income category (14% v 10%; odds ratio, 1.77; P = .009). Bridge patients had at least as many needs for care as did patients in hospice. Bridge patients lived significantly longer (median, 46 v 19 days; log-rank test of survivor functions, P < .001).

CONCLUSION: Patients referred to this bridge program had prognoses that are significantly better than those of patients who enter hospice, but they have needs for supportive care that are at least as great. These findings underscore the importance of initiatives to extend some of the benefits of hospice care to a wider population of patients and should encourage the analysis of similar programs’ ability to meet these needs.

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