• Alexie Cintron, Mary B Hamel, Roger B Davis, Risa B Burns, Russell S Phillips, and Ellen P McCarthy.
• Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. acintron@caregroup.harvard.edu
• J Palliat Med. 2003 Oct 1;6(5):757-68.

ObjectivesTo identify factors associated with hospitalization of elderly hospice patients with cancer and to describe their hospital experiences.DesignRetrospective analysis of the last year of life.SettingSurveillance, Epidemiology, and End Results (SEER)-Medicare linked database.ParticipantsMedicare beneficiaries dying of lung or colorectal cancer between 1988 and 1998 who enrolled in hospice.MeasurementsHospitalization after hospice entry. For hospitalized patients, we describe admission diagnoses, aggressiveness of care, and in-hospital death.ResultsOf the 23608 patients, 1423 (6.0%) were hospitalized after hospice enrollment. Hospitalization declined over time by 7.0% per year of hospice enrollment. Factors associated with higher hospitalization rates were younger age, male gender, black race/ethnicity, local cancer stage at diagnosis, and hospice enrollment within 4 months of cancer diagnosis. The most common reasons for hospital admission were lung cancer, metastatic disease, bone fracture, pneumonia, and volume depletion. Of the 1423 patients hospitalized, 34.6% received aggressive care and 35.8% died in the hospital.ConclusionThe rates of hospitalization for elderly hospice patients with lung or colorectal cancer appear to be declining. However, patients who are hospitalized undergo aggressive care and often die in the hospital rather than at home. This aggressive care may be consistent with changes in patients' care preferences, but could also reflect the current culture of acute care hospitals, which focuses on curative treatment and is ill-equipped to provide palliative care.

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