Background

Brain metastases are associated with considerable morbidity and mortality. Integration of hospice at the end of life offers patients symptom relief and improves quality of life, particularly for elderly patients who are less able to tolerate brain-directed therapy. Population-level investigations of hospice utilization among elderly patients with brain metastases are limited.

Methods

Using the Surveillance, Epidemiology and End Results (SEER)-Medicare database for primary cancer sites that commonly metastasize to the brain, we identified 50,148 patients (age ≥66 years) diagnosed with brain metastases between 2005-2016. We calculated the incidence, timing, and predictors of hospice enrollment using descriptive techniques and multivariable logistic regression. All statistical tests were two-sided.

Results

The incidence of hospice enrollment was 71.4% (95%CI 71.0-71.9, p < 0.001), a rate which increased over the study period (p < 0.001). The odds of enrollment for black (OR 0.76, 95%CI 0.71-0.82, p < 0.001), Hispanic (OR 0.80, 95%CI 0.72-0.87, p < 0.001) and Asian patients (OR 0.52, 95%CI 0.48-0.57, p < 0.001) were substantially lower than white patients; males were less likely to be enrolled in hospice than females (OR 0.78, 95%CI 0.74-0.81, p < 0.001). Among patients enrolled in hospice, 32.6% (95%CI 32.1-33.1, p < 0.001) were enrolled less than7 days prior to death, a rate which was stable over the study period.

Conclusion

Hospice is utilized for a majority of elderly patients with brain metastases although a considerable percentage of patients die without hospice services. Many patients enroll in hospice late and concerningly, statistically significant sociodemographic disparities exist in hospice utilization. Further investigations to facilitate targeted interventions addressing such disparities are warranted.

中文翻译：

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老年脑转移患者的临终关怀利用

背景

脑转移与高发病率和高死亡率有关。临终关怀医院的住院治疗可以减轻患者的症状并改善生活质量，特别是对于那些不能耐受脑指导治疗的老年患者。老年脑转移患者的临终关怀利用的人群水平调查是有限的。

方法

使用监测，流行病学和最终结果（SEER）-Medicare数据库获取通常转移到大脑的原发癌部位，我们确定了2005-2016年之间50148名被诊断为脑转移的患者（年龄≥66岁）。我们使用描述性技术和多变量logistic回归计算了临终关怀的发生率，时间和预测因素。所有统计检验都是双面的。

结果

临终关怀的入学率为71.4％（95％CI 71.0-71.9，p <0.001），在整个研究期间有所增加（p <0.001）。黑人（OR 0.76，95％CI 0.71-0.82，p <0.001），西班牙裔（OR 0.80，95％CI 0.72-0.87，p <0.001）和亚洲患者（OR 0.52，95％CI 0.48- 0.57，p <0.001）显着低于白人患者; 男性比女性少接受临终关怀的可能性（OR 0.78，95％CI 0.74-0.81，p <0.001）。在临终关怀的患者中，有32.6％（95％CI 32.1-33.1，p <0.001）在死亡前不到7天就被纳入，这一比率在研究期间保持稳定。

结论

临终关怀用于大多数脑转移的老年患者，尽管相当一部分患者在没有临终关怀服务的情况下死亡。许多患者较晚才加入临终关怀，因此，临终关怀利用方面存在统计学上显着的社会人口统计学差异。必须进行进一步调查以促进针对此类差异的针对性干预。