Impact of Palliative Chemotherapy and Travel Distance on Hospice Referral in Patients With Stage IV Pancreatic Cancer: A Retrospective Analysis Within a Veterans Administration Medical Center.

Background: Metastatic pancreatic ductal adenocarcinoma (mPDAC) has a poor prognosis despite chemotherapy advancements. Although hospice utilization has increased, timing of referral is not always optimal. Aim: To investigate whether palliative chemotherapy and travel distance to the treatment center impact hospice referral patterns in veterans of the US military in order to identify potential areas for improving referral timing. Design: Demographic and clinical data were collected retrospectively according to the timing of hospice referral. Settings/Participants: Patients with mPDAC within a Veterans Administration Medical Center from 2005 to 2014. Results: Of 58 patients identified, 52 were referred to hospice. The median time from diagnosis to referral and referral to death was 2.4 and 3.1 weeks, respectively. Palliative chemotherapy was administered to 22 (42.3%) patients, with 30 (57.7%) patients not treated due to poor functional status (n = 16, 53.3%) or patient refusal (n = 14, 46.7%). Subset analysis for those travelling >60 miles versus <60 miles to the treatment center showed the median time to hospice referral was 1.7 versus 4.7 weeks. With no significant differences between groups, univariate analysis demonstrated that those referred to hospice >2.4 weeks from diagnosis more often received chemotherapy (P < .001) and lived <60 miles from the treatment center (P = .05). Conclusion: Receipt of palliative chemotherapy and proximity to the treatment center appear to delay referral to hospice in patients with mPDAC. Increasing physician awareness of such factors that may impact the decision to involve hospice is necessary for delivering optimal oncology care.