End-Of-Life Outcomes And Hospice And Palliative Care Utilization In Hospitalized Patients With Metastatic Breast Cancer

Background: Hospitalizations in patients with metastatic cancer occur commonly at the end of life but have not been well-described in those with metastatic breast cancer (MBC). The goal of this study was to describe the reasons for admission, end-of-life outcomes, and hospice and palliative care utilization in hospitalized patients with MBC. Methods: We identified all patients with MBC who had their first hospital admission (index admission) at Massachusetts General Hospital since their diagnosis of metastatic disease between 1/1/2009 and 12/31/2010 through a centralized clinical data registry. We collected demographic and clinical information and data on all hospital admissions and utilization of palliative care and hospice services during a three-year follow-up period. Results: We identified 123 patients hospitalized for the first time since their diagnosis of MBC. The median number of hospital admissions during the three-year follow-up period was 2 (range 1 to 17). Uncontrolled symptoms accounted for half (62/123, 50%) of the index admissions [20 (16%) with central nervous system systems, 17 (14%) with respiratory symptoms, 10 (8%) with pain, 9 (7%) with gastrointestinal symptoms, 4 (3%) with failure to thrive, and 2 (2%) with dehydration]. The majority of patients (93/123, 76%) died during the follow-up period. The median time from first hospitalization to death was 6 months (range 0 to 53). Among patients who died, 20/93 (22%) died in the hospital and 49/93 (53%) died within 14 days of hospital discharge. Among the deceased group, the inpatient palliative care team evaluated 53/93 (57%) of patients at least once during an admission, but only 18/93 (19%) patients attended an outpatient palliative care clinic appointment. A minority of patients who died (27/93, 29%) were referred to hospice upon discharge. An additional 34/93 (37%) patients who died were referred to hospice from the outpatient setting. Conclusions: Hospitalized patients with MBC are commonly admitted for uncontrolled symptoms. They have a poor prognosis, and approximately half die within two weeks of a hospital admission. However, only a minority receive outpatient palliative care or are referred to hospice services from the inpatient setting. These findings highlight the need to develop interventions to improve end-of-life care for patients with MBC who are hospitalized. Citation Format: Amanda Parkes, Jennifer A Shin, Helen Knight, Areej El-Jawahri, Lara Traeger, Jennifer S Temel. End-of-life outcomes and hospice and palliative care utilization in hospitalized patients with metastatic breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-16-01.