• Rebecca N Hutchinson, F Lee Lucas, Mary Becker, Heidi R Wierman, and Kathleen M Fairfield.
• Division of Palliative Medicine, Maine Medical Center, Portland, Maine, USA; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine, USA. Electronic address: rhutchinso@mmc.org.
• J Pain Symptom Manage. 2018 Apr 1; 55 (4): 1165-1172.e5.

ContextTimely hospice referral is an indicator of high-quality end-of-life care for cancer patients. Variations in patient characteristics associated with hospice utilization and length of stay have been demonstrated in studies of other malignancies but not melanoma.ObjectivesWe sought to understand hospice utilization and patient characteristics associated with variability in use for the older melanoma population.MethodsWe used the Surveillance, Epidemiology, and End Results-Medicare database to identify 13,393 melanoma patients aged 65+ years at time of diagnosis between 2000 and 2009, who died by 12/31/10. The primary outcome was enrollment in hospice with secondary outcome of hospice duration. Patient characteristics associated with variations in hospice enrollment were examined.ResultsAmong 13,393 patients who died with melanoma, 5298 (40%) received hospice care. Of these, 17% were enrolled in hospice for three days or less, while 13% had ≥90 days of hospice care. Despite improvements over time in the proportion of patients who received hospice and those who received at least 90 days of hospice care, late hospice enrollments did not change. Multivariable analysis revealed that patients of older age, with distant disease at time of diagnosis, and residing in rural areas or in census tracts with higher rates of high school completion were more likely to enroll in hospice.ConclusionRates of hospice enrollment increased over time but remained under accepted quality benchmarks with variations evident in those who receive hospice services. Efforts to increase access to earlier hospice care for all patients dying with melanoma are essential.Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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